Liposuction of the arms.

In my experience, liposuction of the arms has been strictly limited to females. Prior to the mid-1960s, the "ideal" fuller female figure was quite different from what is presently viewed as desirable. Today's preoccupation with fitness has made muscular definition in the female figure a sought-after goal. This is especially true in regard to the arms. For most women, even those of ideal body weight, the effort and self-discipline necessary to attain muscular definition of the arms is of such a degree as to be unattainable. Liposuction is a reasonable and viable method of achieving this goal. For those with more pronounced lipodystrophy often referred to as the "bat wing deformity" or the "Malaysian Flying Squirrel deformity," 3 liposuction is a simple and rational approach to enable one to fit properly into clothing. Many patients have such significant lipodystrophy that they are required to wear shirts and blouses two to three sizes larger so that sleeves will fit properly. This group of patients often achieve such dramatic results with liposuction that they are able for the first time as an adult to wear short-sleeve shirts and sleeveless blouses. Regardless of where the individual patient falls on this spectrum, if performed properly, liposuction can be an effective, simple, and predictable approach to this problem with a very high degree of patient satisfaction. Liposuction of the arms has been portrayed as a procedure fraught with complications and often of limited benefit. Articles in the medical literature, with few exceptions, stress the limitations of liposuction alone and cite the need for concomitant brachioplasty in a high percentage of cases. Misconceptions concerning liposuction of the upper arms are that the skin often does not retract adequately and that postoperative irregularity commonly occurs. 2,3,5 In my experience, liposuction of the arms, as often as any other anatomic site, produce a high degree of patient satisfaction. Textbooks and published articles routinely caution against excessive fat removal and the limitations of skin contraction. I believe that conservative fat removal is the cause of irregularity and insufficient skin contraction. Thorough fat extraction of the upper arms is usually easily attainable without undue trauma because of to the soft quality of fat in this area. Skin of the upper arm is somewhat analogous to skin of the upper inner thigh. Upper arm skin is thinner and lacks the tautness that is present in most other areas. Upper arm skin, however, has a much greater potential for significant skin contraction than does upper inner thigh skin. Thorough fat removal in the upper arms maximizes the potential final result. Such thorough removal of upper inner thigh fat, while maximizing contraction, will often leave an abnormal and aesthetically unpleasant result. The two most important principles to maximize the potential outcome of liposuction of the upper arms are thorough fat removal and avoidance of undue trauma to the subdermis. 4 The more thorough the fat removal, the more dramatic the skin contraction. Liposuction may be performed primarily for skin tightening even when very little fat is present. Young, nonwrinkled skin routinely contracts splendidly with preservation of the original texture and quality, even in cases of extremely large volume removal. The final result will obviously depend to a great extent on the patient's original skin tone and skin texture but in nearly all cases the end result will be a significant improvement. Brachioplasty and the resultant scar inherently produce such an unattractive and uncorrectable result that it should only very rarely be performed at the time of the initial liposuction. Those advocating skin removal as the initial approach are usually not aware of the tremendous ability of poorly toned skin of the upper arms to retract dramatically after thorough fat removal. Even in extremely high-volume cases, any remaining loose or poorly textured skin will usually be preferable to the very obvious brachioplasty scar (Fig. 1). If significant loose skin remains after an initial liposuction procedure, a second liposuction will usually produce further contraction and improvement. In contrast, the usual lenticular incision and its variations typically result in a long visible scar from the axilla to the medial epicondyle. The scars often become wide and irregular and may produce constriction bands, retractions, folds, and furrows. Even an ideal result still produces such a noticeable scar that the vast majority of patients will not feel comfortable wearing short sleeves.