Upper Arms Liposuction Treatment & Management
- Author: John Y S Kim, MD, MA; Chief Editor: Jorge I de la Torre, MD, FACS more...
Instruct the patient to stop using aspirin, nonsteroidal anti-inflammatory drugs, vitamin E, alcohol, and all tobacco products and to decrease sodium intake at least a week prior to surgery.
After evaluation and proper selection of the surgical procedure, prepare the patient for surgery. Increasingly, liposuction is being used as an adjunct to formal brachioplasty. For instance, a method of performing aggressive liposuction directly under the area of skin that is to be removed is becoming increasingly popular. This method allows preservation of lymphatics while thinning out the flap of skin that is to be removed. However, caution should be exercised in liposuctioning in areas of brachioplasty flap elevation and inset. Compromising vascularity in this case can engender healing problems along an incision line already known for problems due to tension.
Preoperatively, mark the patient with the arm abducted 90° and flexed at the elbow 90°. Mark the incision sites posteriorly, proximal to the radial elbow and posterior axillary fold. The anterior axilla can also be marked for incision, if the anterior arm is to be treated.
Depending on the results of the patient evaluation, if circumferential liposuction is to be performed, additional access sites are needed to allow for cross-tunneling. Suggested sites are the posterior, medial, and lateral areas of the arms.
Tumescent anesthesia with sedation is used. Place the patient in the supine or prone position depending on other procedures performed during the operation. Usually, the supine position allows adequate mobility of the arm. Using a No. 11 blade, make stab incisions in the preoperatively marked areas and infiltrate the wetting solution. The rate of infiltration should depend on patient discomfort. Patients with taut tissue might need a slower infiltration rate to minimize discomfort.
If suction-assisted lipectomy (SAL) alone is to be used, the cannula should be long enough to reach from the incision site to the most proximal area of the arm. For cross-tunneling, shorter and smaller cannulas are needed (usually, 2- to 4-mm; average, 3 mm). Eliminator or accelerator cannulas are preferred.
If superficial liposuction is performed, do so cautiously to avoid postoperative puckering and dimpling of the skin. Aggressive fat removal with grasping and lifting of the fat and downward pressure on the skin, forcing the fat into the cannula, is not necessary and can lead to postoperative contour deformities.
Ultrasonic liposuction is another popular modality for upper arm contouring. In general, ultrasonic liposuction is performed in the inferior (lower) one third of the arm and SAL is performed in the superior (upper) two thirds of the arm.
With the patient in the prone position, perform ultrasonic liposuction through the posterior axillary fold incision and SAL at the radial elbow away from the ulnar nerve. With the patient in the supine position, perform ultrasound-assisted lipectomy (UAL) at the radial elbow and SAL evacuation through the posterior axillary fold incisions.
As with ultrasonic liposuction in other areas of the body, perform the procedure with wetting solution, skin protection, long radial strokes with a long cannula, and final contouring with 3-mm SAL cannulas both proximally and distally.
Be aware of the fat overlying the medial epicondyle, the fibrous fat proximal to the elbow, and the fat located in the proximal one-half of the upper arm, as these areas, if insufficiently treated, can lead to patient dissatisfaction. Failure to adequately suction the most proximal fat can lead to poor skin contraction.
Rohrich et al have suggested 4 keys to maximize contour and prevent irregularities. These are (1) uniform delivery of subcutaneous infiltration, (2) long radial UAL strokes using a blunt-tip cannula, (3) long radial evacuation strokes using a small-diameter SAL cannula, and (4) circumferential contouring using SAL for the upper one third of the arm and UAL for the lower two thirds of the arm.
An approximate amount of infiltrate for the upper arm is 300-350 mL of wetting solution. UAL time ranges from approximately 2 min 30 s to 3 min, with an approximate UAL removal of 50-100 mL. The subsequent SAL contouring volume removed is approximately 250 mL, with treatment times of 4 min 10 s and 5 min 15 s.
