Arm Lift (Brachioplasty) in Orange County AND LOS ANGeles

The Different Zones of the Arm

Zone 1- This is the area that extends from the elbow to the wrist.  Most patients that are looking to have arm lift surgery do not typically need this area to be altered. An incision directly on zone 1 is not common, and the fat deposits can be worked on with liposuction.

Zone 2- This is the area that extends from the elbow to the arm pit.  Arm lift surgery is typically planned on this area. Dr. Agha will examine the distortion to determine whether the issue is just excessive fat or excessive skin. It is common for both issues to be present. When determined, Dr. Agha will state whether liposuction, an arm lift or both will be needed.

Zone 3- This is the area within the arm pit.  A high percentage of massive weight loss patients have deformities in Zones 2-3. In Zone 3, a wing-like flap of skin is formed, and in Zone 2 the skin is loose and hangs from the limbs. To correct this, an incision is made from the elbow through the arm pit.  The incision is placed so that it will nearly be undetectable in clothing, or when the arms are naturally hanging on their sides.

Zone 4- This area extends from the bottom of the arm pit to the outer chest. Patients who have deformities in Zones 2-4 have the same incision that is used to correct Zones 2-3. However, the incision continues over the outer chest wall to remove the excess skin. If Zone 4 has extreme deformities, a different surgical approach called an upper body lift will be performed by Dr. Agha.

Arm Lift (Brachioplasty) in Orange County AND LOS ANGeles

Why Arm Lift Surgery is Done

The most common reason for having an arm lift is to correct soft tissue and skin laxity of the arms. Factors that contribute to soft tissue laxity of the arms include:

1. Age- Typically, with age, the fatty tissue of the upper arm may diminish in volume and result in loose, sagging skin of the arm. Similar to the face, the skin develops wrinkles.   This is mainly a “skin excess problem” that requires skin removal. 
2. Sun damage and smoking- On their own, sun-damage or smoking rarely result in arm tissue laxity.  However, they both can adversely influence skin quality and thus exacerbate the changes that are noted with ageing.
3. Weight Gain- This generally results in heaviness of both the upper arm and the forearm.  The arm inflates as the fatty layer of the arm expands in between the muscles and skin.   Overtime, most of the arm skin stretches and develops internal dermal damage.  These are appreciated as stretch marks especially over the inner aspect of the arm.  The stretched out skin, bearing the excess fat, hangs as bat-wings from the under-surface of the arm. This is mainly a “damaged skin and excess fat problem” that requires both skin and soft tissue removal. 
4. Significant weight loss or Bariatric surgery- During many cylces of weight gain and loss, the skin develops dermal-breakage and thus stretch marks.  Also, the connective tissue mesh that hold the skin to the underlying arm muscles, becomes loose and stretched.  Following the weight loss, the damaged skin and connective tissue mesh are both unable to undergo contraction.  Thus, the stretched-out skin, bearing some excess fat, will sag on the under-surface, leading to ptosis (sagging), or the bat-wing appearance. This is mainly a “damaged skin and excess fat problem” that requires both skin and arm tissue removal. 
5. Previous Liposuction- Aggressive liposuction in someone who does not have optimal skin quality can result in excess loose skin that hangs from the under-surface of the arm.  This is mainly a “skin laxity problem” that requires removal of the excess skin. 

Arm Lift (Brachioplasty) in Orange County AND LOS ANGeles

Defining Arm Lift Surgery

The aesthetically beautiful arm is considered to be lean and firm, displaying features of the underlying muscles. The front and back compartments are defined by the upper arm and shoulder muscles.  The biceps are the main muscle of the front compartment and the triceps fill the back compartment.   On the outer surface, the convexity of the shoulder deltoid muscle merges with that of the arm bicep muscle on the front surface, producing topography that represents a well-built physique. The back surface should be slightly convex from the arm pit (axilla) to the elbow.  

Arm Lift (Brachioplasty) in Orange County and Los angeles

Relative Contraindications to Arm Lift Surgery

• Severe comorbid conditions (heart disease, diabetes, morbid obesity, cigarette smoking, etc.)
• Expecting future pregnancy
• Thromboembolic disease (blood clotting disorders)
• Morbid obesity (BMI >40)
• Unrealistic patient expectations
• Patients who tend to form keloids or hypertrophic scars

Surgical Risks and Potential Complications of Arm Lift Surgery

All surgical procedures, including the arm lift, have potential risks associated with their performance. The decision to have brachioplasty or other body contouring surgeries is extremely personal, and you’ll have to decide if the procedure will achieve your goals and whether or not the risks and potential complications are acceptable.

In this section, you will find further information regarding the potential risks associated with various brachioplasty procedures.

Possible Risks of Brachioplasty Include:

Surgical anesthesia: On the day of surgery, your anesthesiologist will discuss with you the risks of both local and general anesthesia.

Unfavorable scarring: If the sutured area doesn’t heal properly or the area takes too long to heal, the brachioplasty scars may be thicker than normal. If the patient heals relatively quickly, minimal scarring will result. Scars will take years to fade, but they are permanent. Despite Dr. Agha’s best efforts, scar appearance and healing are not fully predictable. The scars may be uneven, excessively wide, and/or asymmetrical. Scars may be unattractive and of a different color than the surrounding skin. Excessive, hypertrophic, and keloid scarring are uncommon. Additional treatments, including surgery, may be necessary to treat abnormal scarring.

