Question: What can be done about the appearance of my aging arms?
Dallas plastic surgeon Dr. Kenkel answers:
Like everything else on planet Earth, the arms are affected by gravity. With time, our skin loses its elasticity, and we start to see sagging of the arms, most commonly on the undersurface of the upper arm. While time always works against us, there are a few other things that can cause progression of this condition. These include sun exposure, weight fluctuations, and certain skin conditions.
- Sun exposure: We all appreciate the effects of chronic sun exposure on our face. The same process occurs on any exposed skin, including our arms. This can result in progressive loss of elastin (necessary for skin recoil) and thinning of the collagen within the skin. The changes may be subtle and manifest as crepe-like skin or more dramatic with hanging skin.
- Weight fluctuations: Any significant weight changes can dramatically affect our bodies. Expansion of the skin with weight gain can thin the dermis, including its components collagen and elastin. Once our skin reaches a critical limit, there is a point of no return where it does not “recoil” back, regardless of one’s age.
- Skin conditions: There are certain skin conditions that may result in an “aged” appearance of the arms, similar to that described for weight changes.
The appearance of the arm skin can be exaggerated by the presence of fat, which also leads to fullness in the area. So what can be done? Like many things in the cosmetic arena, there are plenty of pretenders out there who can promise miracle changes to your arms. Approach these promises with caution and really do your homework.
Let’s review a few scenarios:
- Good skin quality, fat present: These patients have fullness in their arm area due to fat accumulation. The overlying skin is of good quality and elasticity. Fat can be dealt with in a couple of ways.
Liposuction is a procedure that can be done in an operating room or office using a cannula (hollow tube) attached to a vacuum that removes fat. The area is infused with fluid and an anesthetic (if the procedure is done while the patient is awake) and utilizes a few small incisions to gain access to the areas of concern. This is the most aggressive approach to gain the maximal contour. Following liposuction here in Dallas, the patient is placed in a compression garment for a few weeks to help support the area and control swelling. Patients may have some soreness, but this not typically too painful.
*Pictured above is a 24-year-old patient who had liposuction to her arms and is pictured before and 1 year post-op.
CoolSculpting is one option offered at my Dallas office. This procedure uses cold to freeze the fat. Patients undergo 2 treatments over a month’s time and realize their results about 3 months after their 2nd treatment. With CoolSculpting, we anticipate about a 20% improvement in the contour of the arm. As with liposuction, CoolSculpting patients have some soreness but are able to resume most activities fairly quickly.
The key to successful outcomes for these patients is good overlying skin quality, which allows the skin to tighten up after fat removal and not sag.
- Poor skin quality, regardless of fat: This scenario represents the extreme opposite of that described above. These patients have often had significant weight loss or fluctuations resulting in stretching of the skin and loss of elasticity. Patients often refer to this area as their “bat wings” due to the loose skin.
Unfortunately, there really is only one option for these patients: Brachioplasty – (arm lift). An arm lift is a surgical removal of the loose skin and variable treatment of the fat depending on how extensive it is. As in other procedures designed to address loose skin, such as abdominoplasty, breast lift, or thighplasty, there is a trade-off, which in this case is gaining a scar for gaining shape. The arm lift incision is designed on the lower aspect of the inner arm, and we try to conceal it as best we can. The length of the incision depends on how much loose skin is present and the extent of it. These procedures offer dramatic changes, and the scars typically heal well. Some degree of liposuction is often performed during this procedure.
Case #134– This 49-year-old female patient who underwent LAP-BAND® surgery lost over 120 lbs. After maintaining a stable weight, she was a good candidate and decided to have surgery at Dr. Kenkel’s Dallas location. She is shown here 2 years following brachioplasty.
Case #136: Pictured is a 28-year-old female who underwent Roux-en-Y gastric bypass surgery. Subsequently she has lost a little over 100 pounds. She is shown here 2 years following brachioplasty.
Case #123: Pictured here is a 65-year-old female patient of Dr. Kenkel who lost a significant amount of weight following bariatric surgery. This arm lift procedure helped with the droopy, hanging skin beneath the underarm and was tightened and recontoured to allow the patient to feel more confident. She underwent a brachioplasty and abdominoplasty with liposuction. She is shown here 1 year following her arm lift.
Check out more before-and-after photos here.
- Those in between (modest skin laxity, with or without fat): As we mentioned above, fat can be dealt with in a number of different ways. The challenge in this case is how do we deal with skin that is crepe-like or simply has poor quality but does not hang excessively. It seems a big commitment to put a scar on the inside of the arm for these patients.
Skin tightening devices: It would be ideal if a device existed to “tighten” the skin for this type of patient. While there has been tremendous investigation into skin tightening devices, to date, there is not one that delivers a surgical-quality result. We have investigated many devices over the years and have been largely disappointed with the outcomes following these procedures. We are working with a few newer devices that show promise. It is important to understand that office-based skin tightening is not a replacement for surgery, and your expectations must be tempered when considering this path. A frank discussion with your physician is imperative, as is seeing photos of patients who have gone through the procedure. I always recommend seeing good and bad results. There is typically a failure rate of these devices between 10% and 20%.
Pictured above is a 60-year-old patient who received Thermi® RF treatment and is 1 year and 3 months post-op.
Treatment of the arms and their contours can be really challenging. That being said, based on the analysis of the patient and what the cause of the fullness is, there are good options.
As highlighted above, the two extremes are easier to treat than that group in the middle.
Remember: Make sure you do your homework when investigating your options. Always see a board-certified plastic surgeon who has expertise in cosmetic surgery and medicine.
If you’re interested in taking the next step, please contact us to schedule your consultation or call (214) 645-2353.