Sutures are not placed to allow external drainage of fluid. Postoperatively, as with many liposuction procedures, the patient wears a compression garment for 4-6 weeks to minimize swelling.
Patient follow-up care is at 1 month, 3 months, 6 months, and 1 year. At these appointments, evaluate the patient for symmetry, waviness, and contour deformities. Generally, revisions are not performed until 3 or more months have passed.
Poor skin retraction, waviness, contour deformity, and ulnar nerve neurapraxia from UAL are the major complications. Other complications can include seromas, hematomas, and infection.
Lillis believes that if significant loose skin remains after an initial session, a second liposuction often provides additional skin contraction. He also believes that brachioplasty should not be considered until 3-6 months after aggressive liposuction and should be delayed until a second liposuction procedure has been performed.
Outcome and Prognosis
Upper arm contouring with liposuction yields a high degree of patient satisfaction with minimal morbidity. Often skin retraction can be greater than expected. Good patient selection, maintaining realistic expectations, and using the proper treatment modality are extremely important to obtaining satisfactory results. The images below show preoperative and postoperative views of a patient who underwent this procedure.
For excellent patient education resources, see eMedicineHealth's patient education article Liposuction.
Correa-Iturraspe M, Fernandez JC. Dermolipectomia Braquial. Prensa Med Argent. 1954. 34:2432.
Illouz Y-G, DeVillers Y. Body Sculpturing by Lipoplasty. New York, NY: Churchill Livingstone; 1989.
Lillis PJ. Liposuction of the arms, calves, and ankles. Dermatol Surg. 1997 Dec. 23(12):1161-8. [Medline].
Teimourian B, Malekzadeh S. Rejuvenation of the upper arm. Plast Reconstr Surg. 1998 Aug. 102(2):545-51; discussion 552-3. [Medline].
Rohrich R, Beran S, Kenkel J, eds. Ultrasound-Assisted Liposuction. St. Louis, Mo: Quality Medical Publishing; 1998.
Chamosa M, Murillo J, Vazquez T. Lipectomy of arms and lipograft of shoulders balance the upper body contour. Aesthetic Plast Surg. 2005 Nov-Dec. 29(6):567-70. [Medline].
Glanz S, Gonzalez-Ulloa M. Aesthetic surgery of the arm. Part I. Aesthetic Plast Surg. 1981. 5(1):1-17. [Medline].
Lockwood T. Brachioplasty with superficial fascial system suspension. Plast Reconstr Surg. 1995 Sep. 96(4):912-20. [Medline].
Lillis PJ. Liposuction of the arms. Dermatol Clin. 1999 Oct. 17(4):783-97. [Medline].
Nguyen AT, Rohrich RJ. Liposuction-assisted posterior brachioplasty: technical refinements in upper arm contouring. Plast Reconstr Surg. 2010 Oct. 126(4):1365-9. [Medline].
Aly A. Discussion: Liposuction of the arm concurrent with brachioplasty in the massive weight loss patient: is it safe?. Plast Reconstr Surg. 2013 Feb. 131(2):366-7. [Medline].
Asken S. Refinements in the technique of liposuction. J Dermatol Surg Oncol. 1988 Oct. 14(10):1165-72. [Medline].
Zomerlei TA, Neaman KC, Armstrong SD, Aitken ME, Cullen WT, Ford RD. Brachioplasty outcomes: a review of a multipractice cohort. Plast Reconstr Surg. 2013 Apr. 131(4):883-9. [Medline].
|Group I||Group II||Group III||Group IV|
|Fat||Minimal to moderate||Minimal to moderate||Excess||Minimal|
|Treatment||Circumferential liposuction||Suction lipectomy with or without axillary skin tightening versus skin excision with or without suction lipectomy||Circumferential liposuction without undermining and T incision with purse-string closure||Brachioplasty|
|Group||Skin Excess||Fat Excess||Treatment|
|I||Minimal||Moderate||Liposuction (UAL* or SAL† )|
|*UAL - Ultrasound-assisted lipectomy
† SAL - Suction-assisted lipectomy