What Can Be Done For Bat Wing Arms? The Truth About Arm Lift Surgery

Dr. Houssock (00:04):
You are listening to another episode of Perfectly Imperfect. Good morning.

Danielle (00:09):
Welcome to the podcast.

Dr. Houssock (00:11):
Oh, yay. Hey, hold on a second. That means you've been on too much. If you start to know exactly what I'm going to say next. Well, I'm sorry, but you're the best one to talk about with a lot of these topics. So you might as well just be a co-host. You want to be a co-host?

Danielle (00:25):
No, I love you all, but.

Dr. Houssock (00:27):
Okay. Well, she just welcomed you to the Perfectly Imperfect podcast. We are going to be talking about something that might seem small but is actually kind of a busier part of our practice. And really that is just the arms. When it comes to the body, we do a lot of body contouring, most people think about the tummy, they think about even breast surgery, sometimes the thighs, but the arms would probably not be one of the things that people think about the most, but that's not the case in our practice lately, has it been?

Danielle (00:59):
We've seen a big uptick in patients asking for stuff for their arms, for contouring. What can we do about their arms? Yep.

Dr. Houssock (01:05):
Yeah, really cool. And I think there's a couple of reasons why that is. One of them is we are obviously in a weight loss boom in America, at least with the advent of more accessibility to weight loss medications, patients are really able to control something that they haven't maybe been able to do in a long time, and that's their weight. And while there are so many positives to the concept of weight loss, especially in patients who are obese and have multiple medical problems from it, there are some unfortunate downsides to losing weight. And it's so hard to say it that way, but it kind of is because the one thing that does sometimes happen more often than not, especially when you have a lot of weight loss, is that you can be left with excess skin. The skin doesn't necessarily bounce back. It does in some parts of the body better than others and in some patients better than others. But there is definitely a subset of patients who suffer from having excess skin in multiple parts of the body after a significant weight loss. Interestingly, that number is not equal male to female For whatever reason, it seems that more women suffer from excess skin in the upper arms than men.

Danielle (02:19):
We just had this conversation too, a couple of weeks ago, we were saying we see a lot of men that have had significant weight loss and for some reason their arms are not a problem area.

Dr. Houssock (02:29):
They snap back. And so that actually leads me to the first point of that where some patients will come in, they'll say, look, I've got this skin. They usually don't come in for this alone either, and we'll get into that. Most of the time they're actually coming in for something else and they mention the arms. Some people arms are their priority, but not often. But the women will say, we'll, finish up our consult on something else, and they'll say, now what do you think about this? Is this just I got to go to the gym? And that's exactly how they'll say it. And I'll say, Ooh, I mean I guess technically speaking, if you had massive biceps, you could probably fill some skin.

Danielle (03:01):
Right. Makes sense.

Dr. Houssock (03:01):
So maybe that's why our guys are able to not have to be as concerned about excess skin there. I don't know. I think in some ways it probably just has to do with how we carry our fat and when we gain fat, we gain it in our arms and when we lose it, we lose it there and our skin just doesn't snap back the same as men. But obviously if muscle can take the place of some space, but it's not going to get rid of all the excess skin just isn't going to happen. So that's really unfortunately just one of the downsides of weight loss. And this has been studied, and I tell patients this all the time in consultation, that removing or this excess skin actually has been studied and shown to increase your chances of keeping your weight off. So there's a real medical reason.

(03:44):
Obviously we think about aesthetics in our practice quite a bit, but I always go back to the fact that in some ways we're doing more than aesthetics. There is a lot of function and it's scientifically proven that patients will keep their weight off at a higher rate if they have excess skin excised. That's where this whole arm thing comes in. And I wish that it wasn't a problem for patients, but it is. And so because of it, we see a lot of it. How do we go about it Danielle? When they call you or email you for a consultation, how does that conversation go from the beginning?

