Many patients who wish to improve the shape of their upper arms have a considerable surplus of skin. The cause can be, for example, massive weight loss, but the process of skin aging can also leave such signs. In this case only excision can produce the desired improvement in the contour. Even the most careful upper-arm tightening, however, will result in a scar on the medial side of the arm, starting in the armpit and stretching as far as the elbow.

Upper-Arm Tightening

Upper-arm tightening is requested increasingly by women over the age of 60. The only way of eliminating the surplus skin and the wrinkles in the long term is cutaneous excision. The art of the surgeon in doing this is to position the incision in such a way that it is on the medial side of the upper arm and to ensure that the resection of the skin is carried out so generously that the entire upper-arm region is tightened.

The thick skin/fat flaps are dissected off the fascia, protecting the nerves and vessels, following exact marking of the incision line. Every patient must be informed of the possibility of scarring as a result of this operation.

Aftercare is also very important. Subsequently, the scars are treated with ointment and silicone dressing.

Patients with good skin tone and minimal laxity may undergo liposuction alone but care in patient selection is critical. The majority of patients with excess fatty deposits in the upper arm do not have good skin tone and will not be good candidates for liposuction alone. Only patients with a circumferential increase in fat volume but adequate skin turgor and elasticity will be happy after lipo- suction alone. The most significant drawback to brachioplasty is theb long scar extending from the axilla to elbow. The patient must be warned about unrealistic expectations and must be fully informed about postoperative behavior, in particular about how to care for the scar.

Operative Approach

  • Surgical Planning,
  • General anesthesia with endotracheal intubation,
  • Positioning, Disinfection,
  • Fish Incision Technique,
  • Superficial Preparation,
  • Deep Preparation, Hemostasis,
  • Incision of the Dissected Dermofat Flap,
  • Fixing of the Skin Flap,
  • Resection in Stages,
  • Two-Layer Skin Closure,
  • Cutaneous Sutures,
  • Compression Dressings,

Fish Incision Technique

In appropriate cases, with this incision not only vertical tightening in the upper arm area is achieved, but also tangential tightening in the axilla. The advantage of this incision is that the scar is barely visible, and skin folds in the axilla and upper third of the upper arm can be eliminated very effectively. The scar can hardly be seen at all when sleeveless clothes are worn.

 Two-Layer Skin Closure


  • Steri-Strips are first applied as a dressing to relieve the tension on the cutaneous sutures.
  • Afterwards, sterile cotton is wound around wound dressing. In addition, the arm is
  • then loosely wrapped with elastic bandages from the wrist to the shoulder.


  • The dressing is removed on the first postoperative day. The Steri-Strips are left in place for 8 days and can be removed by the patient.
  • During this time there should be antibiotic prophylaxis and the arm should be elevated.
  • The patient should avoid physical exertion for a period of 2–3 weeks in order to permit undisturbed wound healing.
  • To prevent congestion of the lymphatics, lymph drainage can be carried out from the 3rd postoperative day.
  • In most cases, drains may be removed as early as the first day after the operation.