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Trading scars for contour: Signs of surgery hard to camouflage

Article-Trading scars for contour: Signs of surgery hard to camouflage

Before (left) and three months after brachioplasty surgery in a 75-year-old female patient of normal weight. (Photos: Scott Greenberg, M.D.)
National report — Brachioplasty can offer normal-weight people with loose skin and sometimes excess fat on their upper arms an opportunity to achieve a more contoured look. The upper arm surgery can give the massive weight-loss patient freedom from what is often unsightly and sagging arm skin.

But the surgery cannot be successful unless patients are willing to trade their loose skin, excess fat and lack of contour for an often-dramatic scar, according to Scott Greenberg, M.D., F.A.C.S., clinical assistant professor, department of surgery, Florida State University College of Medicine, Orlando.

"The scar can be relatively camouflaged most of the time, because people usually walk around with their arms down," Dr. Greenberg tells Cosmetic Surgery Times. "But once they raise their arms, all bets are off. Even in a short-sleeved shirt, one can see the scars."

Patients also need to be aware that many will experience some degree of numbness after the surgery. The numbness, according to Dr. Greenberg, often disappears with time.

"The numbness is caused by a combination of superficial nerves that are running just below the skin, which end up being stretched and pulled and swollen as a result of the procedure," he says. "But for most patients the numbness is not permanent. Once the swelling goes down, the nerve function tends to come back within four to six weeks."

The procedure Plastic surgeons often design the scar in the brachio-humoral groove, along the long axis of the arm. Dr. Greenberg makes the incision, elevates the skin and subcutaneous tissue flap, marks the areas of excess skin, trims the excess skin and the fat, and sutures the area. He sometimes also will perform liposuction to augment the procedure.

Brachioplasty has evolved slightly with the increasing demand for the surgery from massive weight-loss patients, according to Jeffrey Kenkel, M.D., a plastic surgeon and associate professor and vice chairman, department of plastic surgery, University of Texas Southwestern, Dallas.

"We have had to be a little more aggressive in the treatment of the arms," Dr. Kenkel says. "We used to stop ... primarily in the axilla. Now we will often extend into the armpit and even down onto the chest wall."

The brachioplasty incision can run the entire length of the arm, down to and sometimes below the elbow crease. Dr. Kenkel moves his scar a bit more posteriorly to allow for more effective contouring.

In some cases, surgeons can get away with performing a mini-brachioplasty, where they combine liposuction with an incision limited to the axilla.

"It is a pretty specific patient group that benefits from it; mainly patients who have some skin redundancy in the proximal third of their arms," Dr. Kenkel says.

Postsurgery, Dr. Greenberg emphasizes the importance of patients' wearing compression garments for about three weeks. Dr. Kenkel disagrees, because he believes the constriction often results in blistering.

To control postsurgery swelling and bruising, Dr. Greenberg uses an herbal combination of Arnica montana, a plant extract, and bromelain, a pineapple extract. These have been shown in studies to significantly decrease swelling and bruising when used in combination after surgery, according to Dr. Greenberg. The plastic surgeon has patients begin using them three or four days prior to surgery and continue for a couple of weeks postsurgery.

"The last thing that we do in order to improve lymphatic drainage and decrease swelling and bruising from this is we have patients begin a series of lymphatic drainage massage treatments," he says. "We perform these once a week for three weeks in our office, beginning at a week postoperatively."

Dr. Kenkel tells patients to keep the arms as straight as possible to facilitate lymph drainage.

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