Skin reduction surgery of the arms, i.e. Brachioplasty, is a common procedure performed by patients following weight loss after gastric bypass surgery. Brachioplasty surgery is desired following large weight gain and then loss of the upper arm region. Patients will typically complain about bat wings spanning over their upper arms that flop when they use their arms. Patients will often avoid wearing of short sleeve shirts because their arms make them self-conscious. Brachioplasty that is intended for post bariatric patients has been modified from traditional techniques to address the severe skin redundancy that is present with large weight loss. Traditional brachioplasty excision lines were designed to fit in your armpit which only allowed for minimal skin excision; these incision lines were determined to be inadequate for removal of larger skin redundancies noted in large weight loss patients. As such, these excision lines were modified to lie along the skin redundancy, i.e. which is the longitudinal plane of the arms. Yes, this incision line runs along the lower aspect of your arm but it is placed strategically to be at the bottom on the arm so that when your arms are down on your sides, they do not show.

The modified longitudinally oriented brachioplasty is the gold standard procedure that allows for maximum removal of severe redundant skin. Dr. Mowlavi utilizes liposuction first to not only remove all of the unwanted remaining fat but also to hydrodissect some of the more vital structures such as the basilic and cephalic veins as well as the median sensory nerve away from the excision plane. By utilizing hydrodissection of the soft tissues, Dr. Mowlavi is able to avoid two common side effects of brachioplasty surgery: a)lower arm swelling; b)lower arm insensitivity. Following your first consultation Dr. Mowlavi will customize your brachioplasty surgery to limit your incision line length as well as visibility yet maximize undesirable upper arm skin removal.

Procedure: Elimination of redundant skin and excess fat accumulated over the upper arm.
Length: 1 to 2 hours depending on the amount of soft tissue being removed.
Anesthesia: General anesthesia.
Place of Treatment: Outpatient surgical suite or hospital operating room.
Side Effects: 1) Due to extent of redundant skin excised, patients may experience temporary tightness surrounding skin incisions;

2) Temporary swelling may be noted along the lower upper arms that will subside over the first month;

3)Temporary numbness maybe caused by increase tension in the region; Dr. Mowlavi utilizes hydrodissection of the arms to ensure that permanent nerve injury does not occur during excision of redundant skin.

Risks: 1) Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following surgery. This complication is avoided by providing intermittent pneumatic compression garments.

2) Wound breakdown is more common in these patients secondary to several metabolic and physiologic disorders. Diabetes and nutritional deficiencies are largely to blame for the difficult healing of these patients.

3) Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical elevation of the soft tissue. This fluid accumulates due to a low blood count and protein deficiency both of which are often present in post bariatric patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. Patients are placed on high protein diet preoperatively to avoid this complication.

4) Local skin infection is not uncommon in a patient who has diabetes, iron deficiency anemia (low blood count), and protein deficiency. All of these conditions are corrected well before surgery to avoid this complication.

Recovery: The recovery for upper arm skin reduction surgery is as little as 2 weeks.
Duration of Results: Patients are extremely pleased with upper arm skin reduction surgery as they enjoy physical and mental confidence of showing off their arms. Patients can expect the cosmetic results to last a lifetime as long as they avoid weight gain.

What does brachioplasty surgery involve?

Brachioplasty surgery involves removal of redundant skin and residual fat that may have resulted following weight loss over the upper arms. Brachioplasty surgery requires direct excision of redundant skin and liposuction of the residual fat located over the upper arms. The resulting incision is repaired using a layered plastic surgery closure that minimizes tension on the closure. Patients undergoing brachioplasty will enjoy a lifelong of sleek and youthfull appearaing upper arms.

Am I a good candidate for brachioplasty surgery?

You are a good candidate for brachioplasty surgery if you have noticed flaps of skin that are hanging off of your upper arms like bat wings. These flaps of upper arm skin can be unsightly to the point of avoiding wearing of short sleeve shirts.

How do I plan my brachioplasty surgery?

On your initial visit, Dr. Mowlav iwill evaluate your health status, determine the amount of skin redundancy and residual fat, and show you a customized excision line; You will that have your blood checked. Expect to have iron and Vitamin B12/Folate deficiencies. The iron deficiency will result in a low blood count, which must be corrected before surgery. The correction of the low blood count will take at least 1 month and require taking daily iron pills. If you are a smoker, then you should quit for 1 month prior to brachioplasty surgery in order to allow your body adequate time to rid itself of any residual nicotine. Nicotine in your system results in shutting off of small blood vessels which carry nutrients to the skin; this event could be catastrophic in brachioplasty surgery resulting in extensive wounds requiring months to heal.

How do I prepare for brachioplasty surgery?

