This fact sheet was developed under the aegis of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as an addition to your initial consultation, to try to answer all the questions you can ask yourself if you plan to use surgery baldness. The purpose of this document is to provide you with all the necessary and essential elements of information to help you make your decision with full knowledge of the facts. Also you is it advisable to read with the greatest attention.

 

 

 

• DEFINITION OBJECTIVES AND PRINCIPLES

 

The skin of the inner arm is "requested" in the movements and chokes repeated, which explains why the number of skin ptosis (non-justiciable a secluded inlet) is greater than the simple fat hypertrophy. Where there is a loosening of the skin at this level, an isolated liposuction is not enough, and only re-skin tension is likely to correct the defect: the brachial lifting or lifting of the inner arm. The intervention is therefore to achieve the removal of the excess skin, reduce fatty infiltration underlying and redrape all.

 

 

• BEFORE THE OPERATION

IA thorough clinical examination will identify the type of intervention most appropriate for you (choice of incision, whether or not associated with liposuction). Accurate information of the progress of the intervention, suites and predictable result will be made at the first consultation. Including the location of the residual scar will be well exposed.

A usual preoperative assessment is conducted in accordance with regulations.

The anesthetist will be seen in consultation at least 48 hours before surgery, if a general anesthetic or "vigil" is retained.

No medication containing aspirin should not be taken within 10 days before surgery.

Depending on the type of anesthesia, you may be asked to remain fasting (nothing to eat or drink) 6 hours before surgery.

 

• TYPE OF ANESTHESIA AND CONDITIONS OF INTERVENTION

Type of anesthesia

The lifting of the inner arm may be performed under general anesthesia, local anesthesia supplemented by tranquilizers administered intravenously (anesthesia "vigil") or, in some cases, under local anesthesia.

The choice between these techniques is the result of a discussion between you, the surgeon and the anesthetist.

Terms of hospitalization

The procedure can be done in "ambulatory", that is to say with out the same day after a few hours of monitoring.

However, in some cases, a short hospital stay may be preferable. The input is then in the morning (or even the day in the afternoon) and the output is allowed the following day.

 

• INTERVENTION

 

Each surgeon adopts a technique of its own and it adapts to each case to obtain the best results. Various techniques have been described. The fatty infiltration is corrected by liposuction. The excess skin is removed, leaving a scar, the location and length depend on the size of the skin distension and the type of intervention chosen.

The incision can be vertical, longitudinal running to the inside of the horizontal arm or in one of the plies of the armpit. The two types of incisions may be associated.

 

Lifting arm with the longitudinal incision along the inner arm

This procedure is intended primarily for severe skin laxity with a motivation clearly expressed: in addition to aesthetic discomfort (discomfort to wear short sleeves because of the shabby appearance of the arm), motivation can be as functional (mobility or discomfort to clothing, redness or maceration of the inside of the arm).

A first Liposuction is performed whenever there is a fatty infiltration of the region.

Excess skin is then removed from the application of a longitudinal incision along the inner arm.

The size and topography of this excess have been identified and drawn pre-operatively with the collaboration of (the) patient (s).

The duration of the intervention is on average an hour and a half. It varies depending on the extent of improvement.

End of the procedure a compression bandage is made.

This type of intervention effectively corrects skin and excess fat annoying and unsightly but leaves a vertical scar on the inside of the arm.

Often the scar remains visible which requires a particularly careful selection of surgical indications, good information (the) patient (s) and the collection of a truly informed consent.

Given the drawbacks of this type of facelift in terms of scarring are trying to provide, whenever possible, an intervention, albeit less ambitious, but more acceptable from the point of view scar: it can s act or a facelift with a remote incision in the armpit, or a mixed technique involving an incision in the axilla and a vertical short segment of less than 10 cm.

 

Lifting arm with the longitudinal incision along the inner arm

 

Lifting arm with horizontal incision in the armpit.

This type of intervention is aimed at patients carriers of smaller lesions with excess sagging skin and an interesting mainly the upper third of the arm. From a single incision, horizontal, concealed in the armpit folds of a first and after liposuction was performed if necessary, the skin is removed in excess of the upper part of the inner face of the arm, suture in the armpit to redrape the remaining skin up and in the axillary region. The residual scar is usually inconspicuous but the morphological result is less dramatic than that obtained with a facelift with vertical scar.

The duration of the intervention is on average one hour. End of the procedure a compression bandage is made. This intervention is lighter than the previous it is almost always performed on an outpatient or under local anesthesia or under general anesthesia "vigil."

Such surgery is certainly less ambitious than the previous one, but one of the main advantages of this technique lies in the fact that its simplicity and light weight allow it to be repeated perhaps once or twice in the years following the previous procedure; the practice of this reoperation will improve breast lift and the result each time, depending in particular on the application of (the) patient (e), for an additional skin resection, improved breast lift skin without the scar is elongated and it does so without including the axilla.

 

Lifting arm with horizontal incision in the armpit

 

Mixed or combined technical

It is a synthesis of the two previous methods which it performs as a compromise in regard to the advantages and disadvantages including the scar.

