Brachioplasty is becoming more popular as patients lose large amounts of weight from dieting or bariatric surgery. Some patients seek treatment of excessive skin laxity in the absence of a history of weight loss. Most are women.
Unlike abdominoplasty, a brachioplasty scar cannot be easily concealed in a natural skin crease. Therefore, the scar must be considered when weighing the risk/benefit ratio. Lesser degrees of arm fullness and skin laxity may be treated with liposuction alone.
A scar located in the bicipital groove may be visible from the front. A scar located along the inferior border of the upper arm may be visible from behind when the patient relaxes her arms to her side. A posteromedial scar location is preferred.
Liposuction is done simultaneously both to reduce the fat layer and also to facilitate the skin dissection by opening up a subcutaneous tissue plane. The medial antebrachial cutaneous nerve must be preserved. Care must be taken not to over-resect the skin. Complications include wound dehiscences, spread scar deformities, and dog ears that may require revision. Seromas and infection are unusual.
An L-extension of a brachioplasty onto the torso requires a transaxillary scar. A vertical scar on the torso is not ideal. A scapular lift may be used to treat skin laxity of the lateral “bra fat” area while keeping the scar horizontal and hidden by the bra. This is an alternative option for women who do not have a severe degree of skin excess.
The hands can be a visible sign of aging. Fat injection provides a soft tissue cushion that can make veins and tendons less conspicuous. Laser resurfacing is used to treat brown spots. The two modalities may be combined for maximum hand rejuvenation.
Brachioplasty Hand rejuvenation Fat injection Liposuction Scapular lift Laser resurfacing
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