Operation Guide: What Happens During Brachioplasty Surgery?


Dr Bernard Beldholm

An arm lift may be an option if you have sagging arm skin after weight loss or pregnancy. This article is a step-by-step guide to help you understand how arm lift surgery works. Also known as brachioplasty, an arm lift creates tighter upper arms.

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What is arm lift surgery?

An arm lift (Medically referred to as a Brachioplasty) is a surgical procedure to remove excess arm skin. The goal is to cut and tighten arm skin to improve comfort as well as looks.

Dr. Bernard Beldholm is a specialist general surgeon that performs arm lift surgery in Australia. He has helped thousands of patients renew their bodies after pregnancy or massive weight loss in the last 14 years.

Who needs an arm lift?

Loose skin is common after weight loss. The arms, tummy, back and thighs are often affected. It is hard to hide big arms in clothing, especially in Australia’s warm weather.

If you are eager to learn how the operation works step-by-step, then skip ahead to the Operation Guide below.

Brachioplasty benefits

For patients who are bothered by sagging arm skin, an arm lift has numerous benefits. Doctor Bernard’s arm lift is designed to help you:

  • Get rid of loose arm skin and fat
  • Wear the clothes you love
  • Feel more comfortable participating in activities you enjoy
  • Inspire you to get into the gym (Loose skin no longer hides your arm muscles!)
  • Put the finishing touches on your body after diet and exercise
  • Renew your body after weight loss

If you want to know how the operation works, see the Operation Guide below.

Sounds too good to be true…What are the drawbacks?

All surgery has complications.

The main drawback is the arm lift scar. It’s a long scar. You can’t avoid that. There is no such thing as a scarless arm lift. While the scar can’t be avoided, it can be minimised with the help of a skilled surgeon.

Doctor Bernard makes sure the scar is hidden from the front. He places the incision behind your arm. That means anyone looking at you from the front won’t see the scar while your arms are down. The scar is visible from the back, or if your arms are raised. Once healed, the scar is much less obvious.

Scar fading begins at six to nine months post-op. Arm lift scar fading can take one to two years. Most scars heal nicely. However, scar healing isn’t predictable. Sometimes, a raised scar called a keloid can develop, as well as other problems. While uncommon, there is no guarantee it won’t happen.

What you can do is look at old scars on your body. Did they heal well? Unless you have a history of poor scarring, that is usually not something to worry about.

Don’t worry, the scar is hidden

You won’t see the scar from the front. Your arms will look tight and youthful. Knowing what to expect helps you decide if an arm lift is right for you.

It’s important to have realistic expectations. If you are considering an arm lift, you should know about the scar. You should feel that the benefit of fixing saggy arm skin outweighs the scar.

Are there any other drawbacks?

All surgeries have complications. You need to make sure you are aware of these and able to accept them before you proceed.

Operation Guide: What happens during arm lift surgery?

This is a step-by-step guide to Doctor Bernard’s arm lift operation with VASER liposuction.

1. Surgery prep

Doctor Bernard asks you to follows all pre-op instructions to prepare for surgery. On the day of surgery, you arrive at the hospital and check-in. A nurse greets you and takes your vitals. Next, you change into a surgical gown.

Doctor Bernard meets you to discuss any last-minute questions or concerns you might have. Then, he uses a special marker to draw on your skin.

2. General anesthesia

After the intake appointment, the procedure starts. While you lie on a comfortable operating table, an anaesthetist administers drugs through an IV. Sedative drugs make you feel sleepy. You begin to feel drowsy as the anesthesia takes effect. Your eyes will feel heavy. Your body relaxes. You drift off to sleep, with no memory or sensation of the surgery.

Anaesthetists have another important job. They also monitor your vitals during surgery. They ensure you are safe from the moment you fall asleep to the moment you wake.

3. Body positioning on the operating table

Once you are comfortably sedated, the surgery begins. The first step to a successful arm lift is making sure you’re properly positioned on the operating table. This is very important.

Doctor Bernard takes time to ensure everything sits nicely. You lie on your back, fully sedated. Your arms are placed into arm bars. The arm bars hold your arms upright during surgery. This allows him to perform liposuction and skin cutting in the most effective manner. Your hands are secured to the arm bars to make sure your arms are firmly in place.

4. Arm liposuction

Now your arms are in position. The next step is liposuction. Liposuction gets rid of arm fat. It sculpts your upper arms so they look nice and slim. It also dissects the tissue so less cutting is needed in the next step.  The benefit of liposuction is not just arm fat removal. It also frees the tissue so Doctor Bernard can avoid cutting down to the muscle. That means less tissue trauma and pain in recovery.

