The short scar arm lift procedure is reserved for patients whose excess skin is limited to the one-third of their upper arm (adjacent to the armpit). This technique results in a scar that runs parallel to the natural skin fold of the underarm and thus even with a short-sleeved top no surgical stigmata are seen.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the technique on his Snapchat account. The surgery involved a female patient who developed excess skin after moderate weight loss.
A wedge-shaped excess skin and fat is removed during a short scar arm lift procedure. The resulting scar is a short one that is perfectly concealed by the underarm.
Dr. Smiley said the patient was a good candidate for the short scar arm lift procedure because her excess skin did not reach her elbow.
“If we can do away with the long scar, which the standard arm lift entails, we do it,” he said on Snapchat.
Dr. Smiley said the standard arm lift uses a more extensive incision pattern that the scar extends from the armpit to the elbow. Nonetheless, it remains in a discreet position—i.e., on the inner aspect of the upper arm—so no surgical stigmata are seen unless the patient raises her arms, he further explained.
During surgery, the celebrity plastic surgeon created incisions to remove a wedge-shaped tissue (skin and fat) that was causing the sagging appearance. Afterwards, he tightened the fascia with deep sutures to further improve the contour.
Dr. Smiley reshaped the patient’s arm in accordance with the well-established aesthetic guidelines that suggest that a feminine arm has a relatively lean appearance, although it has a little convexity to the posterior and anterior surface.
before and after photos
After making sure that a high level of symmetry has been achieved, Dr. Smiley then closed the incisions with layers of sutures without picking up the skin (it was only held together by surgical tape). This suturing technique eliminated most of the tension on skin, allowing the wound to heal quicker and the scar to fade better into the background.
Dr. Smiley said that short scar arm lift procedure is occasionally complemented by minimal liposuction to further improve the arm’s contour.
Arm liposuction surgery can provide impressive results when two key variables are present: strict patient selection and meticulous surgical execution.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate arm liposuction as part of a rather extensive body contouring surgery that also involved the patient’s anterior abdomen, flanks, lower back, bra rolls, and inner thigh.
Due to the natural distribution of fat, most of the upper arm circumference needs “contouring,” leading to smoother, more natural results.
Strict patient selection, which is primarily based on physical exam, is the first step to ensure impressive results from surgery. One of the objectives is to assess skin elasticity and its ability to snap back once the excess fat has been removed with the use of liposuction cannula.
During physical exam, the thickness of the hanging skin relative to the upper arm base is assessed, often with the “pinch” method in which the patient’s arm is extended horizontally while pinching the base of the upper arm skin right beneath the muscles. If the skin does not touch the evaluator’s palm, she is most likely a good candidate for a liposuction-alone surgery.
Meanwhile, patients with significant tissue laxity manifested by large or thick hanging skin are poor candidates for liposuction-alone surgery unless a concomitant arm lift is performed as well; this uses a long incision extending between the armpit and elbow, usually on the inside of the upper arm, to achieve a smoother, more athletic appearance.
To further guarantee satisfying results from arm liposuction surgery, Dr. Smiley highlights the importance of understanding what constitute a nice-looking feminine arm. After all, this is almost an exclusive procedure for women.
While most people appreciate a relatively slender arm, a slight convexity (fullness) along the posterior surface between the armpit and elbow contributes to a youthful and feminine appearance. It should be noted that this area is highly susceptible to heavy fat deposit and aging, leading to a varying degree of ptosis (sagging or even bat-wing “deformity”).
To preserve minimal convexity to the posterior surface of the upper arm, liposuction should not be done too aggressively that the contour becomes emaciated or too muscular. Furthermore, preserving a thin layer of fat beneath the skin will ensure a smooth surface.
The patient shown in the videos had about 450 cc of fat removed on each arm. While it may sound a lot, smooth and natural-looking results are to be expected because she has good skin shrinkage.
To further ensure smooth results, Dr. Smiley placed two liposuction incisions that were eminently small and thus expected to fade into imperceptible scars. The first one was placed on the outward-facing surface of the arm (near the armpit) and the other one was positioned right next to the elbow.
The celebrity plastic surgeon said it is important to use incision for each treatment area to achieve smooth results and to preserve the natural contours and valleys of the feminine arm.
The degree of arm lift pain after surgery greatly varies from patient to patient due to individual pain threshold, physical fitness, and extent of surgery (short vs. long incision technique).
Dr. Tarick Smiley, a prominent Orange County plastic surgery expert, says it is expected to experience temporary pain, numbness, tingling sensation, skin sensitivity, and tightness following an arm lift surgery, or medically referred to as brachioplasty.
During an arm lift, Dr. Smiley says the excess skin is removed with incisions made within the armpit fold; however, patients who require extensive correction will need their scar extended into their elbow to achieve the most natural, smoothest results possible.
(Note: Aside from skin excision, the operation also involves reshaping and tightening the fascia, which connects the skin to the muscle. This additional step also contributes to the amount of arm lift pain after surgery.)
The perpendicular scar from “full” or standard arm lift is generally positioned on the inner aspect of the arm so it remains hidden most of the time.
In the first few days, most patients will need narcotics painkillers to help them cope with the discomfort. However, these can be minimized with the use of Exparel injection, which can numb the surgical site for up to four days.
Dr. Smiley, who regularly posts educational videos on Snapchat, often uses Exparel in body contouring surgeries. This medication is injected directly into the muscle before closing the incisions with sutures and has eliminated the need for pain pump, a balloon-like device that slowly releases numbing drugs for several days.
Most patients are “back on their feet” about a week postop and may choose to return to work provided it is only a desk job. Meanwhile, it remains prudent to avoid heavy lifting, rigorous exercise, and stretching the arms for at least six weeks.
