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Brachioplasty: A Modern Approach to Arm Aesthetics
Patricia Fuentes
1, Grace C. Tolan
2, Brannon Claytor
2
1FIU Herbert Wertheim College of Medicine, Miami, FL, United States. 2Claytor Noone Plastic Surgery, Bryn Mawr, PA, United States.
Background: Arm aesthetics often receive insufficient attention in body rejuvenation. Loose arm skin, a hallmark of aging and weight loss, resists minimally invasive procedures like radiofrequency microneedling or laser treatment. Elite arm rejuvenation involves more than skin excision—highlighting contours and muscle definition restores youthful, powerful arm aesthetics.
Methods: Markings are made with the patient standing. Anterior markings begin at the ulnar groove and curve gently from elbow to axilla while skin is pulled posteriorly. A Z-plasty crosses the axilla and may extend down the chest wall for sculpting. Posterior markings follow a similar technique. Patients receive oral pain meds and tumescent anesthesia; procedures are done awake to allow repositioning and muscle flexion. After liposuction, skin is excised to the fascia with care to preserve the medial antebrachial cutaneous and ulnar nerves. Dart incisions aid alignment and tensionless closure. The axillary Z-plasty helps prevent scar contracture. Intraoperative arm movements optimize contouring at the delto-bicipital groove and triceps, while ensuring skin turgor.
Results: Forty-nine patients underwent brachioplasty with liposuction in a QUAD-A facility (July 2020–Dec 2023). Most were women (96%), mean age 50.9 (34–75), BMI 29.96. Two men (ages 56–59) had mean BMI 26.67. Six patients had concurrent procedures including breast reduction, trunk and back liposuction, and mastopexy. One woman developed DVT/PE 7 days post-op following additional 360° liposuction; workup revealed previously undiagnosed Antithrombin III deficiency. No nerve injuries occurred.
Conclusion: Brachioplasty has evolved into an art form. Strategic markings, tumescent anesthesia, contouring liposuction, and dart incisions support optimal skin excision. Awake anesthesia permits patient-assisted repositioning to refine contour and skin turgor. These advancements elevate outcomes in modern arm rejuvenation and optimize aesthetics.
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