Arm Lift (Brachioplasty)
in Dallas, TX
Significant weight loss leads to hanging, loose skin in many areas of the body, especially the upper arms. Many massive weight loss patients are happy about losing the weight but are unhappy with their upper arm excess because it leads to excess upper arm flabbiness and hanging skin. Often these patients will not wear sleeveless shirts and, as with many other parts of their bodies, will continue to have decreased self-esteem.
What Is Brachioplasty?
An arm lift, also known as brachioplasty or upper arm reduction, is designed to eliminate the hanging upper arm skin and fat to allow patients more freedom and self-confidence.
What Is an Aly-Posterior Scar Brachioplasty?
There are a variety of ways to reduce upper arm excess. Dr. Aly developed his arm lift technique over 20 years ago specifically to treat the extensive nature of upper arm excess that massive weight loss patients often present with. It is based on understanding how the deformity is formed and its anatomic basis. This was not understood by plastic surgeons prior to the introduction of the Aly-posterior scar brachioplasty.
Dr. Aly discovered that a normal anatomic structure of the arm, called the “posterior fold,” is what becomes excessive.
The posterior fold transitions from the upper arm, thru the armpit, and onto the chest wall. In people who have normal anatomy the skin of the posterior fold is adherent to the underlying muscles and it is part of the normal appearance of the upper arm as it connects the upper arm to the armpit and chest wall.
Dr. Aly discovered that in massive weight loss patients who present with upper arm excess, the posterior fold is what becomes excessive. It hangs down and becomes problematic for the patient.
The purpose of the Aly-posterior scar brachioplasty is to eliminate the excessive hanging excess skin and fat and match the shape of the underlying muscles.
One can think of the upper arm as a cylinder with an “inner core” made up of the muscles and bone. The inner core is then surrounded by fat of varying thicknesses as well as the overall skin cover. This is shown below in a cross section, or slice of the normal arm.
In patients who gain a lot of weight, the arm fat content increases significantly. Subsequently with weight loss, the fat is reduced, leading to a deflation of the overlying skin, which becomes redundant and hangs from the inner core of muscles and bone.
The Aly-posterior scar brachioplasty eliminates the excess skin as can be seen above.
Does an Arm Lift Leave a Scar?
Dr. Aly’s arm lift procedure is called a “posterior scar” technique because the scar is intentionally located along the edge of the arm when the arm is raised to 90 degrees away from the chest. Posterior means that is located more towards the back.
Alternatively, the scar can be placed more towards the front of the arm, which is used by some surgeons, but it is not used or preferred by Dr. Aly.
There are multiple reasons Dr. Aly prefers a scar placed more towards the back. The first reason is because he believes that the part of the arm that is most visible during normal interaction with other people is the front of the arm. For example, if someone is giving a presentation in front of an audience and their arms are uncovered, the part of the arm that is more likely to be seen is the front of the arm.
A second reason Dr. Aly prefers the scar towards the back is that the area does not have important structures that can be harmed during the surgery.
What Are the Typical Complaints of Patients Who Want Brachioplasty?
Most patients are unhappy with the hanging skin and varying degrees of fat in the upper arm. Sometimes they will call their arms their “bat wings.” Most people will present with excess that starts at the elbow and reaches the armpit, going on to the chest wall.
Typically, patients will have a hard time finding clothing that fits them, and they may also complain of itching and skin irritation.
What Does an Aly-posterior Scar Brachioplasty Accomplish?
For the appropriate candidate, this brachioplasty technique is very effective in eliminating the hanging excess skin and fat and will lead to the arm taking the shape of the underlying muscles.
View our arm lift before and after photo gallery to see photos of previous patients.
Who Needs an Arm Lift/Upper Arm Reduction?
The majority of patients who desire upper arm reduction fit into two groups. The first group is made of patients who are obese and their arms are very thick and large. These patients are not ideal to operate on and most often are advised to pursue weight loss prior to addressing the excess.
The second group is made up of massive weight loss patients who have lost a great deal of fat from the upper arms but have large amounts of hanging skin with varying degrees of remaining underlying fat. This is the group that is amenable to the surgical treatment described here.
Good Candidates for an Aly-Posterior Scar Brachioplasty:
- Have stabilized their weight loss for at least 3 months. It is best for patients to know they can maintain a healthy weight before surgery.
- Have significant hanging excess skin of the upper arms. Ideally, the less fat that is left in the arm, the better the results.
Who Is Not a Good Candidate for Brachioplasty?
- Patients with active and/or uncontrolled major medical problems such as heart disease, lung disease, diabetes, high blood pressure, etc.
- Patients who have active uncontrolled psychological problems.
- Patients who are either gaining or losing weight.
- Weight stabilization is required.
- Patients whose arms are still very full of fat.
- Even if some skin is removed in this type of patient, the resulting arm will still be very large.
How Is an Aly-Posterior Scar Arm Lift Performed?
An arm reduction is a surgical procedure that eliminates hanging skin and underlying fat from the upper arm. In general terms the surgeon removes the excess through a scar that runs along the length of the arm. There are differing techniques utilized by plastic surgeons. Dr. Aly designed the Aly-posterior scar approach specifically for massive weight loss patients. Below is a description of the procedure and how it differs from other techniques.
Marks are made to encompass the excess, which as noted above, is located at the “posterior fold” and they continue through the armpit and onto the chest wall. If one does not include removal from all of these areas, patients often complain that not enough was removed as well as excess of the armpit.
Dr. Aly prefers to perform this procedure under a general anesthetic. Once the patient is asleep a number of maneuvers are performed to confirm the amount that needs to be removed which will lead to the best possible contour of the upper arm, armpit, and the chest wall.
To accomplish the surgery in the safest and most efficient manner, sequential segments of the arm are removed and closed temporarily with clips, as shown on the right.
