Arms and the woman BY CONSTANCE CHEN, M.D.
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rms had their moment in early 2009 when Michelle Obama posed for her first official photograph as first lady in a sleeveless black dress. While some style critics carped that the look was too informal or out of season with the February weather, many women all over the world envied Obama's toned arms and wanted to know how they could achieve similar muscle definition. Workout and diet recommendations proliferated as millions of women went to work on their arms. Women didn't just head to the gym. Some found that weight loss and exercise didn't achieve the results they wanted and headed to their doctors' offices to inquire about a surgical fix for sagging upper arms. As we age, the skin on the upper arms loses elasticity and droops. Fluctuations in weight and heredity also contribute to this effect. While exercise can strengthen the arms and improve muscle tone, it cannot correct skin that has lost elasticity. An arm lift, or brachioplasty, can reshape the upper arm by removing excess skin and fat from the underside of the upper arm from armpit to elbow. The problem is that excess skin resection can leave unsightly scars, while liposuction alone can worsen the problem of loose sagging skin if the woman does not have enough skin elasticity. Good candidates for an arm lift are healthy, nonsmoking adults of any age who are not significantly overweight and whose weight is stable. As with any cosmetic procedure, it is important that those considering surgery have realistic expectations. The smoother, tighter contours produced by an arm lift are relatively permanent as long as weight and
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Michelle Obama’s toned arms – seen to good advantage in the Jason Wu goddess gown she wore to husband Barack Obama’s first presidential inauguration – have inspired women to take to the gym and plastic surgery. Photograph by Tech Sgt. Suzanne Day, USAF.
general fitness are maintained, though there may be some loss of firmness over time as the body continues to age. Scars from an arm lift can be significant, however, so patients need to be sure that they would like to trade an improved arm shape for a visible scar. The procedure may be performed in the hospital or on an out-patient basis, under local or general anesthesia. The number and extent of incisions are dependent on the amount of skin to be removed. They may be on the inside or back of the arm and will be placed to minimize the visibility of scars. A short-scar brachioplasty limits the scar to the armpit, but the smaller scar also makes it less effective for resecting a large amount of loose, sagging skin in the upper arm. Fat may be removed directly or treated with liposuction. Underlying supportive tissue is tightened and smoothed, then skin is replaced over the reshaped arm and secured with stitches. Physical and athletic activity will be limited for several weeks following surgery. Risks associated with an arm lift are those of any surgery, such as bleeding, infec-
tion or adverse reaction to anesthesia, as well as temporary changes in skin sensation. As with any cosmetic procedure, the driving motivation and expectations for results are unique to each individual. For those committed to maintaining a healthy regimen of fitness and weight control, an arm lift can solve a nagging problem that is otherwise resistant to change. Patients need to think carefully about the scars, however. Our goal is always to help people have the bodies they want and to improve their physical and emotional well-being. Constance M. Chen, M.D., is a board-certified plastic surgeon with special expertise in the use of innovative, natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is a clinical assistant professor of surgery (plastic surgery) at Weill Cornell Medical College and a clinical assistant professor of surgery (plastic surgery) at Tulane University School of Medicine. For more, visit constancechenmd.com.
