Exercise Won’t Fix Those Bat Wings! How Arm Lift Surgery Works

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Kirstin (00:10):
Hey, Dr. Koehler and Dr. Gardner.

Dr. Koehler (00:13):
Hello.

Dr. Gardner (00:13):
How are you?

Kirstin (00:15):
Hey, today we are talking about arm lifts.

Dr. Gardner (00:20):
Oh, great.

Dr. Koehler (00:21):
How many arm lifts can you do?

Kirstin (00:22):
I can do zero. Let's talk about why patients report that their upper arms in particular tend to bother them. Is it age related or weight gain and loss, or is there a little more to it?

Dr. Gardner (00:40):
Could be both. There are plenty of people that have issues with upper arm batwings or loose skin due to weight loss, but we also see it with aging loss of collagen, elastin, and over time just sun damage. So it could be either.

Kirstin (00:56):
A lot of people assume that they just need to hit the gym harder or lift more, but what is actually happening in the arms that exercise can't fix?

Dr. Koehler (01:06):
It's the skin. So yes, they might benefit from working out and strengthening those muscles and it might give them a fuller, more toned appearance to their arm, but working out doesn't tighten skin. So it's the same goes for after pregnancy. When you're left with loose skin after pregnancy, that's great. You can get your weight back down to pre-pregnancy weight and you can work out, but a trainer can't tighten your skin, the skin elasticity that's lost, and if that skin doesn't rebound and tighten back up, then there's a couple options, one of them being an arm lift, but you got to remove the excess.

Kirstin (01:44):
I think this one could be for Dr. Gardner. If someone comes to you frustrated about their arms, they've done the workouts, they've lost the weight, and they still feel self-conscious, what are you looking for at that first consultation?

Dr. Gardner (01:58):
Well, I mean, you really want to know that they've kind of bought into the concept because unfortunately, everybody thinks that skin tightening technology is going to just shrink wrap their arm back to where it was pre weight loss or when they were in their twenties, and it's just not going to happen. So there is a place for liposuction and RenuVion or one of the other technologies that can tighten skin. But unfortunately for most people, if they have liposuction and one of those technologies, they're still going to have loose skin and they're going to end up unhappy and they're going to end up needing to have a brachioplasty or an arm lift.

Kirstin (02:39):
So for someone who's never heard of an arm lift before or didn't know that that was a thing, can you explain what it is?

Dr. Koehler (02:46):
There's different variations on the arm lift, but essentially it's an incision that starts near the elbow and goes all the way to the armpit, and sometimes it can extend down into the side of the chest, and then for some people it can even extend down into the forearm. But the typical arm lift incision is from about the elbow to the armpit, and it's to remove the loose skin of the upper arm and the incision. Well, doctors do it two different ways. A lot of surgeons like to put the incision, and I think Dr. Gardner and I both kind of like to put the incision in the medial aspect of the arm so that when your arm's down by your side, it's not something that can be visible. Some surgeons like to put the incision on the backside of the arm, which I guess is great. If you're holding your arms up, nobody can see it. But when you're walking, anybody that's standing behind you can see the scar. So trying to keep the scar concealed is the tricky part, but there's different things that we do to try to make that look as good as possible.

Kirstin (03:47):
What kind of results can it realistically deliver? Is it mostly about tightening skin or reshaping the arm or both?

Dr. Gardner (03:57):
Both. But I mean, tightening the skin is the number one benefit that they're going to see as far as reshaping their arm. It is going to do both. Essentially tightening the skin does reshape the arm, and I always tell 'em, wave goodbye or batwings one more time because it just can be life changing. They're finally going to be able to wear the shirts that they want to wear. They're not going to be worried about people seeing it, making comments. Going to the gym is so much easier. So everything is better once that skin is removed and that applies to all over the body, but for arms, it really does make a huge difference.

Kirstin (04:38):
Are arm lifts something you usually do alone or is it tied into other surgeries, mommy makeovers, things like that?

Dr. Koehler (04:47):
Yeah, I mean, we can combine it with a lot of different procedures and it just sort of depends. We look at several different things, although it can be done, I don't typically like to do arm lifts and thigh reductions at the same time, mainly because on one hand, if you have something done on your lower extremities, you're going to need to use your upper extremities to help yourself get up and down. And likewise, if you do the upper, you want to have your legs to get up with, but that still can be done as a combination. But there's some things that we, some principles that we kind like to look at, which is, for instance, it's pretty easy to operate on. Let's do a breast lift and an arm reduction. We're in the same basic surgical site. The downtime's not going to be greatly affected by doing those two procedures at the same time. So yeah, location of surgeries is one thing that we'll look at. And then also the surgical time. We want to do something that's generally within six hours for outpatient procedures.

