Brachioplasty for Patients with Loose Arm Skin Due to Ageing

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Dr Bernard Beldholm

As you age, your skin loses elasticity, becomes thinner, and begins to sag. Other age-related internal and external factors, such as muscular changes, weight loss and decreased body volume, and sun damage, contribute to skin laxity. An arm lift surgery (brachioplasty) incorporated with VASER liposuction is the ideal remedy for loose arm skin in older patients.

Have you noticed a significant amount of skin laxity on your upper arms that wasn’t there a few years ago and won’t diminish with regular exercise or resistance training? If so, I would like to recommend Brachioplasty (Arm Lift Surgery).

surgical treatments for aging skin on the arms
Surgical treatments for aging skin on the arms

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The human skin tends to lose its elasticity as a person ages. It also loses its ability to retract, increasing the chances of developing skin laxity. I’m Dr. Bernard Beldholm, and today I’ll explain these skin changes and how arm lift surgery (brachioplasty) can address the loose skin and excess fat in your upper arms.

How Ageing Affects the Arms

reduced skin elasticity on arms due to aging
Reduced skin elasticity on arms due to aging

As we age, our skin becomes more fragile and thinner. Depending on various external and age-related factors, the underlying tissues also gain or lose volume. For instance, a sedentary life and sun exposure can cause poorly defined or asymmetrical upper arms. Below is a deeper look into how ageing affects your arms.

Skin Atrophy

Skin ageing over time | Dr Beldholm
Skin ageing over time | Dr Beldholm

If you compared your skin as it was when you were younger to your skin as it will be when you are older under a microscope, you would likely notice huge differences. One key difference is the thickness of the dermal-epidermal junction. When you are young, your dermal-epidermal junction is thicker and begins to thin as you age.

You also might have notice decreased skin elasticity as aged skin tends to be less hydrated and drier compared to younger skin.

Another difference between young and aged skin is that older skin has fewer fibroblasts and keratinocytes. These cells produce new collagen and repair the epidermis, respectively.

Over time, these factors progressively weaken the skin, making it more fragile. This contributes to the sagging appearance often associated with ageing.

arm skin tightening after weight fluctuations
Arm skin tightening after weight fluctuations

Muscular Changes

Muscular changes are predominant as people age. A study by the National Library of Medicine shows that, “[w]ith age, muscle strength and endurance are notably decreased. The decrease in muscle strength is secondary to a diminished muscle mass and protein production. The cross-sectional area of type I and type II fibres decreases with normal ageing, and the relative distribution shifts to a slower profile.”

For people over 65, they lose about 40% of their muscle mass, and fatty tissue replaces it. Furthermore, the skin losing its elasticity doesn’t help with the sagging.

arm lift removes excess skin after weight loss
Arm lift removes excess skin after weight loss

Thinning of the Subcutaneous Layer

The subcutaneous layer is a fat layer under the skin surface that provides padding and keeps it firm. As you age, this layer thins, losing its ability to keep the skin intact. The result is a slack and saggy appearance in the upper arm areas.

Changes in Body Fat Distribution

With age, body fat distribution shifts, often leading to increased fat accumulation in the upper arms and decline in muscle mass. This change can result in a sagging appearance and less defined contours. The loss of lean body mass, particularly in the arms, is intensified by sarcopenia, an age-related progressive loss of muscle strength. 

how arm skin responds to hormonal changes
How arm skin responds to hormonal changes

Hormonal Changes/Menopause

Additionally, hormonal changes, particularly a decrease in oestrogen levels in women, can exacerbate fat redistribution and decrease elastin production, making it harder to maintain a toned appearance. 

Oestrogen levels in women decrease as they approach menopause. This hormone plays a vital role in promoting and maintaining skin health. A study by the National Library of Medicine shows that, “[m]enopause occurs in women as they age. Because of the decreased release of (o)estrogen, menopause may cause a variety of alterations in lipid metabolism. These alterations impact the basal metabolic rate and include increased fat mass and decreased fat-free mass.”

This is also evident in patients who choose to undergo hormone replacement therapy (HRT). These women report better skin elasticity, hydration, thickness, and increased collagen production.

Oestrogen hormone replacement therapy aims to improve your overall skin health, while Brachioplasty is here to address saggy skin and excess fat.

Slower Metabolism

Furthermore, your body’s metabolism slows down as you age despite healthy eating and exercise habits. A study published in the National Library of Medicine explains that, “[s]tudies have shown that fat mass increases and muscle mass decreases with age. However, it is unclear why such changes occur. Resting metabolic rate (RMR) and substrate oxidation rates have been examined with ageing. It has been proposed that reductions in RMR and fat oxidation may lead to changes in body composition. Alternatively, changes in body composition with ageing may lead to reductions in RMR.”

arm skin elasticity as we build muscle mass
Arm skin elasticity as we build muscle mass

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Less Elasticity with Major Weight Loss

Significant weight loss is the number one cause of sagginess in the upper arms for all ages. However, when you are young, your skin is elastic and contracts with the body changes.

