Brachioplasty and improvement in the upper arms

I am often asked by patients, “Dr. I really want to wear sleeveless shirts in the spring and summer, but I am bothered by the appearance of my upper arms. Is there anything that can be done?”

The answer is “yes,” there are surgical options for aesthetic improvement in the upper arms. Those options depend on the amount skin laxity and excess fat in each patient.

Excess fat within the upper arm requires liposuction to remove the fat. Laxity of the skin requires an incision and a potential scar to remove or excise the excess skin. The scar placement and length of the scar depends on the location and amount of lax skin. If both excess skin and fat are present, liposuction and excision of skin are needed. Let’s look at some examples.


The picture above shows moderate skin laxity in the first third of the arm with minimal excess fat. This patient would be a good candidate for excision of the excess skin with a limited scar in the shape of a T placed within the “armpit” or axillae. This scar is represented in red in the picture below.

The next example above represents a patient with both moderate skin laxity and moderate fat. This patient would be a candidate for liposuction and a traditional brachioplasty, in which the scar is placed in the brachial groove as pictured below.

Last, the above picture represents a patient with severe skin laxity that extends on the chest. This is typical in patients who have experienced massive weight loss due to bariatric surgery. These patients require an extended brachioplasty in which the scar runs along the brachial groove as in a traditional brachioplasty, but also is extended onto the chest wall as shown below.

The following are questions and answers one should know if considering brachioplasty:

1. Who is not a candidate for brachioplasty?

Patients with neurological or vascular disorders of the upper extremity, lymphedema of the arms and collagen vascular disorders such as Ehlers-Danlos are not candidates. In addition, patients with severe medical conditions such as heart disease or uncontrolled diabetes are poor candidates.  Your weight should be stable for 6 months to 1 year prior to surgery and it is preferred that you have are not expecting any additional pregnancies. You must be nicotine free for at least 1 month prior to surgery. Patients with a history of keloids or hypertrophic scars are also poor candidates.7

2. What is the most common complication of brachioplasty?

The brachioplasty scar is likely the most noticeable scar in all of aesthetic surgery. The procedure trades a more pleasing shape and contour of the arm for a scar. The scar is not inconsequential and will be visible depending on the type of clothing. The scar may stay thick and heavy for a prolonged period of time. The final appearance of the scar will not be visible until 1 year post surgery. Surveys of plastic surgeons and the general public showed that a scar in the inner arm is preferred to a scar in the back of the arm. The scar in the inner arm is less visible – only seen when the arm is externally rotated – however, the skin is thinner here and thus the scar may become wider. The scar on the back of the arm can be thinner because of better skin quality, however it is more visible from behind when wearing sleeveless clothing.8

Other potential complications include wound dehiscence, seroma, infection, numbness, recurrent skin laxity.

3. What can I expect after surgery?

A drain is in place for less than a week. The arms are wrapped for 2 days and then removed by your surgeon. Then for 2 weeks, patients are encouraged to wear snug clothing such as “Under Armor” long sleeve shirts for compression. No raising arms above shoulders for 2 weeks, afterwards gentle range of motion exercises can start.

4. How much does it cost?

For a consultation and to discuss options call Mountain Brook plastic surgery at 205 871 4440.

References

1-6 Miotto G, Ortiz-Pomales Y. Arm Contouring: Review and Current Concepts. Aesthetic Surgery Journal. 2018, Vol 38(8) 850-860.

7-8 Angelos, TM, Janis JE, Mendietta, CG. Brachioplasty. Essentials of Aesthetic Surgery. Chapter 58, 818-827. Thieme Publishers, New York, 2018.

All you need to know about Fillers

  1. What is a filler and how is it used?

Fillers are injectable products that are injected to rejuvenate and improve facial features associated with aging. This includes filling of rhytids, otherwise known as “wrinkles.” The wrinkle areas most commonly improved by filler injections include:


Nasolabial fold


Marionette lines


Fine lines of the upper and lower lips or “smokers” lines


Tear trough deformity

Fillers are also used to provide volume and augment areas prone to facial aging. This includes the upper and lower lips and the cheek.

  1. What are fillers made of?

There are numerous filler products and each is made of different material. The most common material used currently is hyaluronic acid, this is the composition of Restylane, Perlane, Juvaderm and Belotero.

Others such as Radiesse are made of calcium hyodroxylapatite. Sculptra is made of poly-L-lactic acid.

  1. How do you know which filler or which material to inject?

Different fillers work best for different areas. Hyaluronic acid fillers such as juvaderm tend to absorb more water and therefore are great for areas such as the nasolabial folds, lips, and marionette lines. Sculptra works well for facial augmentation of the cheeks or temples. Belotero works well for fine wrinkles.

  1. How long do they last?

Hyaluronic acid fillers and Radiesse can last up to 1 year. Sculptra can last up to 2 years but requires more than injection.

  1. Is injection painful?

Your surgeon will typically apply a lidocaine topical cream that will need to sit for 30 minutes prior to injection. Typically, this allows for minimal discomfort during injection.

