Rejuvenation of the upper arm.

During the course of life, the upper arm demonstrates skin relaxation and fat deposits that become increasingly evident, particularly with age. However, the degree of skin ptosis and accumulation of subcutaneous fat varies from patient to patient. Therefore, it is critical to evaluate each patient individually, to inform the patient of the available options, and to tailor the procedure to his or her needs. We have described four categories of upper-arm problems. Patients with minimal to moderate subcutaneous fat and minimal skin laxity generally do well with circumferential lipectomy alone. With an increased amount of subcutaneous fat and more pronounced skin laxity, suction lipectomy in conjunction with a "ridge" provides good results, with a well hidden scar in the axilla. In the obese patient in whom skin laxity becomes much more noticeable after suction lipectomy, we recommend a purse-string closure of the modest brachioplasty incision to decrease the scar size. In those patients who have minimal fat but extensive skin laxity, a traditional brachioplasty cannot be avoided. Carefully selected and properly informed patients will result in an extremely high satisfaction rate. The techniques and guidelines described are designed to provide simple, easily performed procedures with minimal complications that safely and effectively rejuvenate the upper arm.