Known technically as Brachioplasty the procedure is undertaken when liposuction alone is insufficient to deal with the problem of unsatisfying excess tissue in the upper arm. This is commonly found (and unkindly called “batwing”) in the aging person, more often female, and in persons who have lost weight either by dieting or bariatric surgery. Further reduction in weight might reduce the volume of fat in the dependent posterior tissues of the upper arm but will not remove the loose skin itself which continues to hang down when the arm is raised.

The surgical treatment is aimed at reducing the dependent tissue. When this is slight it may be possible to make a transverse or elliptical incision in the armpit (axilla) and after liposuction draw up the posterior arm skin, excise the redundancy and suture. This will only be possible for lesser amounts of redundant skin.

Where a larger amount of skin needs to be removed, this may be preceded by liposuction of the arm, removing excess fat, and possibly also going into the posterior axillary region where the fat is likely to have extended. A long incision is made almost from elbow to axilla (sometimes if the quantity of tissue dictates the incision is carried on to the chest), keeping it as medial as possible so the subsequent scar is only visible when the arm is raised. A long ellipse of skin is excised, and the wound sutured. Post-operative dressings will be applied with slight compression of the wound but not so firm that it interferes with venous return.