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.)
A minimal scar arm lift technique results in a scar that lies precisely within the armpit crease for its optimal concealment. However, it can only produce a nice appearance if the patient’s loose skin is concentrated only in the “uppermost” area of the arm.
For patients with extensive skin laxity that reaches their elbow, smooth results and natural contours are only possible with the standard arm lift technique in which the scar goes from the armpit and extends down the elbow. (Note: The scar is concealed when the patient’s hands are at her side.)
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has posted a video on his Snapchat account to demonstrate how a minimal scar arm lift with subsequent liposuction is accomplished.
The female patient shown in the video was deemed appropriate for a minimal scar arm lift technique as her excess skin was limited to the upper one-third of her upper arm.
Dr. Smiley removed a wedge-shaped skin in which the resulting linear scar would be hidden by the armpit crease, allowing the patient to wear sleeveless tops without having to worry about surgical stigmata.
After meticulous wound closure, the celebrity plastic surgeon performed liposuction to further smooth out the arm’s contour. Contrary to popular belief, this procedure does not entail the removal of fat entirely, as doing so can lead to skin irregularities and unnatural (masculine-looking) arm.
Dr. Smiley says a residual layer of fat must be preserved during liposuction to produce smooth, natural-looking contours. For this reason, he always moves the microcannula (a small flexible hollowed tube attached to a vacuum pump) precisely parallel to the skin and in a rather swift fashion to prevent inadvertent over-removal of fat in one area.
Aside from meticulous surgical techniques, Dr. Smiley says patient selection also plays a critical role in the success of any body contouring surgery.
“The ideal candidate should be near her recommended weight. She should also know that maintaining it through healthy lifestyle is the only way to preserve the surgery’s results,” he says.Minimal Scar Arm Lift Explained
The ideal arm lift techniques will differ from patient to patient, although there are generally agreed upon guidelines known to provide smoother, more natural-looking results. For instance, some doctors almost always incorporate simultaneous liposuction to further contour the upper arm and possibly the armpit area as well.
In essence, arm lift surgery removes the excess skin with an incision that is limited to the armpit fold, or an inner arm scar that extends down to the elbow; the latter is reserved for massive weight loss patients due to the large amounts of their redundant skin.
But to further achieve smoother results, there is also a need to reshape the underlying supportive tissue with internal sutures. This additional step also allows the surgeon to eliminate most of the tension on the skin, thus allowing the scars to heal and fade better.
It is critical to remove most of the superficial tension, which is achieved with proper wound closure techniques, to prevent the scars from spreading and migrating, as suggested by Orange County plastic surgery experts.
A good number of patients also require simultaneous liposuction to further improve their arm contour.
Arm liposuction in general must involve most of its circumference to achieve a smoother, more feminine contour (this is almost an exclusive procedure for women). Nonetheless, there should remain a thin layer of superficial fat (beneath the skin) to prevent deformities and skin irregularities.
Aside from improving the arm circumference, simultaneous liposuction can also improve the appearance of fat pads in front and/or back of the armpit. This “unwanted” fat rolls become prominent with age or after significant weight loss.
It is almost always advisable to use microcannulas, which are narrow flexible tubes that remove the “unwanted” fats, instead of larger cannulas.
Microcannulas provide smoother results because they allow for more accurate fat removal, i.e., they remove fats in smaller bits. Furthermore, they require smaller round incisions (1-1.5 mm) that almost always disappear quickly in light-skinned patients.
It is also critical to move the microcannulas precisely parallel to the skin and in a rather swift manner to prevent removing too much fats and thus leading to “Swiss cheese” skin irregularities.
The right arm lift techniques and the use of ancillary procedures can provide long lasting results provided that the patient maintains a healthy, stable weight.
The reasons for arm lift surgery are generally cosmetic related, i.e., remove the excess skin and fat in the upper arm lift and achieve a more balanced silhouette. While the vast majority of people seeking this procedure are massive weight loss patients, those who want to correct skin laxity due to natural aging can also benefit from it.
And because the reasons for arm lift surgery are primarily anchored to aesthetic improvement, it is rarely covered by health insurance. Nonetheless, some massive weight loss patients can expect relief from skin irritation and poor hygiene once the redundant tissue has been removed.
Arm lift surgery typically used an elbow-to-armpit incision placed on the inner aspect of the arm for optimal scar concealment. However, some patients may require their scar positioned more posteriorly, and thus more visible, to achieve a more natural arm contour.
Placing the scar more posteriorly has also been found to promote better scarring as compared to the inner aspect of the arm because it allows the surgeon to close the wound with less “surface” tension, according to California Surgical Institute website.
Occasionally, arm lift surgery is combined with liposuction to further contour the upper arm. It is highly recommended to use microcannula—i.e., stainless steel probe with a diameter that is 2.2 mm or less—because it removes excess fat in smaller bits, therefore giving the surgeon a much greater control.
And with greater control offered by microcannulas, the results tend to be smoother and more natural compared to larger cannulas.
As with any form of body contouring procedure, the patients’ reasons for arm lift surgery must be highly personal; the decision to have the surgery should not come from anyone else, including their loved ones and family.
To shed light on the possible “emotional and psychological benefits” from body contouring surgeries, one study examined massive weight loss patients who have had tummy tuck. It has suggested that patients who had the procedure were more successful in keeping their weight stable than those who did not.
The researchers concluded that the cosmetic improvements could serve as a strong motivation to stick to a healthy lifestyle/long-term weight management.