Addressing the arms

Circumferential liposuction procedure reduces arm circumference, tightens skin. (zinkevych - stock.adobe.com)

A researcher performing circumferential power-assisted tumescent liposuction in 79 women with flabby arms shows the approach not only substantially reduces upper arm diameter but also results visible skin retraction, revealing arm muscle definition and tone, according to a research article published in the American Journal of Cosmetic Surgery.

“Arms are the ultimate barometer of buffness,” according to author Roland Boeni, M.D.

But increasing fat and decreasing skin laxity often turns upper arms flabby.

Brachioplasty is one option for treating flabby arms. But many women forgo the surgery due to concerns of scarring. Noninvasive treatments, including cryolipolysis, radiofrequency and microneedling, offer limited and shorter-term results and are often pricey. And when cosmetic surgeons perform liposuction of the upper arm to address the flab, they traditionally only address the posterolateral aspect of the upper arm, where most of the fat lives. However, even those results are suboptimal, as the approach doesn’t result in visibly defined muscles and skin tightening is limited, according to the author.

POLL: Do you perform any kind of body contouring treatment in your practice (cryolipolysis, laser, ultrasound, liposuction)? 
 
Dr. Boeni evaluated results of a circumferential arm liposuction procedure performed between January 2017 and July 2018 on 79 women, ages 26 to 69 years. He classified patients before the procedure:

• Stage 1, which meant they had minimal fat, less than 250 mL, and no ptosis

• Stage 2a, with moderate fat, grade 1 ptosis of less than 5 cm

• Stage 2b, as moderate to severe fat, grade 2 ptosis, 5 to 10 cm

• Stage 3, with extreme lipodystrophy, grade 3 ptosis of greater than 10 cm

• Stage 4, with mild to moderate fat with severe grade 3 ptosis

The procedure involved infiltrating fat on the proximal part of the lower arm, entire upper arm circumferentially and the para-axillary and parascapular regions with large amounts of tumescent solution. He used two to four 28-gauge needles rather than cannulas to more easily follow the natural curvature of the arms and cause less pain. He then used power-assisted liposuction (MicroAire) with either a 3 mm or 4 mm double Mercedes cannula (MicroAire). The author made several slit-incisions, the locations for which he describes in the paper, and used the open drainage technique. He went from deep to superficial to subdermal liposuction.

“The mean amount of supernatant fat was 1,300 mL (range 600 mL to 2100 mL),” he writes.

Patients wore compression garments for a week post procedure.

At 2- and 6-month follow-ups, the cross-sectional area of the upper arms was notably reduced and, because of liposuction to the deltoid fat pad and para-axillary and scapular region, the shoulders and torsos appeared narrower, reports Dr. Boeni.

Patients noted their smaller arm circumferences the day after surgery.

The skin tightening effect was significant, and by two months after circumferential arm liposuction, the line between the deltoid and biceps and line between the biceps and triceps were more pronounced, Dr. Boeni writes.

There were no complications, such as seroma, chronic swelling, hematoma, irregularities, embolism or infection. Dr. Boeni notes the use of antibiotics prophylactically for seven days to help prevent infection.

Four patients had wound secretion lasting several days, which resolved with treatment. One patient had swollen underarms for several days, but that too resolved with treatment, according to the study.

The lymphatic system was not impacted in this series of patients, the paper reports, and all but three patients indicated they were very satisfied with the contour improvement and the degree of volar skin laxity.

Keys to the operation’s success include that removing even small amounts of fat in a circumferential pattern results in exponential reductions in cross-sectional areas. And a skin redistribution effect happens as physicians undermine the upper arm’s skin with cannulas during liposuction. Excessive posterior skin moves easily, thanks to the aspirated space to the anterior side of the arm, according to the paper.

“Using this approach, surgeons can expand their client base by including elderly and obese patients with skin ptosis who seek leaner and athletic looking arms without scars,” Dr. Boeni concludes.

Disclosures:

The author reports no conflicts.

References:

Boeni, R. Circumferential Liposuction of the Female Arm. The American Journal of Cosmetic Surgery. Published online October 20, 2018. Available at: https://doi.org/10.1177/0748806818807574