Dr. Smiley says that most bruising and swelling will resolve 2-3 weeks. At this period, the use of compression garments might help with their resolution and to some extent even control the pain.
While bruising and swelling tend to resolve easily with time, this may not always be the case with the “lingering” pain or discomfort, which could emanate from sensory nerves starting to “wake up”.
It is important to note that during surgery, some small nerves are injured and can take months to recover fully. While the pinprick sensation or shooting pain is rather inconvenient, this is actually a good sign that the nerves are gradually repairing themselves.
Should the discomfort remain persistent, some patients may take Tylenol and anti-inflammatory drugs, or massage the affected area, provided their surgeons give them permission.
The axillary lift is a type of body lift commonly performed in massive weight loss patients. This procedure deals with the redundant skin and fat along the armpit, which not only causes unsightly bulges but also poor odor, skin rashes, and non-healing irritation.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the axillary lift on his Snapcat account. He performed the surgery in a female patient who had lost a lot of weight and so she was left with redundant skin.
The celebrity surgeon created a wedge-shaped incision covering the armpit and the lateral chest, thus allowing him to remove a large amount of skin and fat. The wound was then closed in a way that the resulting scar would lie parallel to the transverse armpit fold.
Dr. Smiley says it is of critical importance to remove just the right amount of redundant skin to allow for proper wound closure and to prevent limited activities of the arm.
“We should strike the perfect balance between creating a tighter, smoother armpit area and avoiding too much tension, which happens after an over-aggressive skin resection,” says Dr. Smiley.
Hence, he highlights the importance of the surgeon’s experience and “eye for details” when performing any type of body contouring surgery after weight loss.
The resulting scar from the axillary lift could migrate or appear conspicuous if there is too much tension on skin. For this reason, Dr. Smiley always closes the wound in several rows so the tension on the superficial layer is mitigated, which also allows for good healing.
To further promote favorable scars, he recommends silicone sheets and gels as they hydrate the skin. Wound that heals in a moist environment is known to fade better.
Occasionally, the axillary lift is combined with other body contouring surgeries such as brachioplasty (arm lift), arm liposuction, and even breast surgery, says Dr. Smiley.
Brachioplasty techniques vary from patient to patient due to the amount of loose skin and its location. Nonetheless, surgeons will make every effort to hide the scar—i.e., within the armpit fold and/or on the inner aspect of the arm.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has explained the different brachioplasty techniques, focusing more on the benefits and their “target problems.”
Its resulting scar lies parallel to the armpit fold, an area that is highly resistant to keloids or any other types of aggressive scarring. Despite such benefit, this technique is only suitable for patients with mild tissue laxity—i.e., the loose skin is only limited to one-third of the upper arm.
This procedure usually removes a diamond-shaped excess skin before the wound that goes parallel to armpit skin fold is closed with sutures. Occasionally, it is combined with liposuction to remove the excess superficial fat around the arm’s circumference to achieve smoother, more proportionate results.
- Standard or full brachioplasty
The technique is suitable for patients with moderate to severe tissue laxity as it removes loose skin between the armpit and the elbow; hence, the resulting scar made on the inner aspect of the arm extends from the underarm to the elbow.
Most surgeons today avoid the posterior scar placement (so it is seen on the back of the arm) unless the patients require large amounts of skin excision or the risk of wound breakdown is rather high (the inner aspect scar placement is perceived to have increased risk of wound separation due to the natural tension in the area).
In essence, this combines the standard brachioplasty technique with vertical torsoplasty, which can remove the excess skin along the lateral chest. For this reason, the scar from the armpit is extended towards the side of the chest.
The extended brachioplasty is a good option for massive weight loss patients who want to improve the shape their arm, armpit, and lateral chest.
Regardless of the incision pattern, a good surgeon will make every effort to eliminate most of the tension on skin to achieve the best scar possible. This is done by closing the wound in several layers, with the deepest tissue receiving most of the tension, which is gradually reduced as they go nearer to the skin surface.
The appearance of brachioplasty scar is perceived to be a major concern of patients with sagging skin in their upper arm caused by significant weight loss. Nonetheless, most feel that the “tradeoff” of having scars is worth it, particularly when the main goal is to have more slender arms that look proportionate to the body.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video to demonstrate the appearance of brachioplasty scar resulting from the “standard” technique.
The female patient shown in the video has “flabby” upper arms due to large amounts of redundant skin that extended down to her elbow. For this reason, she required an incision pattern technique that extended from the armpit down to her elbow.
Dr. Smiley was able to remove a large wedge-shaped excess skin along the inner arm between the biceps and triceps. The brachioplasty scar from this technique is hidden as people usually hold their arms by their sides.
While placing the brachioplasty scar on the inner aspect of the arms is perceived to be the most ideal technique, sometimes having it more posteriorly (i.e., back of the arm and thus more visible) may provide a better contour. Nonetheless, the patient may have to ponder on the ramifications of each scar technique/placement.
A scar placed more posteriorly is also perceived to heal and fade better because of the reduced tension. The inner aspect placement, meanwhile, is believed to be slightly more susceptible to wound separations due to the natural tension in the area.
However, Dr. Smiley remains partial to the inner aspect scar placement because there are many ways to reduce tension on the wound and thus ultimately promote “better” scars. For this reason, he encourages his patients to take a proactive approach in scar treatments that typically include the use of compression garments, silicone gel and/or sheets, and sunscreen.
Dr. Smiley advocates the use of scar gels and other treatments containing silicone, which hydrates the skin and helps the scar fade better and remain thin and flat. (Note: Wound is known to heal better in a moist environment; hence, the mucosal skin of the mouth has almost zero risk of scarring. The same “line of thought” can be applied to keeping plastic surgery scars unobtrusive with the use of silicone gel and sheets.)