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Simple techniques can ensure aesthetically pleasing brachioplasty

Paris — Brachioplasty is just one of the many surgical interventions plastic surgeons perform in aging skin or in patients with plenty of excess skin following a significant weight loss.

Plastic surgeons can help sculpt the patient's arm into a more cosmetically and aesthetically acceptable form.

Hocine Bouabid, M.D., a plastic surgeon based here, offered his extensive experience and insight on this intervention and the dramatic aesthetic changes seen following this relatively simple and straightforward procedure, at the Anti-Aging Medicine World Congress here.

Outpatient basis

Dr. Bouabid says that a brachioplasty can be performed on an outpatient basis. Only if the procedure is combined with other procedures should the patient remain in the hospital for a few days of recovery.

Typical candidates for this procedure are those patients who have undergone a massive weight loss or simply in those patients where the gravitational forces and their aging skin due to time have left their arms with sagging or hanging, redundant and sometimes unsightly loose skin.

Dr. Bouabid tells Cosmetic Surgery Times that the lifting of the arm is a simple one to two hour surgery, can be easily coupled with a liposuction procedure and can be performed under a local or general anaesthesia.

In this standard technique, the surgeon first marks the area of excess skin to be removed with the patient standing or sitting. Then, an incision is made along the underarm and down the arm to the elbow of the patient. Hanging, loose excess skin and fat are then removed, and the subsequent scar looks like a "T." He says that it is crucial that the incision line runs along the inside of the armto hide the resulting scar tissue. A drain is placed and remains for one to two days following surgery. After surgery, bandages are applied to the arm, ranging from an extensive absorbent bandage with elastic support to a simple dressing with tapes (Steristrips).

Dr. Bouabid explains that because the skin in the upper arm is very mobile, the surgeon should be wary not to "over-undermine" unnecessarily. He says that the possible risks of this surgical procedure include postoperative discomfort, bleeding, infection, scarring, as well as sometimes difficult-healing wounds. Numbness and swelling are other possible side effects, but these are less common and often only temporary.

Fraught with pitfalls

However, if the surgeon is not prudent, this procedure can be fraught with complications and pitfalls, Dr. Bouabid explains.

"Before executing a brachioplasty, it is of paramount importance to plan the operation to every last detail, from the preoperative markings on the skin to be removed, to the proper bandages and drains. The design of the operation must be clear and correct. Also, it is crucial for the surgeon to always keep in mind that the cubital nerve runs from deep to superficial at the level of the elbow."

Even though this procedure is usually performed on an out-patient basis, the plastic surgeon stresses the necessity to control and follow-up on the patients according to their acute and immediate postoperative side effects following their surgery.

Since scarring is arguably the greatest drawback of this operation, the patient must understand and realize that the surgeon is simply exchanging one cosmetic problem (loose, sagging skin) for another (scars). No surgeon can predict preoperatively how a patient's scars will heal. Even so, Dr. Bouabid stresses that if these meticulous and cautious principles are applied well, the technique is simple and optimal cosmetic results can be achieved.

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