This technique combines a horizontal incision in the armpit and a short vertical scar less than 10 cm to the inside of the arm.  

AFTER THE INTERVENTION: THE OPERATING SUITES

 

The output will be generally the same day or the day after surgery.

In the postoperative course, bruises (blue) and edema (swelling) may occur. They regress in 10 to 20 days after surgery.

The pain is usually minor, limited to a few phenomena tightness and twinges well covered by standard analgesics.

The healing period can be a bit uncomfortable because of the tension exerted on the banks of the suture during this period, it will be necessary to prevent movement of brutal stretch.

If a work stoppage is necessary, it will take into account the nature of the work.

Sedentary work can in most cases be taken quickly, within a few days.

The practice of sport can be resumed gradually from the fourth postoperative week.

The scar is often dew during the first three months and then fades in general after the third month, and gradually over 1-2 years. This development is based on the intrinsic properties of each patient. It must be protected from the sun and UV during the first three months.

 

 

• THE RESULT

It is appreciated within 6 to 12 months after surgery.

We observe, in most cases, a good correction of the fatty infiltration and sagging skin, which significantly improves the morphology of the arm. The improvement in functional terms is also very clear, especially in the case of lifting with longitudinal incision.

Scars are usually visible, mainly in relation to the longitudinal component of the inner arm, which is not hidden in a natural fold.

With the development of technology and experience, the results of this intervention have markedly improved.

It is nevertheless a delicate surgery for which the greatest rigor does not in any way immune to a number of imperfections or complications.

 

• FAULTS OF THE RESULT

Most often, a lifting of the inner arm properly indicated and performed makes a real service to the patient (s) with obtaining a satisfactory and consistent with what was expected result.

However, it is not uncommon for localized imperfections are observed without them are real complications:

- These shortcomings include the particular scar which can be a bit too visible, distended or adherent. In case of excessive tension on the suture, the scar may have different unsightly aspects (hyper-pigmentation, thickening, retraction, adhesion or enlargement). If the scars fade well in general with time, they do not disappear completely. In this regard, we must not forget that if the surgeon who performs the suture healing it is the fact of the patient.

And these scars are subject to the vagaries of any healing, with the risk of hypertrophic changes which require specific treatment.

- The results of liposuction on them can be characterized by a lack of correction, slight residual asymmetry or small surface irregularities. These imperfections result are generally accessible to most often beneficial complementary treatment "small touches" surgery performed under local or single-depth local anesthesia. However, no reoperation is indicated before the sixth postoperative month (stabilization of the result).

 

• POSSIBLE COMPLICATIONS

A facelift of the inner arm, although often done mainly for aesthetic reasons, are nevertheless a real surgery, which involves the risks associated with any surgical procedure, however small it may be. We must distinguish the complications of anesthesia and those related to the surgery.

 For anesthesia, during the consultation, the anesthetist inform himself the patient risks. You should know that anesthesia in the body sometimes unpredictable, and more or less easy to control: the fact of using a fully qualified anesthetist working in a surgical context that the risks are statistically almost negligible. Current techniques offer optimal safety, especially as the subject is healthy.

 For the surgery, choosing a qualified plastic surgeon trained and skilled in this type of surgery, you limit these risks without removing them completely. Indeed, complications can occur with the waning of a lifting of the inner arm which is one of the most delicate operations of plastic and cosmetic surgery.

Among these possible complications, it must include:

• General complications: thromboembolic events (blood clots, pulmonary embolism), although generally rare, are the most formidable. Rigorous preventive measures should minimize the impact: port stockings, early mobilization, possibly anti-coagulant therapy.

• Local complications:

- The hematoma in fact quite rare, can justify its disposal to avoid the risk of damaging the aesthetic quality of the result.

- The occurrence of infection is favored by the proximity of a natural crease (cottage microbial usual) and is prevented by pre hygiene and rigorous post-operative until complete healing. Its

Treatment may, as appropriate, to further surgery, possibly a drainage and a prescription for antibiotics. It can leave unsightly scars.

- The occurrence of persistent lymphatic flow is sometimes observed. It may be complicated by effusion (swelling) that may require

puncture but dries usually without specific sequelae.

- Skin necrosis may exceptionally be observed. It is generally limited and localized. Prevention of these necrosis is a well-posed indication and the achievement of an appropriate and prudent technical gesture.

- Alterations in sensitivity, including the reduction of the sensitivity of the inner arm, can be observed: the normal sensitivity usually returns within 3 to 6 months after surgery.

 

In total there should not overstate the risks, but just be aware that surgery, even seemingly simple, still a small share of hazards. The use of a qualified Plastic Surgeon ensures that it has the training and knowledge required to avoid these complications, or effectively treat if jurisdiction.

          

These are the pieces of information that we wanted to bring you in addition to the consultation. We recommend that you keep this document, read it again after the consultation and reflect "a clear head." This reflection may raise new questions for which you wait for additional information. We are available to talk during the next consultation, or by phone, or even on the day of surgery when we meet in any way before anesthesia.