Commentary on: Brachioplasty by Power-Assisted Liposuction and Fat Transfer: A Novel Approach That Obviates Skin Excision.

Abstract

The authors present a brachioplasty classification system and a series of 95 consecutive patients undergoing nonexcisional arm contouring.1 Their surgical approach comprises three procedural elements: (1) power-assisted liposuction of the posterior arm; (2) “tunnelization,” to facilitate skin retraction; and (3) fat grafting to the volume-deficient area of the proximal medial arm (or the “brachial triangle”) using pre-injection tunnelization. The authors posit that tunneling facilitates skin retraction and that the addition of volume to the brachial triangle lifts the lax posterior skin. Additionally, the authors contend that, when this technique is employed, postoperative skin excision can be avoided in some patients. Postoperative scarring is a significant consideration in arm contouring procedures. Brachioplasty scars, especially those located on the distal portion of the upper arm (which is less frequently covered by clothing) can be difficult to fully conceal and, compared with scars in other body areas, seem to take longer to fade.2 However, although scar appearance is the chief concern of many patients, the predominant complaint of others is the laxity of the arm skin and soft tissue. These patients frequently report feeling embarrassed when their arm “flops around” during activities and want to alleviate this tissue hypermobility and have smoother, tighter arm skin. Such patients may readily accept the scars …