After all of the segments are removed, the external clips are replaced with internal sutures so that the final closure has no outside stitches. Finally, medical grade glue is placed on the skin.
Does Dr. Aly Use Drains With Arm Lift Surgery?
Dr. Aly does not use drains in any of his body contouring procedures including the Aly-posterior scar brachioplasty. Drains are supposed to decrease the chances of developing a seroma, which is a fluid collection that can occur after surgery in the area operated on. Dr. Aly has found that using internal sutures that close space where potential fluid can accumulate are far more effective at reducing the rate of seromas.
Will Brachioplasty Help Me Lose a Significant Amount of Weight?
Body contouring procedures in general should not be thought of as a way of reducing weight. The amounts of skin and fat removed are often negligible in comparison to the entire body mass.
Brachioplasty, as well as other body contouring procedures, should be thought of as surgeries that improve and create contour of the body part that is operated on rather than weight loss surgeries.
What Is Dr. Aly’s Experience With Arm Lift Surgery?
Dr. Aly is a board-certified plastic surgeon and the innovator of this procedure. He has been performing the Aly-posterior scar brachioplasty since he introduced the technique over 20 years ago. He has the most extensive experience in the world performing this technique. Dr. Aly has taught this technique to a multitude of plastic surgeons from around the world, and he continues to do so till today.
Dr. Aly also specializes in body lift surgery for patients who have achieved significant weight loss.
What Results Can I Expect After an Arm Lift?
It is important to note the Aly-posterior scar technique is based on sound “plastic surgery principles,” which dictate that the surgeon:
- “Understand the deformity”(described above)
- Recognize the “ideal normal”, which in this case is the shape of the underlying muscular anatomy
- Design an operation that allows one to approximate that ideal as much as possible. Note that not every patient is able to achieve ideal contour. As a general rule, “the attained results are highly dependent on the presentation of the patient.”
The improvement in arm contour after Aly-posterior scar brachioplasty generally ranges from very good to superb. The more deflated an arm is at presentation, the better the result is.
View our arm lift photo gallery to see the results of previous patients.
Arm Lift Timeline
What should I expect prior to upper arm reduction surgery?
- An initial visit where Dr. Aly will perform a complete history and physical.
- Dr. Aly will determine if you need to see any other physicians to “tune you up” prior to surgery.
- You will have a set of photographs taken which will allow Dr. Aly to make the correct diagnoses and plan for the upcoming surgery/surgeries.
- Dr. Aly will then discuss the potential different surgical procedures that you may require and will show you pictures of patients who have undergone similar procedures.
- Dr. Aly will have a discussion with you about the potential benefits and risks associated with arm reduction surgery.
- A set of laboratory exams are performed to determine if you have any abnormalities that need to be adjusted prior to surgery.
- Many patients will require multiple operations to eliminate all of their massive weight loss excess. Dr. Aly will sit down with you to create a course of action to accomplish your needs.
- One or two days prior to surgery you will have markings placed on your arms in preparation for surgery.
What happens on the day of brachioplasty surgery and the early period after it?
- On the day of surgery, you are admitted to an area where you are prepared for surgery.
- You will meet the anesthesiologist and they will discuss your anesthesia plan.
- Dr. Aly will come in and say hello and make sure the markings are still in place, and if need be, adjust them.
- You will then be taken to the operating room and the anesthesiologist will put you under general anesthesia.
- Surgery is then performed which requires somewhere between 2 to 4 hours depending on your particular anatomy.
- Dr. Aly does not use drains, so you will not have to worry about that.
- Most patients who undergo brachioplasty by itself, will go home the same day of surgery. Occasionally patients are admitted overnight depending on where they live and their finances.
- You are expected to get up and walk a few hours after surgery, at least a few steps. After you are awake and alert you are expected to ambulate normally with the precautions mentioned below. Walking and staying out of bed is very important because it reduces the risk of blood clots.
- While in bed or sitting in a chair, your arms will be placed on enough pillows to elevate them to a level at, or just above, heart level.
- You are also expected to keep your arms elevated above heart level when walking.
- Your arms are to be elevated for two weeks after surgery except during eating and when using the bathroom.
- The arms will usually seep a little blood tinged fluid for a day or two after surgery.
- The next day after surgery you are encouraged to mostly sit in a chair or walk, with as little time as possible in bed.
What should I expect the first few weeks after an arm lift?
- Patients will usually come back to see Dr. Aly within a few days after discharge for a check on their wounds and overall well-being.
- During the first week after surgery you are expected to walk at least 6 times a day and stay out of bed as much as possible.
- During the first few weeks after surgery Dr. Aly sees you to make sure that you are doing well and not experiencing any problems such as wound separations or fluid collections.
- After a week to 10 days you will be expected to wear a light compression garment. Dr. Aly will let you know when you can stop wearing it.
What should I expect after the first few weeks after an Aly-posterior scar brachioplasty?
- After the first few weeks you are seen approximately once a month for 3 to 4 months, depending on how you are progressing.
- Seromas, which are fluid collections that can develop in the area that was operated on, can occur after the first few weeks. Dr. Aly will look for these fluid collections and if found he will treat them.
- Occasionally some of the deep sutures will come through the skin and they can be taken care of during these longer-term follow-up visits.
- Dr. Aly will usually see local patients every 2 to 3 months from the 6 month to the 12-month mark. If you live far away, the time between visits can be extended depending on how you are doing.
- Most patients will stabilize their results in 1.5 to 2 years after surgery. Dr. Aly prefers to see most patients up to that time. If you are able and willing, he will continue to see you yearly after that.
- Most patients are able to get back to doing most normal activities in 3 to 4 weeks after surgery, but this varies from patient to patient.