The arms are vulnerable to changes that occur with age or weight fluctuation. These changes can cause skin laxity that is typically accompanied by varying degrees of fat accumulation, producing a saggy and floppy appearance of the upper arms. A patient that has gotten less young or has lost weight, and has that extra skin hanging on the arms, and no matter how hard they work out, they just can’t get rid of that floppy skin, then an arm rejuvenation or a brachioplasty may be the right procedure for them.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine. During his training, Dr. Couto had the privilege to have mentors, such as Jeffrey M. Kenkel, a top leader in the field of body contouring, including arm rejuvenation.
The arm rejuvenation are procedures aimed to optimize the contour and tone of the upper arms. This could simply consist of removal of stubborn fat with liposuction and energy based skin tightening devices (eg. JPlasma) or resection of skin laxity and tightness of the upper arm with an arm lift. Most commonly, liposuction and an arm lift are combined, as it helps create a better definition.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s health and medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Dr. Couto will emphasize the importance of avoiding nicotine products (e.g. cigarettes, nicotine patch, vape, etc), having the blood sugar levels well controlled, and the importance of adequate body weight. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential.
2) Learning Patient’s Surgical Goals
Dr. Couto has a deep discussion with the patient to learn what are the areas of concern and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Physical Exam
A focused physical exam of the upper extremities and trunk are performed. During this part of the consultation, we evaluate the degree of skin excess and the distribution and amount of fat along the arms. These factors help determine whether the patient is a candidate for a liposuction and energy based skin tightening devices (eg. JPlasma) only , short-scar arm lift, traditional arm lift, or extended arm-lift.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and also discuss the steps involved to book the procedure with us.
Patients with saggy and droopy upper arms due to the presence of excess skin and fat that does not improve with diet or exercise are candidates for arm rejuvenation. This procedure is not a weight loss method. Therefore, patients should be in a relatively normal body weight, and maintain an active and healthy life after the procedure to continue with the improved results.
Arm lifts are typically combined with liposuction. These two procedures work in a synergistic manner to better define the upper extremity. The liposuction (hyperlink) is usually performed first, followed by the arm lift.
Arm rejuvenation is a spectrum of techniques individualized for the needs of each patient. There are different types of arm lifts, and each of the different techniques are characterized by the length of the incision and the location where the scar is hidden. These are selected by the location and amount of skin excess that requires resection.
There are four different techniques that Dr. Couto uses to perform an arm rejuvenation:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery.Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient.
We always emphasize to our patients that all vitamins and herbal supplements (eg. Fish oil,Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this might increase risk of bleeding. Furthermore, we remind them that using any nicotine products can increase can affect their recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) affects a person’s capacity for healing, and thus increases risk of complications. If the patient is undergoing an arm lift, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Similarly, patients with a history of diabetes mellitus and that are candidates for an arm lift must have a glycosylated hemoglobin (HgbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake after any surgical procedure. This could be easily achieved with supplements available in our practice.
We will provide a detailed postoperative protocol to ensure that the patient has a comfortable and quick recovery. Patients undergoing a traditional or extended arm lift will have drain tubes placed. This helps prevent fluid collection in the arms and expedite the recovery. They are typically removed 5-7 days after surgery. The patient will also be placed in a specialized compression garment that helps minimize swelling and maintains the upper arm contoured. Swelling and bruising are to be expected and can be noticeable for several weeks. In order to minimize the swelling and inflammation, we may have our patient undergo lymphatic drainage massages. It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized postoperative pain medication protocol provided by Dr. Couto.
Patients are usually able to fully use their arms and perform their routine daily living activities with the exception of lifting or pulling objects above 10 pounds. We normally recommend our patients to take 7-10 days of work (less if working remotely from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (e.g. running, spinning, biking) 4 weeks after surgery, lower body work out and abdominal exercises 6 weeks after surgery, and upper body workout 8 weeks after surgery. It may take 3 months for the swelling to completely subside and see your results.
The length and location of the scar is determined by the location and amount of skin and/or fat excess that needs to be removed. For example, the incisions for a patient requiring only liposuction will be almost invisible compared to an individual requiring resection of skin excess through an traditional or extedended arm lift. In an arm lift a scar is unavoidable, the patient is trading a scar for a more defined and better contour upper arm. That being said, the scars are placed in strategic areas of the upper arm to make them less noticeable. The great majority of our patients are not bothered by the scar, since they feel that it is not obvious and the benefit of a well contoured arm is greater than having a scar.
If the patient is having only liposuction or mini arm lift, you will not have drains placed. However, patients undergoing a traditional or extended arm lift will have drains postoperatively. Drains help maintain the desired contour by preventing fluid from accumulating in the arms. Surgical drains are commonly removed 5-7 days. Occasionally, Dr. Couto will not use drains on the arms; however, these are only indicated in specific situations.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
Smoking cigarettes or the use of nicotine products (eg. vaping, chewing tobacco, nicotine patch) represents a higher risk of complication for patients undergoing arm lift than for those having only liposuction of the arm. Unlike isolated liposuction, an arm lift consists of a greater degree of intervention and longer incision. Therefore, in an arm lift the body requires greater healing capacity. This ability of the body to heal can be reduced when smoking cigarettes or using nicotine products.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or using any nicotine containing products at least 8 weeks before any type of arm lift procedure.
Absolutely! You are free to use your arms at any moment. Dr. Couto will instruct you to avoid lifting or pulling anything heavier than 10 pounds during the first weeks after surgery and to abstain from upper body workout for 2 months.