Danielle (04:16):
Usually I will ask them about what we were just talking about. Has it been a weight loss thing or is it just a small problem area that bothers them? I will usually give a patient both. I will give them information about both and obviously we'll talk about both the full brachioplasty excision versus something that we have called the BodyTite. So I'll usually give them information about both and just see, I tell them that you'll definitely walk through options with them when they come in for the consult and see what they're a good candidate for.

Dr. Houssock (04:44):
Unfortunately, up until very recently we only had excisional options. People want to hear that there's some nonsurgical magic and there are some lasers that can tighten skin and maybe increase collagen. And we love Morpheus8 for instance, for the face and areas that are, I would say smaller and there isn't significant laxity, you can see a little bit of texture and tone improvement with things that are nonsurgical. But unfortunately still to this day, there's really not a great option that's nonsurgical. There is a less invasive option. But again, just like every other thing we talk about when we talk about options, it's never going to give you the result of excisional procedure. The real downside to the brachioplasty for most patients is that incision and the scar because no matter what you do, you're going to have a scar from elbow to armpit and oftentimes down the chest wall. So there is a group of women again that Danielle and I see where the amount of laxity they have is just not worth that incision and it makes perfect sense and we pretty much know what patients that's going to be. But there's also that subset where they have so much skin at this point and some people will call it bat winging, so much extra skin that they are absolutely willing and happy to trade that scar to get all that skin excised.

Danielle (06:03):
And they're always, always happy afterwards, even with the incision there. Before and after, even at six weeks out, all of those patients are thrilled with their decision to do the brachioplasty.

Dr. Houssock (06:14):
A hundred percent, a hundred percent. And it's funny, really that's hard to say when you talk about results and how patients are going to be, but they really are happy patients because we are straight up removing the excess skin and they buy onto that incision, they buy onto the fact that they're going to have that. And because of it you leave the OR with a smaller arm. I mean there's just no other magic than that. But we harp about that in the consultation that there's going to be a permanent scar. And while I always say we maximize your result the best we can, I use my proper technique in the OR, we teach you how to take care of it. We have you use scar gel, it's still going to be a scar. It will not be invisible. Where I place it is not very easy to find unless you're literally lifting your arms like this.

(06:58):
Even when you hug somebody, it's not really obvious. So you'd have to really be lifting your arm up this direction to see it. It's not very out in the open. And also it does get better with time. So in the very early stages it could be bright red and obvious and it does lighten over time. But the truth about an incision in an area that is constantly moving is that it cannot be perfectly linear, invisible. There are parts of the body we do, for instance, the breast where you're not really moving that part of your body, but the arms are, we literally live with using our arms. So it's just impossible to keep that from having some type of tension on it. And that is why it's one of the areas of the body that we pretty much say makes some of the least pleasing scars because you have to use your arms. You literally can't be like this for six weeks. It's just not possible.

Danielle (07:47):
And we do, we tell every patient that and they still, no matter how they heal or how red they might be, they're still happy with it.

Dr. Houssock (07:55):
Always, always, yes, it's the one spot, but I think it is our education on it.

Danielle (07:59):
I show lots of photos.

Dr. Houssock (08:02):
Sure. And that's important. Photos of our patients. I always say not like some random patients from the internet, but our patients and as long as they buy onto that, they really do have great outcomes. The way that we do our brachioplasty, we do typically, unless you are exceedingly thin, we do combine it with some contouring, liposuction because when you do lose weight, you may still have some remaining in other parts of the arm that we're going to remain. So I will contour the remainder of the upper arm in addition to releasing the tissues where we are going to be excising. And I think that's just important because we're thinking about overall contour. I feel the same way about abdominoplasty. We're looking at you as a whole cylinder. And so yes, you've got this hanging skin here, but what about this area? We might as well just while we're in there, contour that a little bit and that's what we'll do.

Danielle (08:50):
Question about that because just I know people ask...Any reason you would ever cross here? I know we have patients that will ask that. What about this part of my arm?