This is not the case when you get old. Older skin has less elasticity and minimally contracts. 

Long-Term Sun Damage

Sun exposure is cumulative therefore, the older we get, the longer our skin has been exposed to the damaging rays of the sun. Long-term exposure to these rays degrades the skin’s elastin fibers and collagen. This results in your skin losing its elasticity and strength.

Your upper arms are among the areas exposed to the sun the most. Therefore, they are more affected and weakened, leading to sagginess.

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How Brachioplasty Surgery Rejuvenates Ageing Arms

Brachioplasty surgery is an ideal solution for sagging upper arms caused by aging. Here’s how the procedure is performed:

You will be placed under general anesthesia during the body contouring surgery. I will begin the surgical procedure as your FRACS surgeon by performing VASER liposuction on the arms. After removing the excess fat, I will pinch the skin to assess the extent of loose skin and then remove it accordingly.

Excess skin and fat removed from arm | Dr Beldholm
Excess skin and fat removed from arm | Dr Beldholm

Special Considerations for Mature Arm Lift (Brachioplasty Surgery) Patients

As much as I recommend Brachioplasty surgery, it is not for everyone. That’s why it is important you book an appointment with me to determine if you have the ideal patient profile. Here are some factors that we’ll consider during our consultative session.

Realistic Expectations 

Even though an arm lift procedure tighten skin and improves the firmness of your upper arms, you shouldn’t expect them to look like they did in your 20s. The procedure does not stimulate collagen production for younger, youthful skin.

Risks and Complications for Ageing Patients

We’ve established that self-skin rejuvenation decreases with age. Therefore, older brachioplasty surgery patients are at a higher risk of developing wound-healing complications, such as skin infection. Furthermore, older skin has poor molecule adhesion, which slows down healing.

Wound healing happens in stages. In the proliferation stage, keratinocytes are produced to cover the mucosal and dermal wound surfaces, creating an epithelial environment. As you age, the production of keratinocytes reduces, increasing the risk of surgical complications. Another phase is the tissue remodeling stage, where collagen plays a crucial role.

Medical conditions, such as diabetes, can increase the risk of developing wound-healing complications. This is why we’ll consider these factors during our consultative session to determine if you’re an ideal Brachioplasty patient.

Complications in Younger Patients vs Older patients

Arm lift surgery complications, such as seroma, infections, and poor wound healing, can also manifest in younger patients. However, if we are to compare identical patient profiles for a young and older person, the risk of developing complications is higher in the latter.

As your surgeon, I am responsible for minimising procedural risks and complications. If you’re a smoker you do not qualify for the surgery unless you quit.

General Health and Anaesthesia

lose arm skin after losing weight
Loose arm skin after losing weight

It is important to be in good health when undergoing surgery. Common age-related medical conditions, such as clogged arteries and increased blood pressure, increase the chances of developing these complications.

Therefore, before we plan your surgery, I will have to ensure you are in good overall health. I will also examine your medical history to determine if you are the ideal arm lift surgery patient. It is important to note that this applies to people of all ages. 

Assistance Following Procedure

We’ll proceed with the arm lift surgery once we’ve established that you are a good candidate for the procedure. You should expect to spend a night or two post-surgery as we observe how your healing process rolls out. If there are no issues, we’ll discharge you, and you’ll need assistance.

The procedure will limit your arm mobility, and you’ll have to refrain from doing many activities for a while, such as driving. This means you’ll need someone to drive you home, to our follow-up appointments and other personal errands.

Furthermore, you’ll need home assistance. Before your upper arms heal completely, you’ll need someone to help you with many day-to-day activities, such as cooking and cleaning.

upper arms immediately showing results from healthy exercise habits
Upper arms immediately showing results from healthy exercise habits

Lifestyle Changes

After your upper arms completely heal from the surgery, you’ll need to incorporate healthy habits, such as exercising, into your lifestyle. Your top priority should be maintaining a stable weight. You can adopt natural remedies and practices to help you maintain a stable weight and lead a healthy lifestyle.

Watch what you eat to prevent fatty tissue or fat cells from reforming your upper arms. Adopt habits such as eating a balanced and healthy diet and regular exercising to avoid weight gain. Please avoid any strenuous exercise at all cost during recovery. We’ll discuss this in depth during our consultation session and follow-up appointments.

Brachioplasty Complications

Widened out scar
Widened out scar

With brachioplasty surgery comes a certain set of risks, with one of the most common being unsightly scarring, which can vary in severity from patient to patient. While some may experience minor scars, others may develop keloid scars that are raised, darker, and more pronounced. Additionally, excessive bleeding, infections, wound healing problems, and pain are common risks that patients must be prepared for.