Kirstin (05:45):
So earlier Dr. Gardner mentioned RenuVion, which is a less invasive procedure, but are there nonsurgical options that give dramatic results?

Dr. Koehler (05:55):
No.

Dr. Gardner (05:57):
No. Not at all.

Dr. Koehler (05:58):
No. I mean, the RenuVion is considered surgical. It's maybe minimally invasive and it does give results, but as Dr. Gardner said, it's on select people. It's really more for the patient that I would still say as a liposuction candidate if we didn't even have RenuVion, but the RenuVion is going to give them that much better of a result. A person who was not a candidate for liposuction doesn't become a candidate because we have RenuVion. Wouldn't you agree, Vince?

Dr. Gardner (06:28):
I would. And even the other thing I would say is somebody may come in and say, gosh, I've got this little bit of loose skin. Let's just RenuVion it and tighten it up. That really doesn't, again, in my opinion, doesn't really make a whole lot of difference because normally that is skin that's been stretched out. It's just not normal skin. It's weight loss skin, and unfortunately just heating it up, they're going to be disappointed. And so for most of those people, you can tell when they come in and if they say, I've lost 80 or 90 pounds, I will say there are people that have lost 80, 90, a hundred pounds and their arms really don't look that bad. It's amazing how some areas just look better than others, and it depends on where the patient carried their weight. Some people may not have carried much weight in their arms, but skin is different. Skin is funny, and sometimes it responds differently in different people. You may have the same people, five foot four lost a hundred pounds and one of 'em arms look terrible. The other one's arms don't look so bad. So it's very individual.

Kirstin (07:32):
Is there any type of arm lift that can be done without major incisions?

Dr. Koehler (07:37):
Well, there is, but it doesn't work. I wouldn't say it doesn't work. We were talking about this, we were doing an arm lift today and we were talking about it. There's kind a mini arm lift where the incision's just kind of right in the armpit and you can tuck and take a little ellipse up and tuck it a little bit. The amount of skin that you get tightened with that procedure is very minimal. The scar is well hidden, but the amount of tightening is very, very minimal. So much so that that's not a procedure that I really offer because I just don't feel like it's going to get most, like 99% of the patients that I would see would not be happy with that result.

Dr. Gardner (08:22):
It's called a crescent lift, and every time they raise their arm, it really widens and pulls on that incision, and so they end up with a really widened incision, which kind of negates the whole point of trying to remove that skin. So I would say there are very few people that are a legitimate candidate for that surgery. And I agree, I don't really offer it because I don't see the benefit.

Kirstin (08:46):
Let's talk about what recovery looks like from an arm lift, like day to day. Is it painful? How do we manage discomfort here at this office?

Dr. Gardner (08:58):
We like to keep those incisions pulled together. So I like taping. There are different ways we can tape not necessarily silicone tape, because silicone tape doesn't have any tensile strength. So I use tape and we use compression. The combination of tape and compression is really powerful as far as post-op recovery. Unfortunately, this is some of the thinnest skin in your body, and when you put an incision there, it can widen because it's so thin. If there's tension on it, your body will lay down more collagen, you can end up with a really thickened scar. And so sometimes we have to come back and inject it with steroids, or worst case scenario may have to revise or cut out the scar and start over. So scarring is one thing, but that really doesn't hurt a lot. And as far as post-op pain, wearing good compression can really help get the swelling down and I think can help increase or speed up recovery. But as far as pain, everybody's different. I see some people that come in the next day look like nothing happened and other people have more discomfort and it's really an individual thing, but most people recover from arm lifts pretty well.

Kirstin (10:06):
Okay.

Dr. Koehler (10:08):
Yeah, I'd say that the biggest nuisance with arm lifts is, as he mentioned, the skin is extremely thin and it is highly prone to some breakdown. Everybody wants their arms super tight. Well, if we get it too tight, it's going to tend to break down. And then if you don't get it tight enough, then you've got a disappointed patient. So it's a very fine line. And because the skin is the only thing holding that together, the sutures in the skin, yeah, that's the one negative thing that we do sometimes see with arm reductions.

Kirstin (10:41):
All right. What sorts of things can you not do while you're recovering, and how soon can somebody go back to working out or lifting after an arm lift?

