ASPS Study Spotlights New Techniques to Contour Arms, Remove Excess Skin After
Massive Weight Loss
Losing Weight Only First Step for Post-Bariatric Patients

Thousands of people successfully lose significant weight each year. After massive weight loss, many people are unaware that their skin may not conform to their smaller body and unfortunately the “perfect” body is still a dream. Previously, people who had excess skin surgically removed were left with visible and thick scars. New techniques described in Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), modified existing methods and created new approaches to achieve a cosmetically pleasing contour of the upper arm, one of a number of procedures post-bariatric patients may need.

“Severe weight loss, following bariatric surgery to treat morbid obesity, is a major cause of upper arm contour deformities,” said Berish Strauch , MD , ASPS member and author of the study. “Many of these patients who lose 150 or more pounds develop a contour deformity similar to a bat’s wing that extends from the elbow across the armpit to the chest wall. Unfortunately, many patients have been reluctant to undergo a brachioplasty, where the arm is reshaped, due to problems that result with current techniques. By modifying these techniques, we’ve been able to decrease patients concerns and create a satisfactory outcome for the patient.”

In addition to a brachioplasty (upper arm surgery), people who have severe weight loss undergo multiple plastic surgery treatments to contour the skin to their new body. Common plastic surgeries include buttock, thigh, upper arm and lower body lifts as well as tummy tucks. The number of people who have had gastric bypass surgery jumped last year to more than 103,000, according to the American Society for Bariatric Surgery, leading to a significant increase in demand for these procedures.

According to Dr. Strauch, patients undergoing upper arm surgery were often displeased with their surgical outcome because they could see the scar. Previously, plastic surgeons placed the scar between the bicep and tricep on the arm, an extremely visible spot. This study recommends that surgeons move the scar halfway back to the underside of the arm where it is less visible to the patient.

Also, patients were dissatisfied with scars that did not heal optimally, according to Dr. Strauch. Previous techniques did not take into consideration the pull on the skin when an arm is flexed and extended. Building on a rubber band principle, the modified technique uses an s-shaped scar, running the length of the upper arm, which allows the scar to expand and contract with the arm’s movements and to heal better. Over time, the scars were thinner, softer and less noticeable.

Another benefit of the modified techniques described in the study is that the skin of the armpit concaves. By performing a Z-plasty, a special incision and repair technique, the tissue settles into the armpit as it did naturally prior to weight loss or surgery.

“There isn’t anything better than making patients feel wonderful about them,” said Strauch. “Recognizing the long journey of losing significant weight for my patients, it’s an incredible feeling to watch them look in the mirror for the first time after contouring surgery and observe the excitement in their faces.”

Reprinted with permission from the American Society of Plastic Surgeons Web site.

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