Improving Outcomes in Upper Arm Liposuction: Adding Radiofrequency-Assisted Liposuction to Induce Skin Contraction

Abstract

Brachioplasty is frequently recommended for patients with more skin laxity than subcutaneous fat. However, many patients are reluctant to accept a visible scar that will affect the activity of the upper arm or clothing choices. Traditional liposuction is effective when minimal skin laxity is present, but the dual problems of postoperative residual skin laxity and unsatisfactory contour irregularities are common when upper arm skin laxity is the chief complaint. The author investigates the degree of skin contraction resulting from treatment with radiofrequency-assisted liposuction (RFAL) and attempts to determine whether, after long-term follow-up, the classification of upper arm deformities and their corresponding treatment protocols can be refined to offer patients with prominent skin laxity an alternative to traditional brachioplasty. A prospective, institutional review board-approved pilot study was planned with 12 consecutive patients who presented to the author's private clinic for treatment of upper arm laxity. Patients were included only if they were categorized as Stage 2b, 3, or 4 according to the El Khatib and Teimourian system. Based on the "pinch" test and the vertical measurement of skin distal to the bicipital groove as described by El Khatib, a novel caliper was devised to quantify the shortening of the pendulous volar skin. Treatment regions were tattooed prior to surgery and measurements from a Vectra system (Canfield Scientific, Inc., Fairfield, New Jersey) confirmed the preoperative surface area. All patients were treated with the BodyTite device (Invasix, Inc., Yokneam, Israel). No patient underwent skin resection in the volar treatment region. Skin contraction was measured at one year posttreatment. Statistical analysis was conducted with a paired t-test. RESULTS One year after treatment with RFAL, the mean surface area reduction in the volar upper arm region was 33.5% bilaterally. The mean degree of pendulous vertical "hang" shortening was 50% bilaterally. Statistical analysis showed a P value of >.001 for both measurements. Treatment with RFAL achieved statistically significant skin contraction in the upper arm region. Patients in categories 2b and 4 were successfully treated with RFAL instead of traditional brachioplasty (which is recommended by the current classification system). Category 3 patients, however, did require a short-scar brachioplasty procedure to obtain satisfactory results.