Bleeding/Hematoma: Bleeding may result if the sutured areas do not heal correctly or if there is improper coagulation after the arm lift procedure. A hematoma is a blood collection that can form under the skin and enlarges as a tender bulge.If a patient notices any unusual bleeding after brachioplasty, they must contact Dr. Agha immediately. Do not take any aspirin or anti-inflammatory medications for ten days before surgery as this will increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can also increase the risk of surgical bleeding.

Infection: Major Infection with fever and large areas of red skin (cellulitis) is unusual after this type of surgery. Should a serious infection occur, treatment including intravenous antibiotics or additional surgery to remove dead tissue and drain abscesses may be necessary. Minor wound infections accompanied by exposed and “spitting” sutures can occur and are usually easily dealt with by limited debridement, antibiotics, and dressing care. There is a greater risk of infection in smokers, those with diabetes, and with multiple procedures.

Fluid Accumulation (Seroma): Drains are often placed at the surgical site at the end of the operation to collect the seepage of fluid. After their removal in about 5 to 7 days, body fluids (serum) occasionally accumulate underneath the skin. Should this occur, it may require aspirations. If that fails to cure the seroma, then the patient will need to be seen either in the office or operating room for the insertion of new drainage tubes and the removal of seroma cavities. This is very rarely necessarily.

Poor Wound Healing: Individuals that have a slower than average healing rate or those who are smokers may find that they do not heal properly, that the sutured areas reopen easily, or that they are more prone to infection. Patients should avoid smoking three weeks prior to and after the procedure so that their body’s natural healing process is not hindered.

Wound Dehiscence: In general, your skin closure is in multiple layers. Separation of the superficial, deep, and/or both layers may occur any time during your first post-operative month. Suture breakage, knots untying, sutures tearing through an excessively tight closure, too much movement or bending by the patient, and skin necrosis (death) are some of the recognized causes of dehiscence. Breakage of sutures in the superficial layer of skin may be sutured closed or allowed to heal secondarily at the judgment of Dr. Agha.
Deep dehiscence may require a return trip to the operating room for closure under anesthesia. These healing problems may require frequent dressing changes, extra office visits, and further surgery to remove the non-healed tissue. Open wounds may take weeks to heal or secondary closure may be appropriate. Wounds allowed to heal on their own usually benefit from secondary scar revision. Smokers have a high risk of skin loss and wound healing complications. Do not smoke for 3 weeks before and after your surgery.

Suture Granuloma: Some surgical techniques use deep sutures. These items may be noticed by the patient following surgery. Sutures may spontaneously poke through the skin, be visible, or produce irritation that requires removal.

Numbness in Skin Sensation: Post-operative diminished (or loss of) skin sensation (numbness, pins and needles sensation, burning or itching), and/or pain at the surgery site may be temporary or very rarely permanent.

Contour Irregularities: Contour irregularities and depressions may occur after these procedures. Visible and palpable looseness and wrinkling of skin can also occur. On occasion, asymmetrical fullness, bulges, and depression may be present.

Asymmetry in Scar Placement or Contour: On occasion, asymmetry may occur after an arm lift. Although this is not typical, it is a risk associated with the brachioplasty procedure. Every body and every patient is different.

Pain that may Persist: Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after surgery.

Nerve damage: If improper healing occurs, the patient may have some nerve damage. The possibility of nerve damage should be discussed with the physician before the procedure. Nerve damage can result in over-sensitivity, or it can result in a lack of sensitivity in certain areas where the arm lift was performed.

Allergic Reactions: In rare cases, local allergies to tape, suture material, or topical preparations have been reported. Systemic reactions which are more serious may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.

Residual Deformity: Despite best efforts to obtain a pleasing arm contour, a small degree of residual deformity may persist or develop months after the surgery.

Need for Revisional Surgery: The practice of medicine and surgery is not an exact science. Should complications occur or some aesthetic expectations remain unmet, additional procedures or other treatments may be necessary. Other complications and risks can occur but are even more uncommon.

Suboptimal Aesthetic Result: You may be disappointed with the results of surgery. Under treatment with residual laxity and looseness or over treatment with excessive tightness of skin can occur with flattening of regional contours and widening or thickening of scars. Considerable care is exercised to achieve the optimum shape, but for a variety of reasons, the ultimate results may be suboptimal. At times, it is desirable to perform additional procedures to improve your results.

Deep Vein Thrombosis (DVT) and Pulmonary Complications: Deep vein thrombosis is a rare but worrisome complication of plastic surgery. It represents formation of blood clots in the deep veins of the legs during anesthesia and surgery. Although a sequential compression device will be used to reduce the risks, few patients may still develop DVTs. Pulmonary complications may occur secondarily to migration of the vein blood clots into the lungs (pulmonary emboli) or partial collapse of the lungs after general anesthesia. Should either of these complications occur, you may require hospitalization and additional treatment. Pulmonary emboli can be life-threatening or fatal in some circumstances.

Long Term Effects: Subsequent alterations in body contour may occur as the result of aging, weight loss or gain, pregnancy, or other circumstances unrelated to the above procedures.