Since your brachioplasty surgery will require general anesthesia, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated and contaminate your lungs during induction of anesthesia. Since, you will have anesthetic medications administered throughout the case, you will remain groggy for some time and will require a ride to and from the surgery center if you elect not to commit to an overnight stay on the premises. You should choose a caretaker who is conscientious and who can spend the first night with you.

What results can I expect after brachioplasty surgery?

Over all, brachioplasty patients should be commended for their due diligence in losing their excess weight. By providing these patients a final skin reduction procedure for their upper arms, we are able to obtain for you the contoured upper arms that you have dreamed of. Patients are extremely satisfied with their surgery and their desire to wear short sleeved shirts. By providing a thorough preoperative workup, safe intraoperative course, and frequent postoperative visits, patients should expect a speedy recovery and return to a more aesthetically pleasing upper arm contour and a enjory more freedom with their choice in clothes.

Where will my post brachioplasty surgery be performed?

Since your brachioplasty surgery will require general anesthesia, it must be performed in an operating room that is part of a outpatient surgery center or in an in-house office based operating room, but it is of utmost importance for patients to make sure that the office facility has been accredited by a surgical accreditation body such as AAAASF.

What type of anesthesia will be used for my brachioplasty surgery?

Since your brachioplasty surgery requires removal of moderate amounts of skin in an area of the arm that is very sensitive, it will require general anesthesia. This is because skin in this area possesses a large number of sensory nerves (pain fibers) that would be triggered during cutting of the redundant skin; general anesthesia ensures that these pain fibers are shut down during the operation.

What should I expect after brachioplasty surgery?

You should expect to feel sore throughout the upper arm in the early postoperative period. The soreness can be minimized by continuous wearing of the compression garments. In general, the compression garments should be worn for at least 2 weeks in order to prevent development of any contour abnormalities. Lymphatic drainage compromise is most common in these areas. Lymphatic drainage is promoted by performing mechanical massage, body wraps, and external ultrasound treatments when needed.

When will I be able to return to work following brachioplasty surgery?

Patients can expect to return to work within 1 week to 2 weeks following brachioplasty surgery. Patients are advised to gauge their return to work by their overall soreness which dictates the tasks which they may perform.

Are there any side effects associated with brachioplasty surgery?

Due to extent of redundant skin excised, patients may experience increased tightness around the upper arms. This may lead to temporary swelling of the lower arms and hands. Prolonged swelling up to 3 months is not uncommon due to poor lymphatic drainage following extreme weight gain and loss. Lymphatic drainage is further compounded by extended surgical incisions required to remove the redundant skin. Lymphatic drainage is promoted by mechanical message, body wraps, and external ultrasound treatments when necessary. Despite attempts to remove all redundant skin, patients may develop recurrent skin laxity following surgery, described as “Recurrent skin laxity Syndrome.” This return of laxity is due to the loss of skin elasticity, a direct result of prolonged skin stretching throughout the years of obesity. Differences in laxity in local regions of the asymetry may be responsible for slight asymmetry that develops following surgery. Temporary numbness in the arms are possible as sensory nerves that are not visible to the eye may by transected by virtue of excising redundant skin.

Are there any risks associated with brachioplasty surgery?

Surgical treatment of post bariatric patients requires specific precautions not only because patients are often compromised physiologically but also because the surgeries can be quite extensive. Patient safety is the most critical consideration when managing these patients whose hemodynamics and ionic balances have been altered. Surgery should be limited to 7 hours and patients should be offered an overnight stay with a nurse. This surgical time limit, necessitates

Are there any risks associated with post bariatric surgery?

Surgical treatment of brachioplasty patients requires specific precautions mainly because patients may be compromised physiologically but also because the surgeries can be quite extensive. Patient safety is the most critical consideration when managing these patients whose hemodynamics and ionic balances may be altered. Patients are encouraged early ambulation in order to minimize the risk of developing vein clots which can then embolize (travel) to vital organs. Intraoperatively, patients are also provided safe guards against vein clots with intermittent pneumatic compression boots and anti-thrombotic medication through the veins if patients still have a high BMI. Another consideration involves correcting ionic imbalances resulting in iron deficiency anemia and B12/Folate deficiencies. Early blood work evaluation allows the Dr. Mowlavi to correct all abnormal parameters in preparation for surgery. Other intraoperative measures include safe guarding against pressure sores with generous cushioning of the axilla (arm pits), knees, heels, pelvis, and elbows. Finally, since patients have a larger ratio of surface area to volume they are at risk for hypothermia (cooling of core body temperature) and should be provided a warm operating room, warming blankets, and warm fluids by vein. Surgical incision lines may present healing difficulties. Wound breakdown is more common in these patients secondary to several metabolic and physiologic disorders. Diabetes and nutritional deficiencies are largely to blame for the difficult healing of these patients. Seroma formation refers to the accumulation of plasma fluid in pockets created by surgical elevation of the soft tissue. This fluid accumulates due to a low blood count and protein deficiency both of which are often present in post bariatric patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. To counter formation of seroma and to protect incision lines, customized compression garments are used to cover upper arm incisions.