Dr. Gardner (10:52):
So one of the big things about after an arm lift is raising your arm over your head. And why is that? Well, because like Dr. Koehler said, the incision comes from the elbow down the inside of the arm, what we call the biceps groove up into the armpit, and then usually down a little bit. And that downward slope puts a lot of tension right here on this joint space. And the more you raise your arm, the more likely you are to have a little bit of widening, and sometimes it can gap open. Well, obviously the armpit stays moist and there's a lot of movement. And that combination of moisture and movement tends to increase the risk of wound separation, wound breakdown, and can delay wound healing. So that's the biggest thing as far as recovery. And the same thing for the thighs, the groin area and thighs because of movement and moisture can cause some breakdown. So I would say that's the biggest holdup as far as recovery.

Kirstin (11:47):
When do you start seeing results and how long does it take to see the final outcome?

Dr. Koehler (11:53):
Well, you see the results right away, next day. You can see the size of the arm, especially people who have lots of skin laxity. I mean, you can see an immediate change, but it's going to take six, eight weeks for a lot of the swelling to come down. And like a lot of the procedures we do, it's somewhere between three and six months for the vast majority of swelling to be gone and scars to start to really mature. So scars can take a year or more to really fully mature, but we see a lot of variation on that from patient to patient. Sometimes I see people in their six, eight weeks from surgery and their scars look great and their arms look great, and other people it can take longer. So it varies, but the changes is pretty immediate. It's just the initial swelling you have to go through. And most people, by four to six weeks, the vast majority of swelling is gone.

Kirstin (12:42):
I think we've talked before about tummy tucks and how your skin could possibly stretch back out a little if you gain weight or have another pregnancy. Is that the same with arm lifts? Are those results permanent or can things loosen back up over time?

Dr. Gardner (12:57):
It's the weight loss skin, unfortunately. And when you have weight loss skin, it is not normal skin. So yes, it doesn't matter where on the body, I tell patients it can stretch out anywhere on the body. Now, a lot of times if we do a revision, take a little bit more skin, usually after the second time, it doesn't tend to stretch out the way it does or way it can because we've tightened it up again, but it's just not normal skin. And so all bets are off.

Kirstin (13:27):
So there's an honest question that people sometimes hesitate to ask. Does anyone ever regret having an arm lift?

Dr. Koehler (13:34):
Well, I'm sure there's someone that has regretted the procedure. And interestingly, I had a lady, I think we may have talked about it on one of our other podcasts, but I had a lady that I did not do her breast reduction, but she came in to have me look at her scars. And when she changed and I looked at her scars, I was thinking, oh, this is going to look really bad. Well, it turned out it looked really good, and whoever did it did a fantastic job. But the issue was is that I guess in her head, what she had envisioned how it was going to look was not in sync with what she had. And so even like I told her, I said, I would put that on my website. It looks really good. She was horrified by the scar. So I think sometimes if the communication's not there, the understanding, we cannot erase scars. There will always be a scar. Yes, they can fade. So I think the times of disappointment, one would be maybe not understanding realistically what they thought they could achieve. And then the other is like Dr. Gardner said, I mean, you can't shrink wrap the arm and make it 16 years old again. The skin is different. It's going to look a lot better. So it's usually about managing expectations. So yes, certainly there's somebody who's been disappointed by the procedure.

Dr. Gardner (14:47):
I enjoy doing arm lifts or brachioplasties. I think those patients, by and large are generally extremely happy. And I would say that for almost all the weight loss patients that we see, they're just happy. I mean, when you've been so successful with your weight loss that now your problem is not weight, your problem is skin, that getting that skin removed is just so emotionally life-changing. It's amazing how many of these patients post day one come in, you take down their dressings and they start crying on you because they're so happy with getting rid of that unwanted skin. So I just think that they're all good procedures, and I really enjoyed those type procedures because the patients are generally so happy. But they, like Dr. Koehler said, they have to be accepting of scars. But I tell 'em, I said, look, it's a trade off. You're going to get rid of all this skin, but you're going to have the scars. And rarely does somebody even balk at the thought of that.

Kirstin (15:49):
All right. Do you have a burning question for either of our doctors or me? You can leave us a voicemail on our podcast website at Alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Gardner and Dr. Koehler.

Dr. Gardner (16:03):
Thank you.

Kirstin (16:04):
Go back to making Alabama beautiful.

Dr. Koehler (16:05):
On it.

Announcer (16:08):
Got a question for Dr. Koehler. Leave us a voicemail at AlabamatheBeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.