Arms- Contouring

Her desire is the same as her patients’—to achieve the best contour with the least invasive methods possible. 

 

Her latest journal article, pending publication in the Aesthetic Surgery Journal, describes a new method of achieving skin contraction without cutting skin out. While many surgeons use laser assisted liposuction (Smart Lipo or LAL), claiming that it tightens skin, the statistics just don’t back that up. Dr. Barry DiBernardo published an article on this, showing that while traditional liposuction (SAL) causes skin to shrink by about 13%, laser assisted liposuction causes skin shrinkage of 17%. 

 

When you have “bat wings”, both of those numbers look pretty small. Most of us who have extra skin in the upper arm region need quite a bit more skin tightening. That’s why Dr. Duncan has been doing clinical research for the Invasix company (Yokeneam, Israel)  for over three years. She is the only person in the region to have a BodyTite device. While several platforms of the device are FDA approved, the strongest performer (RFAL, or radiofrequency assisted liposuction) is in the final stages of phase III clinical trials. Dr. Duncan uses this device under Investigational Review Board oversight, and has excellent results with the BodyTite. 

 

Figure 3. Diagram of the Invasix Body Tite hand piece. This device utilizes an internal cannula with a tip that emits RF energy and suctions simultaneously, and an overlying external electrode that reflects heat into the dermis of the skin in the treatment region. An “ironing” motion is used to heat the tissue in the region needing fat emulsification and skin contraction.

 

Dr. Duncan  presented  “Finesse in Contouring the Upper Arm” recently at IMCAS Asia in Singapore. Her study showed that the use of the BodyTite device can  reduce the number of brachioplasties, or surgeries in which upper arm skin is cut out, because the BodyTite can shrink the skin of the upper arm as much as 50%. The degree of hanging skin was reduced by half in her series of twelve patients. In volunteers, temporary tattoos were placed and the surface area was measured by a computer before and after treatment. The average surface area reduction was 33.5%, a dramatic improvement over SAL and laser lipolysis. 

 

When choosing a treatment for upper arms, the recommended procedure will depend on the amount of extra skin and extra fat present. If the excess of either is minimal, Ulthera (microfocused fractionated ultrasound) might be an option. The advantage to this procedure is that it is totally noninvasive and has no down time. However, the results with Ulthera are subtle, and most patients need more improvement. If you are young, and have more fat without a lot of skin laxity, liposuction might be a good option. 

 

 

This 28 year old patient had minimal skin laxity; her deformity was mostly due to excess fat.  She was a candidate for liposuction alone.  Most patients with upper arm deformities will need more than traditional liposuction.

 

 

Goals of treatment are more than just simple fat reduction—sculpting to achieve muscle definition is important. Also—an area frequently overlooked—is the posterior arm. Many women note that when the arm is adducted, or at their side, the back of the arm bulges out in an unattractive way. By treating this area (not just the undersurface of the arm), reduction of that bulge can be achieved.  Most people don’t fit into this category. The ones seeking treatment generally have more fat and more skin laxity. 

 

 

 

 

 

                                           

 

Results: RFAL

 

This 55 year old patient had RFAL to her arms.  She had little fat, mostly skin laxity.

 

RFAL after one year.  Note the severe degree of skin laxity in the pre-op photo.  While the result is not perfect, the remarkable amount of skin tightening achieved withe the BodyTite has helped this woman to avoid the long scars normally seen with a brachioplasty.

 

 

RFAL- This year old Native American had massive weight loss of 80 lbs..  She had very little residual fat in her upper arms, but was bothered by the very loose skin near her axilla.  Because her skin type usually heals with noticeable scarring, she wanted to avoid skin excision.

 

RFAL-This 44 year old woman had very large upper arms with quite a bit of excess skin and fat.  Traditional liposuction would leave an empty, droopy skin envelope.  RFAL was performed in order to tighten skin and correct bat wings without long scars.

 

 

Brachioplasty

Note the extreme disproportion in this  49 year old woman's upper and lower arm.  She had circumferential RFAL and brachioplasty.  Note that the scar is placed so that it does not show very much.