Does everybody undergoing skin reduction surgery need to undergo brachioplasty surgery?

Patients who lose extensive weight will notice deflation of their skin due to the loss of fat cell volume. The redundant skin can be quite extensive and may be aesthetically unsightly and functionally prohibitive. When patients present for their consultation, it is fascinating how patient are unique and demonstrate weight gain and loss of the different regions. For example, one patient may have most prominent skin redundancy isolated to the legs, another may demonstrate thin lower limbs and skin redundancy isolated to the arms. As such, not every post bariatric patient may require brachioplasty.

Do patients need to be monitored by a nurse overnight following brachioplasty surgery?

Patients undergoing post bariatric surgery are evaluated much in the same manner as other surgical patients. If patients have medical illnesses other than the redundant skin they are trying to eliminate, then they will require an overnight stay at one of the local overnight stay houses near our office or have a nurse accompany them at home. In addition to identified medical illness, patients are evaluated with respect to their body mass index. The body mass index (BMI) is a parameter that measures the degree the patient is overweight. When the BMI is greater than 30, the patient is considered a high risk candidate and recommended to spend the night with one of our registered nurses. Over all, isolated brachioplasty procedure does not require overnight supervision; however, if multiple surgeries are performed such as in a total body lift, then overnight supervision with a nurse may be recommended.

Does the upper arm skin redundancy come back?

The redundancy of skin will not return unless patients relapses and regain the extra weight. There is a early postoperative complication called “Recurrent skin laxity syndrome” which is associated with early return of apparent skin redundancy which appears within 1 month of surgery. This complication is related to the fact that post bariatric patients in contrast to routine cosmetic patients desiring skin tucking must undergo a more aggressive excision of redundant skin as their skin has lost its elasticity and thus will give following surgery. This effect is taken into consideration when designing amount of planned redundant upper arm skin excision.

Can you get arm numbness following brachioplasty surgery?

Arm numbness can occur if the antibrachial/median sensory branches are injured during surgery. Injury to these nerves is minimized by utilizing liposuction to hydrodissect the nerves away from the redundant skin planned to be excised.

What steps can be taken to minimize scarring of the arms?

The upper arm can be vulnerable to poor scarring following brachioplasty. As such, we utilize an aggressive scar prevention protocol. This starts with minimizing tension of the incision line with a multi, 3 layered closure of the incision line. In addition, specialized tapes, called Steri-Strips, are applied to the incision lines which act as an external stitch without the risk of railroad tracking. Steri-strips are maintained for one month, after which, topical silicone tape and/or gel is recommended for another two months. During this recovery period, Intense Pulse Light therapy and steroid injections will be implemented when necessary.

How our patients feel about us:

Made me feel comfortable from the very beginning... Dr. Mowlavi and his entire staff are the best. My reconstruction surgery was a year long journey and I could not be happier with the results. Dr Mowlavi is a compassionate and caring surgeon. He and his staff have become like an extension of our family. I had a bilateral mastectomy with reconstruction in a single surgery. Dr Mowlavi answered all my questions and made me feel comfortable from the very beginning.

Anonymous Laguna Beach, CA

The procedure brought back years of confidence in myself... From the moment I stepped into the office I was pleasantly surprised by the friendly disposition of all the staff... After the procedure I was floored! I was surprised that such a great result could be achieved without the use of an implant which I did not want to get. As I admired myself in the mirror 2 weeks post op, Dr. Mowlavi smiled and said modestly, "Its all you!" I nearly cried as I had not perceived of my natural body looking truly beautiful in over 20 years. This procedure brought back years of confidence in myself that I had lost 90 lbs, 20 years and 2 children ago. For anyone considering plastic surgery but has fears and feelings such as I did you owe it to yourself to consult with Dr. Mowlavi and his staff. They are truly the best at what they do.

Lorene B.

Dr. Mowlavi is the best choice in Orange County... My highest recommendations go out to Dr Mowlavi for the skilled and fantastic work he performed on me... Being post bariatric surgery and not being the easiest of cases, Dr Mowlavi made sure we addressed the areas that I would gain the best results, made me fully aware of what to expect from the surgery, recovery and results. From my consultation to my post-surgical appointments... the entire Mowlavi staff treated me with special care, always making me feel like I was family, greeting me with hugs, smiles and ensuring I am doing well from the many follow up calls to all of the post-operative visits. I can not say enough to express how thankful I am to Dr. Mowlavi and his staff, and to let people know that if you are post cancer, bariatric or just need to have work performed to improve your appearance and quality of life, Cosmetic Plastic Surgery Institute with Dr. Mowlavi is the best choice in Orange County. You are all the BEST!

Jenifer D. Irvine, CA

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