Arm liposuction and arm lift: how do they differ?

Looking at upper arm concerns in terms of fat, skin, and extent

Changes in the contour of the upper arms are a common cosmetic concern, and the skin and the fat under it are the main targets of treatment ^[4]. A 2022 review explained that the causes of sagging upper arms are complex, and it covered ways of classifying them along with surgical and nonsurgical treatments ^[4]. Improving upper arm contour is described as a goal for both people who have lost a large amount of weight and people who want to maintain the shape of their arms as they age ^[1].

A 2018 review stated that assessing how much fat there is, how much excess skin there is, and whether the deformity is limited to the upper part of the arm or extends to the whole arm or the side of the chest helps in deciding whether to perform liposuction alone, skin excision alone, or both, or to use nonsurgical devices ^[1]. In general, if the skin has kept its elasticity and fat is the main problem, liposuction is considered; if the skin is very loose, liposuction alone can do little to reduce the sagging skin, so excision is discussed as well.

What is an arm lift?

An arm lift is surgery that removes excess skin and fat from the arm and pulls the remaining skin taut to refine the contour, and various methods have been introduced since the 1930s ^[1]. A 2018 review found that arm lifts are increasing and can be performed with low complication rates and good satisfaction, but it stated that there is no consensus on the best shape and location for the incision and that no study has shown any particular technique to be better ^[1].

A 2014 article described the cosmetic flaws that can occur after an arm lift and stated that because these flaws are difficult to correct, it is important to avoid them from the start ^[5]. Drawing on cases in which the author performed an L-shaped arm lift combined with liposuction, the article examined the role liposuction plays in refining the shape of the arm ^[5]. In statistics from the International Society of Aesthetic Plastic Surgery (ISAPS), arm lifts fall under the category of body and extremity procedures, and procedures in this category increased from 2.6 million in 2009 to more than 5.1 million in 2023 ^[6].

How common are complications after an arm lift?

A 2022 systematic review and meta-analysis analyzed 29 studies with 1578 patients, and all of the included studies were observational ^[2]. The pooled rates were 9.9% for abnormal scarring, 7.79% for sagging or recurrence, 6.81% for wound separation, 5.91% for seroma, 3.64% for infection, 2.47% for nerve-related complications, 2.46% for lymphedema or a lymphocele (a collection of lymph fluid), 2.27% for skin necrosis or delayed wound healing, and 2.06% for hematoma ^[2]. The rate of repeat surgery for cosmetic reasons was 7.46%, and the rate for other reasons was 1.62% ^[2].

A 2018 review pooled 27 studies from 1995 to 2015, covering 1065 patients, and complications were observed in 308 of them (28.9%) ^[3]. The most common were hypertrophic (raised, thickened) scars, seroma, and hematoma; nerve injury occurred in 16 patients (1.5%), and no major complications such as thromboembolism or sepsis were observed ^[3]. The rate of repeat surgery varied widely between studies, from 0% to 21%, and the authors stated that because minor complications occur at a high rate regardless of surgical method, patients should be told about the possibility of hypertrophic scarring and nerve injury ^[3].

What changes when liposuction is added?

After analyzing several factors together, the 2022 meta-analysis reported that placing the incision on the inner arm was associated with a higher risk of complications, and that adding liposuction was linked to lower rates of some complications ^[2]. However, these are pooled results from observational studies in the absence of large clinical trials, and the authors presented them as reference evidence for explaining the surgery, obtaining consent, and choosing a surgical method ^[2].

All of these figures come from arm lifts, which involve cutting away skin, and weight loss is described as the main reason people have an arm lift ^[3]. These numbers should therefore not be used to judge the risks for someone whose weight has not changed much and who is having upper arm liposuction alone for cosmetic reasons. The research summaries used for this article contain no data giving the complication rate of upper arm liposuction on its own.

A rare but serious infection to be aware of

Necrotizing fasciitis is a rare but potentially life-threatening infection after surgery ^[7]. In a 2017 systematic review covering 30 years of literature, only 18 of 3782 papers on necrotizing fasciitis dealt with cases after cosmetic surgery; among these, liposuction was the most common procedure, and the buttocks and legs were the areas most often involved ^[7]. Most cases appeared within 3 days after surgery with nonspecific symptoms, so the authors stated that whenever infection is suspected after cosmetic surgery, this condition should always be kept in mind and the patient should be monitored closely ^[7]. If you have unusual pain, swelling, or fever after surgery, it is best to let the clinic know right away.

Recovery and what to check during your consultation

After upper arm liposuction, swelling, bruising, and changes in sensation can occur, and the contours may be left uneven. An arm lift leaves a scar on the arm, so you should check its location and length in advance. Nonsurgical fat reduction and skin tightening devices are promising for some patients, but it was judged that higher-level evidence is needed to clarify which patients each device is suited to ^[1]. Even upper arms that look alike may call for different methods depending on the condition of the skin and changes in weight, so it is best to decide with a specialist who has examined you in person.

• Whether the sagging is caused by fat or by skin
• Whether the deformity is limited to the upper part of the arm or extends to the whole arm or the side of the chest
• The difference between liposuction alone and liposuction combined with excision
• If skin is removed, where the scar will be and how long it will be
• Possible complications and the chance of needing another operation