Dr. Houssock (09:00):
Yeah, it depends on the patient. I mean some people literally do have hanging skin coming down to the mid forearm. There are pros and cons to doing that if you need it. I think it's reasonable to do. However, it's important to know that it's crossing a joint and anytime we cross a joint, you always have risk of scar contracture and pain and difficulty with moving that joint. So I don't take that lightly. So the answer is I will just like I'll cross the armpit to go into the chest wall. I will do it if it seems to really improve the outcome. That's what I would say. That's basically how we do it. And then the recovery isn't really that difficult in the sense that it's not, I wouldn't say the most painful procedure we have. However, what makes it difficult is it's your arms. You have to be careful using your arms for four to six weeks. And so obviously you can't keep them still, but you have to be very gentle with them and be careful with your recovery. So just like anything else, you need to be able to give yourself the time to recover to maximize your results.

Danielle (09:56):
And is there any surgeries that you wouldn't combine with the arms at the same time for a brachioplasty?

Dr. Houssock (10:03):
Probably for me it's thighs just because I want you to have some limbs. You could really could do anything else. You could do breast with the arms. A lot of our patients do breast and arm at the same time. Makes total sense. They'll do arms with tummy, but I don't like doing arms with thighs because then I feel like I'm literally taking you out of commission. To get out of a chair, you have no limb to really use properly and it's just going to set you up to have a complication. So that's the only one I can think of that I wouldn't do it with.

Danielle (10:29):
And I cut you off. I know you were getting ready to mention the drains. I heard you say that.

Dr. Houssock (10:33):
Oh yeah.

Danielle (10:33):
So recovery with the arms.

Dr. Houssock (10:34):
Yeah, I mean you do get drains for this, but they're in for about a week. It really just, honestly, it just helps a ton with swelling. We do the liposuction, so because of that we add fluid to your upper arm and the arms swell. All of our patients come and their fingers are swollen, their forearms are swollen. So I try to minimize the swelling by having that drainage, but it's not like it's a huge pocket that's filling. It's just there's a lot to it. And because of that, I think it speeds up your healing. I don't think patients really complain too much about their discomfort actually.

Danielle (11:05):
No, no. The garments are our lifetime struggle for perfect garments.

Dr. Houssock (11:08):
Yes.

Danielle (11:10):
That's usually really the patient's biggest complaint usually is having wear the garment or uncomfortable or can't wait to be done with the garments usually.

Dr. Houssock (11:17):
Totally, totally. I would say we have the best arm garment that we've had that we've tried 'em all, but the one we have right now is a combination where it's almost like a crop top and it has the arms and the whole body. Because one of the biggest complaints is the digging at the armpit and the ones we used to use would end there and it would dig. And so now I think we might be as close as we've been to getting the best garment for arms.

Danielle (11:41):
Now the only complaint is where it comes down to here, but that's not really where the incision is. So

Dr. Houssock (11:47):
Never ends.

Danielle (11:47):
We're getting there.

Dr. Houssock (11:48):
That being said though, I do actually, this is a somewhat new technique of mine that I wasn't doing before, but I am doing now, I actually do put all my brachioplasties from the OR into ACE wraps. I want them to be very, very controlled in the sense that I want 'em to be padded. I want to be able to control my compression right out of the OR. So I actually do send you home from surgery in ACE wraps and then I take them down at 48 hours and then I put you in a nice garment at 48 hours. That's been so good because with all the pads that I like to use, it was really hard to get you in the garment properly and get the padding to stay. Val would probably tell you my nurse in the OR that that's been a game changer is putting them in the ACE wraps. Alright, so let's say the other patient comes in, no way. I don't want that scar. What are we doing?

Danielle (12:41):
We're doing BodyTite, BodyTite with liposuction.

Dr. Houssock (12:44):
So tell the story that I always tell Danielle about how we didn't have anything and this thing came around.

