Arm lift: the surgical solution for arm skin laxity
Arm lift, called brachioplasty in medical terminology, is a surgical procedure designed to treat excess skin and fat on the inner arm, from the armpit to the elbow. This procedure is responding to growing demand, with nearly 20,000 procedures performed in the United States in 2019, a 20% increase from 2015.
Arm skin laxity, often described as a "bat wing" appearance, can result from several factors: massive weight loss (particularly after bariatric surgery), natural aging, or genetic predispositions. Beyond the aesthetic aspect, this excess skin can cause functional problems including skin irritation (intertrigo), hygiene difficulties, recurrent infections, and significant psychosocial impact.
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Clinical indications for arm lift
Profile of appropriate candidates
Brachioplasty is primarily intended for people with significant arm skin laxity that cannot be corrected by exercise alone.
Main indications:
- Massive weight loss (generally more than 45 kg) with residual excess skin
- Age-related skin laxity
- Distended skin after pregnancy
- Physical discomfort related to excess skin (irritation, infections)
- Psychological impact and clothing limitations
Clinical studies demonstrate that body contouring surgery, including brachioplasty after massive weight loss, significantly improves patient satisfaction, function and quality of life.
Eligibility criteria
Ideal candidates:
- Stable weight for at least 6 to 12 months
- BMI below 30 kg/m² (ideally)
- Good general health
- Realistic expectations regarding scars
- Non-smoker or having quit for several weeks
In practice: arm lift not recommended if you...
- Have unstabilized morbid obesity
- Have uncontrolled comorbidities (diabetes, hypertension)
- Actively smoke (increased risk of scarring complications)
- Are pregnant or breastfeeding
- Have uncontrolled coagulation disorders
- Have excess fat without significant skin laxity (liposuction alone may suffice)
The preoperative evaluation determines the appropriate technique according to the extent of skin laxity and associated excess fat.
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How arm lift works: surgical techniques
Principles of brachioplasty
Brachioplasty consists of excising excess skin and adipose tissue from the arm, creating a smoother and more toned contour. Several techniques exist depending on the extent of laxity.
Main techniques:
Classic brachioplasty: Longitudinal incision on the inner arm, from armpit to elbow. This approach allows treatment of significant skin laxity along the entire length of the arm.
Mini-brachioplasty (limited incision): Short incision concealed in the armpit, suitable for mild laxity (less than 5 cm of ptosis). This technique minimizes scar length but is suitable for a selected population.
Posterior brachioplasty: Incision placed on the posterior aspect of the arm for a less visible scar. A recent comparative study shows that the postero-medial approach offers the best results, with 92% of patients rating the result as "excellent" or "very good".
Liposuction-assisted: Liposuction can be combined with skin excision to optimize contour, particularly in patients with associated excess fat.
Procedure steps
The procedure is generally performed under general anesthesia, although local anesthesia with sedation may be sufficient in some cases.
Surgical steps:
- Preoperative marking in standing position, arms raised
- Incision according to chosen technique
- Resection of excess skin and fat
- Liposuction if indicated
- Tightening of supporting tissues with internal sutures
- Skin closure in multiple layers
The operative duration varies from 1 to 3 hours depending on the extent of the procedure and possible association with other body contouring interventions.
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Arm lift results: timeline and efficacy
Aesthetic results
Results are visible immediately after the procedure, although edema and bruising partially mask the final result during the first weeks.
Timeline:
- Immediate results: more defined arm contour, despite post-operative edema
- 2 to 4 weeks: progressive reduction of edema and bruising
- 3 months: result largely visible with continued improvement
- 12 to 18 months: complete scar maturation and final result
Scars evolve considerably during this period. Due to the anatomical position and tension on the arm, scar maturation can take 12 to 18 months, significantly longer than in other anatomical areas.
Patient satisfaction
Published clinical data report high satisfaction rates despite the presence of visible scars.
A retrospective study of 31 patients who underwent bilateral brachioplasty reports:
- Overall satisfaction: 4.3/5
- Contour improvement: 4.3/5
- Symptomatic improvement: 4.9/5
- Scar appearance: 3.9/5
- 94% report improved self-esteem
- 94% feel more comfortable wearing short-sleeved clothing
- 94% would repeat the procedure despite the scars
These results demonstrate that functional and aesthetic improvement largely compensates for the presence of scars for the vast majority of patients.
Durability of results
Brachioplasty results are generally durable provided a stable weight is maintained. Significant weight gain can compromise results by stretching the weakened skin and creating new stretch marks and enlarged scars. Natural aging can cause recurrent skin laxity over the years, but the improvement generally remains significant compared to the preoperative state.
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Arm lift pricing in Belgium
Price range
In Belgium, brachioplasty rates vary according to the extent of the procedure and the chosen facility.
Indicative rates: In specialized centers in Belgium, prices generally range from €3,200 to €3,900 depending on the complexity of the procedure.
