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Page 2 of 7 Andjelkov et al. Plast Aesthet Res 2018;5:18 I http://dx.doi.org/10.20517/2347-9264.2017.96

for plastic surgeons as the extension of scars limits the indications for brachioplasty and reduces patients’
acceptance.

[1]
Since Correa-Iturraspe and Fernandez first described aesthetic brachioplasty in the 1950s, the procedure
has become an established division of upper extremity contouring for plastic surgeons. The dramatic rise in
bariatric procedures has correlated to an exponential rise in patients seeking aesthetic brachioplasty. There
[2]
were 15,183 brachioplasties performed in 2010, a 4392% increase compared to the figures for 2000 . At the
same time it is associated with significant complication rates from 25%-40% and revision rates between 3%-
[2,3]
25%. Most of these complications are due to the patients’ dissatisfaction with the appearance of the scar .
This dissatisfaction has prompted members of the plastic surgery community to evaluate and refine current
procedures, seeking a more aesthetically pleasing outcome. Using this impetus, the authors of this paper
describe their current practice using fat grafting as an adjuvant to limited brachioplasty.

The majority of our patients seeking brachioplasty have typically had major weight loss after bariatric
surgery or either diet and/or exercise. Yet there is still a significant portion of patients who are normal
weighted but are still presenting with loose skin in the arm region due to the process of aging. These patients
suffer from senile skin elastosis, but even after conventional brachioplasty, their skin still appears loose. This
sub-group of brachioplasty patients always refer to a procedure with long scars as a matter of great concern.
Considering this, it is a challenging task to offer those patients a satisfactory result. These patients are a
minority in global brachioplasty statistics. This is probably the principal reason for a paucity of published
techniques and options for these patients. However, changes in the position of incisions in continuity with
the development of limited brachioplasty has demonstrated a reduced risk of idiopathic nerve and vascular
[4,5]
damage, and improved scarring .
We present a more conservative aesthetic procedure in order to correct only mild to moderate sagging
skin, improve the skin quality, and to reduce scaring. The authors believe surgical approaches should differ
depending on the amount of skin laxity and fat excess. The purpose of this paper is to demonstrate an
improvement in the current short scar brachioplasty surgery, to analyse patients’ satisfaction rate and to
propose an option for “border line” patients that do not accept extensive scars.

METHODS
In this article we present our experience with short scar brachioplasty in combination with posterolateral
liposuction, fascia anchoring and fat grafting in the inferomedial arm in order to improve skin quality and
correct minor irregularities.

The patients were all normal weighted at time of operation, and did not change weight significantly pre- or
post-operatively. All patients were in opposition of major scars, but still sought for contour improvement of
the arm region. The limitations of the suggested technique were explained in comparison with traditional
skin excision and the consent forms were signed. All patients were examined and carefully evaluated for
both the amount of fat present and the amount of skin laxity in the arm region. Determination of excess was
made by the pinch test. Patients with greater than 1.5 cm of fat detectable with the pinch test were candidates
for liposuction. However, skin laxity was assessed also pinching the excess skin between the fingers, but in
[6]
the diferente manner, and measuring the length of excess skin as described by Sacks .

After physical examination, classification of upper arm deformity was determined for each patient according
[4]
to the modified Rohrich classification system . There were 3 groups of patients in our study: IIa, moderate
skin excess and minimal fat excess, proximal location of skin excess; IIb, moderate skin excess and minimal
fat excess, entire arm skin excess; IIIa, moderate skin and fat excess, proximal location of skin excess.