More women are seeing their plastic surgeons for brachioplasty, according to recent statistics.
American Society for Aesthetic Plastic Surgery (ASAPS) statistics from 2015 show demand for the surgical batwing solution rose 929.7% in the last two decades — nearly 26,000 upper arm lifts were performed in 2015, compared to 2,516 in 1997. According to 2015 statistics by the American Society of Plastic Surgeons (ASPS), there was a nearly 5,000% change in the number of upper arm lifts from 2000 to 2015 — from 338 in 2000 to 17,099 in 2015.
Treatments for addressing the under arm wobble range from traditional and mini brachioplasty to liposuction and, more recently, use of devices, such as the ThermiTight (Almirall Company).
Seattle, Wash., plastic surgeon Richard Baxter, M.D., tells Cosmetic Surgery Times that traditional brachioplasty offers a sure-fire way to fix the cosmetic concern. And the scar that results — spanning the elbow to armpit — fades with time and is a tradeoff for optimal results.
“Brachioplasty is still the best option for many patients, depending on age and prior weight loss. The newer devices work best on younger patients and those with less excess skin,” Dr. Baxter says.
Liposuction is a good option for reshaping the arms, but only on patients with firm skin. Liposuction on arms with skin that has lost its elasticity can leave the arms looking deflated, Dr. Baxter says.
But Boca Raton, Fla., plastic surgeon Jason Pozner, M.D., says he’s doing fewer brachioplasties because many patients are unwilling to undergo the traditional surgical approach.
“For the massive weight loss patients, [we] still need traditional brachioplasty,” Dr. Pozner says. “But for younger patients with a little fat and laxity, either liposuction plus [ThermiTight] or laser lipo is best. Sometimes, these tightening devices are combined with mini brachioplasty.”
To minimize the brachioplasty scar’s appearance, Dr. Baxter recommends focusing on scar placement and using silicone taping. Dr. Pozner says he uses the laser post-surgery to minimize scars.
Examining Nonsurgical Options
Treatment alternatives include using liposuction or minimally invasive as well as noninvasive devices.
Claims for various devices, such as ThermiTight and CoolSculpting (Zeltiq), include reducing localized fat and/or tightening underarm skin. But there is very little clinical data to differentiate the various approaches, according to Dr. Baxter.
“All RF devices work by heating tissue causing a healing response that produces the effect. The number of treatments depends on the device and the condition of the tissue being treated,” Dr. Baxter says. “[Liposuction] works great on younger patients with good skin tone. I still do it frequently.”
While Dr. Baxter says liposuction continues to offer more dramatic results than minimally invasive options, future studies could show a benefit to some of the technologies for treating under arm sagging.
“We need more clinical data. [But,] in theory, noninvasive destruction of fat calls may cause some inflammation which in turn can produce some tightening,” Dr. Baxter says.
Dr. Pozner prefers use of the ThermiTight or laser lipo as surgical alternatives. He is less likely to use noninvasive external devices. A promising technology, but one that’s pending FDA clearance in the U.S. is BodyTite (Invasix), which is radio frequency-assisted “LipoTightening,” according to the Invasix BodyTite website.
“BodyTite may be good, as well. [But it’s] newer, and we don't have the U.S. experience with it, yet,” Dr. Pozner says.
Patient Motivation, Satisfaction Levels
Plastic surgeons who also were Invasix consultants did a study on radiofrequency-assisted liposuction for upper arm contouring, the results of which were published in August 2013 in Plastic and Reconstructive Surgery Global Open. In the study, 40 patients had radiofrequency-assisted liposuction under local tumescent anesthesia for cosmetic arm contouring, and 27 completed a postoperative patient satisfaction survey. Sixty-five percent of patients responding said they chose the less invasive option because they could have it under local anesthesia; 55% said their ability to return to work quickly was a motivating factor. At six months postop, 38% said they were extremely satisfied; 49% were very satisfied or satisfied; and 13% were not satisfied with arm contouring, according to the study.
Dr. Pozner says he doesn’t think providers get much arm skin tightening with external devices, except, maybe a microneedling device with radio frequency. And for that, usually three treatments are needed to address loose skin. Such an approach is doable for younger skin with good elasticity.
“CoolSculpting can get some results in the right patient,” Dr. Pozner says.
But for looser skin and older patients, plastic and cosmetic surgeons will likely need a device that uses radiofrequency internally or the laser.
Important considerations for surgeons, Dr. Baxter says, are proper patient selection for each option, whether surgical or not, and setting realistic expectations.
“For noticeably loose skin, brachioplasty is still the gold standard. Younger patients with a little fat are best candidates for noninvasive/minimally invasive options,” Dr. Baxter says.
Dr. Baxter reports no relevant disclosures.
Dr. Pozner was an investigator and had stock options with Invasix, had stock options with Thermi, was on the Zeltiq advisory board and lectured for the company. He received equipment and or discounts from Sciton and Cynosure, which make laser lipo devices.