Women sometimes jokingly refer to this as their "wings," hanging skin on the underside of the upper arms is a condition that eventually impacts almost everyone, yet despite all the advances in cosmetic surgery, there is really no easy fix.

That’s because once excess skin develops in any part of the body, it can only be eliminated by surgical removal. In the case of the upper arms, the scars usually can’t easily be hidden from public view, as in the case of a facelift or tummy tuck. While there are emerging technologies involving non-invasive energy application (such as radiofrequency) which may provide some minimal skin tightening, these approaches will not replace surgical excision for patients with substantial skin laxity.

Loose skin occurs when the skin has lost some or much of its elasticity. Causes for this include heredity, massive weight loss, frequent and marked weight fluctuation, normal aging and environmental factors such as sun exposure and smoking. Hydration and topical skin treatments have minimal favorable effects either in prevention or treatment once the damage is done. Does exercise help? Only in the sense that increased muscle definition makes upper arms more attractive. Sadly, even exercise won’t eliminate or improve lax, excess skin.

If the appearance of excessive bulk on the undersides of the upper arms is actually excess fat, and the patient’s skin tone is good, liposuction alone can often resolve the problem with very minimal scarring.

However, in the far more common case of excess skin, brachioplasty (upper arm reduction) can be performed in two primary ways. For patients with substantial excess skin, an incision is made along the length of the inner arm, into the armpit and sometimes down the lateral chest wall. Excess skin is excised and the incisions are closed with absorbable sutures. Occasionally a drain is used. Compressive dressings are applied to control swelling. For patients with only small amounts of excess skin (usually younger patients who have firmer skin tone
and whose weight has not fluctuated greatly), a modified brachioplasty can be done, which involves a much more limited incision, in the armpit only.

After a traditional brachioplasty, arms will be swollen for several weeks. Scars begin to fade in 2-3 months and take 12-18 months to reach their final appearance. The use of long-absorbing sutures and newer barbed suture technology to minimize tension and spreading of the scar, compression garments
and topical scar treatments all help minimize scarring, but the scars never completely disappear. So if "wings" have become a problem, understand you are not alone.

David J. Levens, MD, PA, FACS is a Columbia University Medical School graduate, a Board-certified plastic surgeon, and former Chief of Surgery at Coral Springs Medical Center. In practice in Coral Springs since 1989, he can be reached at 954.752.1020 or www.DrLevens.com.