  1. What are my limitations after injection?

Most surgeons recommend no exercise the day of the injection. The day after there are no restrictions.

  1. Are there any complications to be aware of?

Although not a complication, the most common complaint is under-correction. Over-correction can also occur, so discuss in detail with your surgeon your goals and expectations prior to injecting.

The injected material may be palpable or bumpy and cause nodules. This can usually be corrected with massage.

Although rare and infrequent, serious complications can occur. If filler material is injected into a blood vessel, this can result in skin necrosis – this is more common around the nostrils of the nose. Board certified plastic surgeons are well aware of this risk and are trained with techniques to avoid this complication.

Another rare and infrequent but serious potential complication is blindness. This occurs with injection of filler material around the eyes. Again, board certified plastic surgeons are well aware of this risk and are trained with techniques to avoid this complication.

  1. How do I learn more and how much does it cost?

Call Mountain Brook Plastic Surgery for consultation with board certified plastic surgeons!

ALL YOU NEED TO KNOW ABOUT BOTOX

What is botox?
Botox is a drug made from a toxin produced by the bacteria Clostridium botulinum.

How does it work?
Acetylcholine is released from nerve endings and causes muscles to contract. Botox binds to nerve endings preventing the release of acetylcholine and therefore preventing muscle contraction.

How is it used?
Botox is used to treat numerous medical problems. It is most commonly known for treatment of facial wrinkles and, in fact, is the most common cosmetic procedure in the world. It also can be used to treat parotid gland hypertrophy, profuse sweating of the underarms, hand and feet, and for the treatment of migraines.

For facial wrinkles, where is it commonly used?
Common areas for injection for improvement of facial wrinkles include the frown lines of the glabella (vertical lines between the brows), forehead wrinkles, smile lines, crow’s feet, bunny lines, elevating the corners of the mouth, dimpled chin, and for the platysmal bands of the neck.

Does the injection hurt?
A very fine needle is used to induce the least amount of discomfort. Some patients prefer a lidocaine cream applied to the area to be injected to temporarily numb the skin. Some patients tolerate the injection with little discomfort without the lidocaine cream.

How long does it take the botox to take effect?
Results are typically apparent after 2-3 days.

How long does botox last?
Each patient is different in terms of response, the average length of time of effectiveness is 3-4 months.

Are there any side effects and any limitations after injection?

  • Some patients may experience a headache following injection. This typically subsides without treatment.
  • Occasionally injections are not symmetric which may result in asymmetry. These asymmetries may be remedied with a small “touch up” injection.
  • Overtreatment of the forehead may result in a drooping brow. After the botox “wears off,” the brow position will return to normal.
  • Upper eyelid droop may occur if injections on the brow are too low. This can be treated with eye drops prescribed by your physician that counteract the effects of botox.
  • Limitations following treatment will vary from physician to physician. Some recommend no exercise the day of injection, others recommend no lying down for 4 hours after treatment, and some do not restrict their patients.

How can I learn more?
Call Mountain Brook Plastic Surgery (205) 871-4440 for consultation!

What is a tummy tuck? – Dr. Brad Denney

A “tummy tuck” is a cosmetic surgery that involves rejuvenation of the abdomen and flanks. Your plastic surgeon may also refer to this procedure as an abdominoplasty. There are three major components of a tummy tuck – management of excess skin, contouring of excess fat, and tightening of the abdominal muscles.

Multiple terms are used to describe tummy tucks, such as “mini” or “full” abdominoplasty. This refers to the degree of excess skin and fat that exists, and therefore the length of the incision needed to accomplish abdominal rejuvenation. If there is a small amount of excess skin and fat below the belly button, a “mini” abdominoplasty may be performed. The incision is made in the middle third of the abdomen along the bikini line. A “full” abdominoplasty, on the other hand, deals with moderate to larger amounts of excess skin and fat above and below the umbilicus, and therefore requires a longer incision, typically the entire length of the bikini line and around the belly button itself.

Patients who typically benefit from a tummy tuck include those who want improvement in their abdominal contour and waistline and want to fit better in clothing. Patients typically notice changes in their abdominal contour after pregnancy that cannot be improved with exercise alone. This is usually due to rectus diastasis, or widening of the abdominal muscles, due to the pressure on the abdominal wall in pregnancy.

The surgery itself takes about 3 hours and most patients are able to go home the same day. Most surgeons will leave a drain under the skin that will be removed by your surgeon after a few days. Many patients will feel the need to walk “hunched” over for a few days due to the tightening of the abdomen. Liposuction is often utilized as part of the tummy tuck procedure, especially along the flanks. It is expected to have bruising and swelling in the areas of liposuction for several weeks after surgery. Typically, a tummy tuck scar is hidden in the bikini line. Most surgical incisions will fully heal in 6-8 weeks.

The most serious possible complication to be aware of with this procedure is a DVT, or a blood clot in the legs, or rarely a PTE (blood clot in the lungs). In the lungs, blood clots can potentially be fatal. Therefore, all surgeons will stress early post-operative ambulation to prevent the development of blood clots.

For more information and to schedule a consultation, please call our office at (205) 871-4440.