Arm liposuction 50/50? A patient saw me in the office yesterday. She is having a tummy tuck and breast reduction this fall. She came in again to discuss adding liposuction of the arms at the same time. She was confused though. She had done her usual research on the internet; technologies guide to cosmetic surgery, and found that only about half of the people who had the procedure in the U.S. were happy with their results. Why? She asked. I explained….the key to arm liposuction is not the fat, but the skin. We can suck fat out of almost anywhere, but our tools to shrink skin are limited. In a patient with tight full arms when the fat is removed, the skin shrinks up nicely. In a patient with loose, bat wing laxity under the arms, liposuction will make the situation worse. So the paradox is that young patients do much better than older patients with arm liposuction. The correct operation for loose flabby arm skin is to tighten it through Brachioplasty. Brachioplasty is like a tummy tuck for the arms, but the tradeoff is that the scar is in a conspicuous location. The reason I think that so many patients are unhappy with arm liposuction is that surgeons are not picking the right candidates. When Ultrasonic liposuction came out it promised to tighten the skin……not so much. The same was said of laser liposuction whose skin tightening is limited at best. Beware of the Groupon liposuction deals!! If it was such a wonderful technology would you need to sell it with a Groupon?? So think of your arms like this: Hold your arms out to the side and with your opposite hand wobble the upper arm skin back and forth. If there is no wavy wobble then you may be a good candidate for arm liposuction, if there is a wavy wobble like my grandmother, Brachioplasty will do best. If you are in the middle you might do okay with liposuction but safest to already be comfortable with Brachioplasty as a plan B in case the skin does not shrink up the way you want. Obviously, your plastic surgeon can help to guide you, but as you leave the office, the advice you get should independently make intuitive sense to you as well. So back to my patient: We had plans to tighten her breasts, tighten her tummy and like these areas her arms were loose as well. She is not a good candidate for arm liposuction, but she is a good candidate for Brachioplasty. While she does not want the Brachioplasty scar, she was appreciative of my candor and left the office with an answer that made sense.