Danielle (12:50):
We didn't, we didn't the same when we talk about it with every patient that has a little bit like even in the upper back or the jawline for face. So FaceTite, BodyTite, we had nothing in between. It was either a facelift, it was arm lift, upper back lift. There was nothing for those patients that just had a little bit but also still needed some skin tightening. They couldn't just get away with liposuction. And then this machine came along and it's really been a game changer

Dr. Houssock (13:15):
Really. Totally. And so it is still done in the OR it uses radio frequency energy and it breaks the collagen bonds in a controlled manner that is able to allow the collagen to then realign and then it tightens and it's really cool. A lot of this stuff has to be done properly, it has to be done safely, but when done right, it really can create a really great result. Now it will not create a brachioplasty result. As far as all the body parts that we use, this BodyTite machine, I would say that it's equivalent in the arm to how it does in the jawline. Those two areas and the upper back are so nice with this machine in the arm. How it works is I will make a small incision at the elbow. I will place some tumescent fluid, which is the numbing fluid in the arm, and then I use the BodyTite machine.

(14:07):
It will tighten the skin that we have that is lax. And then after that it will also, while it's doing that, it also melts any additional fat you have. Once I'm done with the BodyTite, I then go in and I contour liposuction the rest of the arm, including the area where we were working. It makes a great result in the right patient, in the right patient. We'll be very honest about whether you're a candidate. If you have so much laxity that I think that it's not going to be worth your while, I'm always honest about that. In that patient population, I'd say you're better off just either doing nothing at all or you go for the brachioplasty because the result you're going to get from the BodyTite won't be worth the investment. But a lot of patients just have a little bit, it's not even weight loss patients with this.

(14:45):
It's oftentimes very healthy women. Again, I think it's probably has to do with our hormones and as we age, but some of the areas that we, even in the fittest women will find that we have skin laxity is in the upper arm, the area right above the bra line here, the upper back. And these are all areas that literally have nothing to do with weight loss. Just like time, literally time. No drains with the BodyTite, still wearing a compression for six weeks, obviously very small incision. So you don't have to be worrying about scarring. Recovery time, I usually ask you to not do any heavy lifting, heavy sweating for two weeks with the BodyTite. It's four weeks with the brachioplasty. So for obvious reasons, when you have a bigger incision, I ask you to wait longer to do your activity. Both procedures take time to see your full results, but I would say the brachioplasty is pretty obvious pretty quickly. Whereas the BodyTite takes more time, you'll see an immediate result that's improved. It really does take six whole months to see the full ability of what that BodyTite can do.

Danielle (15:45):
And we do see that. We watch you closely and take photos over months time and we definitely see a progression.

Dr. Houssock (15:52):
Yeah, totally. Totally. And it's just like a patience thing. And it has to do with that collagen. As the collagen tightens, those bonds realigned, it gets tighter and you can really see that.

Danielle (16:01):
Can you think of anyone that was a good candidate for the BodyTite did it, and then ended up wanting a brachioplasty that they weren't happy with the BodyTite? I couldn't think of anyone either. Yeah,

Dr. Houssock (16:10):
No, no. It's vetting patients, making sure that they're choosing the right thing, but also it's expectations. Again, if you're expecting a brachioplasty result, then you're not going to be happy with BodyTite. But if you're expecting an improvement, it definitely can do that.

Danielle (16:24):
And I always tell patients, and I think your Instagram is linked on here under your highlights, there is a one called SkinTite. And I always tell patients to go look at that because there's actually videos of you doing the procedure if they're okay watching it. And then you can see the immediate result in the video and it's pretty impressive I think.

Dr. Houssock (16:42):
Yeah, it's really cool. It's really cool. We love it. And again, we love it for multiple parts of the body, but I would say one of the hardest scars to sell is that brachioplasty scar. There's an entire population now that could be benefited by this nonsurgical treatment. I call it nonsurgical, but it still is surgical. You're still in the OR I would say less invasive surgical treatment that we've been really thrilled with. And that's the other side of it too, is I really can't think of somebody who's been disappointed with that result.