Awareness and preparation for these potential complications are crucial for anyone considering a brachioplasty procedure.

Surgical Scars in Older Patients

Arm lift surgery, similar to any major surgery, will leave a scar. The good news is that this scar tends to fade quicker in older patients, provided the incision made is allowed to heal completely. This is because of reduced inflammatory response that limits the development of hypertrophic and keloid scars. I will also place the incision on the back of your arm to reduce scar visibility.

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FAQs

Is It Safe for Older Patients to Have Other Body Contouring Procedures During an Arm Lift?

Having multiple body contouring surgeries at once increases the risk of developing complications, whether old or young. I advise my patients to wait at least three months before they consider getting another body contouring procedure.

Will I Need to Wear a Compression Garment After an Arm Lift (Brachioplasty)?

Yes. Compression garments promote healing by preventing blood clots and improving blood circulation in the affected area. They also lower the risk of developing excess fluid build-up (seroma), reduce swelling, and help the affected arm muscles adhere together.

Should I Have an Arm Lift Before or After I Have Lost Weight?

I advise my patients to wait until they have attained their goal weight before considering brachioplasty surgery. This ensures that your body is stable and noticeable results will be long-lasting. 

What Is Extended Brachioplasty?

Extended Brachioplasty is a more invasive procedure that addresses skin laxity and excess fat in areas other than your upper arms. The surgery involves removing sagging skin from your armpits, chest, and inner arm. The result of an extended upper body lift surgery is a better appearance of your underarm, upper arm, and lateral chest wall.

Can I Use Private Health Insurance for An Arm Lift (Brachioplasty Surgery)?

Yes. If your condition is deemed medically necessary, your insurance may cover the procedure, however, it depends on whether your situation qualifies for the strict necessary criteria. A medically necessary condition poses a life-threatening risk or hinders the body’s normal functioning. However, insurance will likely not cover your procedure if it is performed strictly for cosmetic reasons.

Dr Beldholm’s Final Thoughts

Dr Bernard Beldholm consulting with patient
Dr Bernard Beldholm consulting with patient

Brachioplasty for patients with loose arm skin due to ageing offers a transformative solution for anyone struggling with physical discomfort and loss of self-esteem due to loose arm skin. This procedure not only enhances physical appearance by removing excess skin and fat, but it also improves functionality and allows you to embrace your body at any age. 

If you’re ready to take this step, please contact us and book a consultation. We will discuss every detail of this procedure, assess your suitability,  and schedule surgery at your convenience. 

References

  1. Siparsky, P. N., Kirkendall, D. T., & Garrett, W. E., Jr (2014). Muscle changes in ageing: understanding sarcopenia. Sports health6(1), 36–40.
  2. St-Onge, M. P., & Gallagher, D. (2010). Body composition changes with ageing: the cause or the result of alterations in metabolic rate and macronutrient oxidation?. Nutrition (Burbank, Los Angeles County, Calif.)26(2), 152–155.
  3. Motlani, V., Motlani, G., Pamnani, S., Sahu, A., & Acharya, N. (2023). Endocrine Changes in Postmenopausal Women: A Comprehensive View. Cureus15(12), e51287.
  4. Nisi, G., Giardino, F. R., Giudice, M., Fasano, G., Cuomo, R., & Grimaldi, L. (2022). The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures. Journal of clinical medicine11(17), 5038.
  5. Chowdhry, S., Elston, J. B., Lefkowitz, T., & Wilhelmi, B. J. (2010). Avoiding the medial brachial cutaneous nerve in brachioplasty: an anatomical study. Eplasty10, e16.
  6. Lockwood T. (1995). Brachioplasty with superficial fascial system suspension. Plastic and reconstructive surgery96(4), 912–920.
  7. Strauch, B., Greenspun, D., Levine, J., & Baum, T. (2004). A technique of brachioplasty. Plastic and reconstructive surgery113(3), 1044–1049.
  8. Hurwitz, D. J., & Jerrod, K. (2010). L-brachioplasty: an adaptable technique for moderate to severe excess skin and fat of the arms. Aesthetic surgery journal30(4), 620–629.
  9. Knoetgen, J., 3rd, & Moran, S. L. (2006). Long-term outcomes and complications associated with brachioplasty: a retrospective review and cadaveric study. Plastic and reconstructive surgery117(7), 2219–2223.
  10. Aljerian, A., Abi-Rafeh, J., Ramirez-GarciaLuna, J., Hemmerling, T., & Gilardino, M. S. (2022). Complications in Brachioplasty: A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery149(1), 83–95.
  11. Nguyen, L., Gupta, V., Afshari, A., Shack, R. B., Grotting, J. C., & Higdon, K. K. (2016). Incidence and Risk Factors of Major Complications in Brachioplasty: Analysis of 2,294 Patients. Aesthetic surgery journal36(7), 792–803.

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