Liposuction is a three-step process. First, a wetting solution is applied to the tissues inside your arms. The wetting solution is made of adrenaline and local anesthetic. It helps to stiffen and isolate the fat cells. That way, the fat is more easily removed with liposuction.

Next, fat removal begins. Instead of traditional lipo, Doctor Bernard uses special equipment called VASER liposuction. VASER is a cutting-edge technology that breaks fat cells apart with ultrasound energy.

Breaking fat apart makes it easier to remove. Older forms of liposuction manually break up the fat in an aggressive back-and-forth motion. This causes more pain and swelling in recovery. Instead, VASER uses gentle ultrasound energy to loosen fat cells. Fat is removed with gentler suction, compared to traditional lipo.

VASER technology also removes fat closer to the skin surface, according to the manufacturer. In Doctor Bernard’s experience, it provides a better result than other liposuction machines.

Finally, traditional liposuction is performed to suction out the remaining arm fat. Your arms look much slimmer at this stage.

5. Marking your skin

A special marker is used to mark your skin. These markings help Doctor Bernard plan the incision. This ensures the arm lift scar is a neat, straight line. This step is very important. Since all surgery leaves a scar, it is essential to make the scar as attractive-looking as possible.

Once your skin is marked, Doctor Bernard knows how to cut the excess arm skin during the operation. This step must not be rushed. While skin markings are made before surgery begins, they need to be adjusted after liposuction removes the fat.

6. Double-check that everything is correct

Doctor Bernard trials the incision closure. This is done with surgical clamps. The clamps hold your skin in place so he can see what your arms will look like once the loose skin is removed. While placing the clamps, he feels where the muscles and underlying tissues lie. The goal is to remove the exact right amount of skin — not too much, not too little.

7. Cutting off the loose arm skin

Next, Doctor Bernard cuts off the excess skin. Thanks to VASER liposuction, the underlying tissue is pre-loosened for easier cutting. The incision must not go too deep. The cut should be just deep enough to get under the skin. The skin is trimmed away from your elbow to armpit.

“There is a fine line between taking too much [skin] and not enough. [Upper arm skin] tends to loosen a bit within the first six months of recovery, after the swelling comes down. As a surgeon, you need to expect that. You need to cut and close the incision a bit tighter during the operation [to account for it],” he explains.

“However, if you make it too tight, you won’t be able to close the skin and that’s a disaster. You end up [needing] a split skin graft. It will never look the same ever again. So it’s really important to get this step correct. Make it tight, but not too tight. The other thing is if you make it too tight, then you’re going to potentially have issues with blood supply to the arm and other [areas]. So this is a really, really important step of the operation”.

8. Closing the incision

Finally, your loose arm skin is gone! The next step is closing the incision. Keep in mind the wetting solution makes your arms look swollen at this stage. This is temporary. Once the fluid dissipates, the skin loosens up a bit. Therefore, the incision closure should be tight initially, but not so tight that it create a problem later.

Choosing the correct sutures is also important. “Sutures” is another word for “stitches”. Doctor Bernard uses deep, permanent sutures and superficial absorbing sutures to close the arm incision. All sutures are durable and high quality.

9. Repeat all steps on the other arm

Now one arm is complete. It is time to repeat the steps on your other arm. The arm lift surgery time is one to three hours. Some arm lifts take longer than others. It depends how much loose skin you have. If you are having another procedure at the same time, the operation takes longer.

Can arm lifts be combined with other cosmetic procedures?

Yes. After massive weight loss, many patients have two skin removal procedures at the same time. This saves money on hospital fees. There is only one recovery period.

Combined procedures are safe in many cases. For example, you might want an arm lift with abdominal liposuction or breast work. However, there are limits to the types of procedures that can be done safely at the same time. Doctor Bernard explains what can and cannot be done during your consultation.

An arm lift with breast work is a popular choice. For women, a breast lift helps to fix sagging breasts after breastfeeding, pregnancy or weight loss. Breast implants can also be added to restore volume to deflated breasts.

Some men can benefit from an arm lift and chest surgery. Some patients have gynaecomastia, a common condition that causes enlarged male breasts or “man boobs”. An arm lift with gynaecomastia surgery provides an attractive upper body. After major weight loss, some men need a chest lift to fix loose chest skin This can also be added to your arm lift surgery.

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30 Belmore Rd
Lorn NSW 2320


This website contains adult content. You must be 18 years or over to read. All surgery carries risks. You should seek a second opinion before proceeding. Results vary from patient to patient. See our disclaimer.
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