Danielle (17:10):
No, I can't either. I can't either. I was trying to think. There's been a few patients we've done just the Morpheous8 on that had just the tiniest, tiniest bit and they've been happy with that too. But that's a smaller population of patients. But I think we just do a good job about really educating the patients I really do. And expectations.

Dr. Houssock (17:28):
I agree. I don't think we're doing magic here. I think we're doing good surgery here in our practice, but I genuinely feel that the reason why we can say we don't see a lot of disappointed patients has nothing to do with the fact that I'm some type of magician. It's really about,

Danielle (17:43):
I mean, you're pretty good.

Dr. Houssock (17:44):
Well thanks. But it's also from the minute that they start communicating with you, we set expectations. We are very honest. The one thing that I can guarantee you that you're going to get from Danielle and I is honesty that in a world of crazy marketing and social media and flashing lights and fireworks, you really, in the end, don't really care about all that in the end. What you care about is what you're really going to get for your money and your investment and time. And we know that because we're consumers too. So honestly, it's just been a very natural and organic pact that we're always going to be that way with our patients. And

Danielle (18:24):
It's easy,

Dr. Houssock (18:24):
It' is so easy.

Danielle (18:24):
When you're honest and we're not trying to sell you on anything. And I hear you say that a lot in a consult for different things too. I'm a surgeon. If I'm telling you not to do a surgery, you're a better candidate for something non-surgical.

Dr. Houssock (18:38):
We're lucky in our practice to have all the options. We're very blessed to have a full service medical spa that we can send you to amazing injectors and laser technicians that are very good. And I say that because we are their patients too. And so I have that ability and if I think that's better for you, I'm going to send you there, and vice versa. When you're in their chair, and this just happened truly organically, I didn't sit around a round table and say, listen, everybody, we're going to be an honest practice.

Danielle (19:06):
Right?

Dr. Houssock (19:06):
It wasn't like that. It wasn't like, listen, just so you know, we're not trying, we've just organically created this environment here. And so when you come to see our injectors, it's the same exact thing. If they feel they can help you, they're going to be honest and help you. And if they can't, they're going to be honest about that and they may send you our way, they may send you our way if you're interested in hearing about the surgical options. But you can rest assured if you walk into our practice, it may not be what you want to hear, but it's what you should hear. That's what you're going to get. And I think that's very important in the end. Sometimes we want to be told magic, but in the end you're just going to be disappointed.

Danielle (19:45):
And that's the last thing we want, disappointed patients for sure.

Dr. Houssock (19:47):
No, absolutely not. Because you know what? Your disappointment is our disappointment. We love happy patients. We say that all the time. One of our biggest goals is to make you happy. So we're on the same page there, but we can't make you happy if your expectations are beyond things that we can meet.

Danielle (20:02):
The cost difference obviously is different. And that's all on our website. And if anyone has questions, always feel free to email me and I can certainly give you that information.

Dr. Houssock (20:10):
Oh. I know something that people ask about the BodyTite, they'll ask, how many is it one and done? And I do say yes, unlike laser therapies, which are often multiple BodyTite is a one and done. But I always use the caveat that you're going to continue to age. I would anticipate a good five year result from BodyTite, maybe more. But I would say the reason why I don't say more than that is because you are going to continue to age after it. I don't stop you in time.

Danielle (20:35):
That's true.

Dr. Houssock (20:36):
Things can return depending on the reason that you need it, you may not have as a significant need in the future. But I would say it does get you a result that does not require multiple treatments. It's not meant to be a multiple treatment option. Whereas our lasers you'll often see will say they're a package of three. That is not the case for BodyTite. Alright, carry on, Danielle.

Danielle (20:58):
Yes, carry on.

Dr. Houssock (21:01):
Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic medicine. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEVplasticsurgery.com or follow us on Instagram @DrCareHoussock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, Apple Podcasts, Spotify, or wherever you'd like to listen to podcasts.