Dr Rafizadeh of Morristown New Jersey classifies the arm lift candidates into three categories.
The arms become a major problem after weight loss because they are exposed, especially in the summer time when people wear short sleeves. It is definitely more disturbing to see hanging soft tissue and skin after loosing part of the adipose tissue than before the weight loss when everything was tight. This is also referred to as bat wing deformity.
Removing the extra skin and fat can leave a visible scar that we try to hide in the medial (inside) part of the arm, but raising the arm will expose that area. As in most other areas in plastic surgery, the results depend on how severe the deformity is before we start. I’d like to create three categories of arm deformity. Lets classify them by roman numbers.
I: Minor degrees of laxity and excess fat that can be dealt with by liposuction. In these cases the skin will retract and the arm contour is reestablished without a scar.
II: In these cases there is too much skin laxity and liposuction alone may not take care of the problem. I would liposuction the arm and excise the skin under the axilla (armpit). In these cases all the hairy part is removed as well as the sweat glands and the scar is hidden in the armpit. Depending on how much excess skin there is, this can give a major improvement.
III: There is too much skin and the only way to get a good result is to remove it along the axis of the arm which results in a longitudinal scar. In these cases a big segment of skin and subcutaneous tissue can be removed and the skin closed in the inside of the arm. This procedure is difficult. The skin closure is under tension and the scaring can be significant. I learned a nifty technique from one of my colleagues in Lyon France who has a big practice in body contouring after major weight loss and gives lectures all over the world. I liposuction the arm and on the inside of the arm, I remove almost all the fat. The excess skin becomes very obvious and easy to remove. The skin can then be closed without tension and the scar heals well and is less visible.