Factors influencing cost:
- Extent of procedure (mini-brachioplasty vs. complete)
- Association with liposuction
- Unilateral or bilateral treatment
- Type of anesthesia
- Length of hospitalization
- Surgeon's experience
Coverage and reimbursement
Brachioplasty is most often considered an aesthetic procedure and is therefore not reimbursed by health insurance.
However, in certain well-defined situations, a medical indication may be recognized, particularly in cases of:
- Very significant excess skin causing chronic irritation
- Repeated infections in skin folds
- Significant functional limitation
- Sequelae after massive weight loss, particularly after bariatric surgery
The preoperative consultation with the surgeon allows evaluation of your situation and determination of whether a medical indication can be retained.
Inclusions in the rate
Quoted prices generally include:
- Surgeon and anesthesiologist fees
- Operating room costs
- Hospitalization (outpatient or overnight)
- Compression garment
- Post-operative follow-up consultations
It is recommended to clarify precisely what is included during the initial consultation.
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Complication rates and safety profile of brachioplasty
Safety data from medical literature
A systematic literature review of 1,065 patients treated in 27 studies reports the following safety data:
Overall complication rate: 28.9% (308/1065 patients)
The majority of complications are minor (95% according to a 16-year retrospective study). No major complications such as thromboembolism or sepsis were reported in the systematic review.
Specific complications:
- Hypertrophic scarring: 10.79% (115/1065)
- Seroma and lymphocele: 6.94% (74/1065)
- Delayed healing and dehiscence: 5.72% (61/1065)
- Infection: 3.19% (34/1065)
- Nerve injury: 1.5% (16/1065)
- Hematoma: 0.75% (8/1065)
Reoperation rate: Surgical revision rates vary from 0 to 21% according to studies, with an average of 12.5% to 16%. The majority of reoperations concern minor scar revisions to improve contour.
Specific complications to monitor
Nerve injuries: The medial brachial cutaneous nerve and medial antebrachial cutaneous nerve are particularly at risk. These nerves are located in the dissection plane and can be injured, causing temporary or permanent paresthesias. Cadaveric studies have confirmed this anatomical risk.
Hypertrophic scars: The most frequent and concerning complication for patients. The brachioplasty incision is perpendicular to Langer's lines and the arm skin is particularly thin, favoring hypertrophic scars. Scar management (silicone sheets, massage, sun protection, corticosteroid injections if necessary) is essential for 12 to 18 months.
Lymphedema: The lymphatic system can be disrupted, causing persistent arm swelling. This complication is generally temporary but can be permanent in rare cases.
Context and critical perspective
It is important to note that these complication rates come from studies including various surgical techniques, different patient populations and surgeons of varying experience. Rates can vary significantly according to:
- Surgeon's experience
- Technique used
- Patient profile (BMI, comorbidities, history)
- Duration of follow-up
Patients must be fully informed of the near-certainty of having visible scars and the risk of minor complications before making their decision.
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Contraindications to arm lift
Absolute contraindications
- Ongoing pregnancy or breastfeeding
- Active infection or progressive malignant disease
- Uncontrolled coagulation disorders
- Unstabilized serious medical conditions
Relative contraindications
- BMI > 30 kg/m² (increased risk of complications)
- Unstable weight
- Active smoking (cessation recommended several weeks before and after)
- Poorly controlled diabetes
- Uncontrolled hypertension
- Significant cardiovascular diseases
- Nutritional deficiencies
- Psychiatric instability or body dysmorphic disorder
Alternatives to consider
For patients with relative contraindications or minimal laxity:
- Liposuction alone (in case of excess fat without significant skin ptosis)
- Non-invasive skin tightening treatments
- Weight stabilization before procedure
- Optimization of comorbidities
Thorough preoperative evaluation determines the suitability of the procedure for your individual situation.
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Recovery and post-operative care
Immediate post-operative period
Hospitalization: Brachioplasty can be performed on an outpatient basis or require overnight hospitalization depending on the extent of the procedure and patient comorbidities.
First days:
- Protective dressings on incisions
- Compression garment to be worn continuously
- Possible drains to evacuate fluids (removed after a few days)
- Normal swelling and bruising
- Pain controlled by analgesics
- Arms kept in elevated position
Recovery timeline
Week 1:
- Light activities possible
- Avoid raising arms above head
- Showering possible according to surgeon's instructions
Weeks 2 to 4:
- Progressive resumption of daily activities
- Wearing compression garment as recommended (generally several weeks)
- Avoid sudden arm movements
Weeks 4 to 6:
- Resumption of most activities
- Avoid carrying heavy loads
6 weeks and beyond:
- Progressive resumption of physical and sports activities
- Continued scar management
Complete recovery generally requires 4 to 6 weeks, with scar maturation extending over 12 to 18 months.
Warning signs requiring medical contact
- Excessive bleeding or blood-soaked dressings
- Fever or discharge from incision (signs of infection)
- Pain not controlled by prescribed analgesics
- Abnormal swelling of an arm
- Persistent changes in sensitivity or mobility
- Shortness of breath or chest pain (signs of thrombosis)
Frequently asked questions about arm lift
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