Background: Arm contouring for lipodystrophy and ptosis
are increasing in demand with age and especially after massive
weight loss following bariatric surgeries. Aesthetic arm contouring
is one of the most requested surgeries to those patients.
Multiple classification systems were described to guide the
management during pre-operative assessment. Treatment
options vary between liposuction only, skin resection only, a
combination of liposuction and excision, or possibly the use
of newer energy based skin tightening devices. One of the
most undesirable sequelae is visible scarring either due to
widening or migration of the scars. Location of the scar and
elimination of fat deposits and excess skin are the ultimate
concerns of patients seeking this surgery. The focus of this
study modification has been aimed to improve the poor
aesthetic result of scar sequelae and over all arm contouring.
Aim of Work: Developing a modification in surgical
technique for brachioplasty, that eliminates excess skin with
adequate arm contouring, and position scars in the least visible
location, thus achieving better overall patient satisfaction.
Methodology: This study was conducted on 15 patients
who presented seeking arm contouring in the period from
October 2017 to May 2019. Among these patients the average
age was 38. Average BMI was 27.5kg/m2. 60% of the cases
presented following Bariatric surgeries, 26.7% presented with
skin excess following fluctuations in weight and effect of
aging, and 13.3% presented with excess skin following previous
unsatisfactory liposuction.
Routine liposuction done initially, incision done down to
the honeycomb plane, undermining was carried deep to the
superficial fascia up to the anterior border of triceps. Skin
flap was redraped and pulled in an upper medial vector.
Results: This upper medial vector helped in improving
the contour of the arm in a homogenous way, eliminating skin
excess especially in the area above the olecranon in the distal
arm and also avoids the presence of bands while closure.
Early complications was limited to one case with 2cm wound
dehiscence, while late complications showed 5 cases with
scar hypertrophy and 4 cases with scar pigmentation.
Conclusion: The mentioned technique proved to be reliable
in achieving favorable arm contouring, with acceptable scarring
and a low incidence of complications.