Does the mere thought of wearing a sleeveless dress or tank top in public make you shiver in horror?
You're not alone.
Few women who have exited their 30s are comfortable enough with the size, shape and tone of their upper arms to bare them in public. All but the most fit or brave hide them in sleeves of varying lengths to cover up one of the most obvious, largely unavoidable and early signs of aging: flabby upper arms.
Yes, we're talking about that curtain of loose skin and fat that swings from side to side when you wave or point or dance or otherwise raise your arms higher than your chest. Some call them bat wings. Every time I see mine in the mirror at the gym I think of the little valance curtain in the kitchen of my childhood, that swag of fabric that hung across the top of the window. At least my arms don't have the fuzzy little red balls along the edge like the kitchen curtain did.
Upper arms are "probably the most difficult area to tone up on a woman," said Dina Gilbert, a certified personal trainer at a Tampa, Fla., YMCA. The upper arm is made up of the biceps muscle in front and the triceps muscle in back. "As women age, it gets floppy and the triceps gets saggy," Gilbert said.
This un-fab flab becomes most noticeable as middle age approaches, usually after age 40, but for some women as early as their 30s.
This is when women start to gain weight that isn't easily lost; the underside or backs of the arms is a favorite place for fat to collect. Middle age is also when skin starts to lose its elasticity and when formerly firm muscles seem to turn to mush (a condition called sarcopenia that really accelerates after age 50, especially if you've been inactive). Skin that used to stretch and contract with fluctuations in weight can't do that so well anymore. Once stretched, upper-arm skin doesn't snap back into shape like it used to.
Genetics may also work against you. Look at the adult women in your family. Do they have big upper arms or loose skin that drapes? If so, chances are you will, too, especially if you're more than a few pounds over your ideal weight.
"We look at entire families," said Dr. Jaime Perez, a Tampa plastic surgeon. "They will have a certain distribution of fat and skin. Exercise and weight loss may help make the arm look smaller, but you will still see the drooping and baggy skin. It's very difficult to fight genetics."
It's no accident that women such as first lady Michelle Obama, pop star Madonna and trainer-coach Jillian Michaels (of "Biggest Loser" fame) have awesome arms. They've worked at it, hard, for years.
Prevention is your best defense against flab. Specifically, maintaining a healthy body weight throughout life and including strength training in your exercise routine, particularly in your teens and 20s, are key to keeping fabulous arms.
If your arms already jiggle, you may never achieve Madonna's rock-hard triceps, but you may be able to improve upon what you have. And don't underestimate the practical virtues of strong arms -- we all have to lift stuff, right?
Besides, while you're working on your arms, you're also exercising the rest of your body, including your most important muscle, your heart.
"You have to work on your whole body," said Jeanmarie Scordino, exercise physiologist and fitness trainer at Morton Plant Hospital's Cheek-Powell Wellness Center in Clearwater, Fla. "You can't spot train that one muscle to be perfect," she said. "A good calorie-burning, high-intensity exercise routine along with exercises that strengthen the muscles will give shape and definition to the arms."
The favorite among trainers? Push-ups. But you don't have to start with "hit the floor and give me 50" military-style push-ups.
"I start people with kitchen-counter push-ups," Scordino said. Also known as incline push-ups, all you do is stand a few steps back from a counter, arms shoulder width apart and hands on the surface in front of you, so your body is on an incline. Holding your body in a straight line, bend the elbows, lower your chest to the counter and push back. As you get stronger, move farther away from the counter and place your hands farther apart. When that's easy, try single-arm counter push-ups.
Gilbert likes to start women with push-ups on the floor, knees bent and the back flat, arms shoulder width apart. Lower your upper body toward the floor as far as you can. "Be careful not to allow your hips to push up toward the ceiling. Keep your back flat and level with the hips," she said. At first, you may only be able to do a couple, but gradually work up to more until you're strong enough to straighten your legs fully just like they do in the military.
Lifting free weights and using resistance bands are also good for the arms. But once the exercise gets easy, it's time to kick your workout up a notch. Don't be afraid of heavy weights -- you won't bulk up.
Most trainers recommend three sets of eight to 12 repetitions of each exercise.
"If by the time you get to your third set and the weight is easy to lift, it's time to move to a heavier weight (or tighter band). You must progress or you're wasting your time. You get endurance, but not increased strength. You're not stimulating that muscle to grow," Scordino said.
It's also important to rest in between exercises. Take a minute or so between sets to stretch or work a different muscle group. Work your legs, for instance, with lunges or squats. And allow at least a day off (two is even better) between arm-focused workouts to allow your muscles time to recover.
Particularly after age 40, women who have lost a significant amount of weight -- at least 40 pounds -- probably won't be able to firm up their arms no matter how much they exercise and diet. Ana Villanueva, a Tampa acupuncturist and doctor of Oriental medicine, found that out after losing more than 100 pounds over the last 10 years. She did it the old-fashioned way, by eating right and exercising, starting with walking, then jogging and later added cycling and strength training with weights.
"I pushed myself to the extreme to reshape my body, but I was never going to have the results I wanted," the 44-year-old said. "It didn't matter how much exercise I did or how many trainers I hired. The only way to get the changes I wanted would be with plastic surgery."
She went to Perez for brachioplasty, surgical removal of excess fat and skin from the upper arms. "It was life-altering for me," said Villanueva, who lost 3 inches from her arms. "My arms are still big, but they are shaped and better defined now."
Perez said he sees a lot of women like Villanueva.
"They come to see me because they are sick of working hard and not getting the results they want. They want a solution, a permanent correction," Perez said.
The younger you are and the better your skin tone and elasticity, the less invasive (and less expensive) cosmetic treatment is likely to be.
Options include nonsurgical skin tightening, such as laser treatments. A newer technique is body sculpting with extreme cold temperatures (the U.S. Food and Drug Administration has approved this procedure specifically for the tummy, but it's not out of the question for the arms, experts say). There also is liposculpting to break up fat and tighten skin, as well as liposuction to suck out fat. You can have excess skin and fat surgically removed. And various combinations of all these procedures can be used, too.
Brachioplasty, the operation Villanueva had, is an extreme measure. It leaves a long scar that stretches from the elbow into the armpit. Some surgeons make the incision in a straight line. Perez makes an S-shaped incision on the arm and a Z-shaped incision in the armpit, which he says is more likely to give patients full range of motion after surgery.
"Patients come to me knowing they will have a scar. It is not for everybody," said Perez. "But the scar improves after a year to where it's almost faint."
Villanueva had her surgery in December 2010 and recently had another, smaller, touchup procedure on one arm.
"At first the scar bothered me," she said. "But it does fade as time passes. If I had to choose between my arms like they were or the scar, I would choose the scar."
Cosmetic treatments don't come cheap. For mild flabbiness, you'll spend hundreds of dollars for skin-tightening treatments. Full surgery will run you $5,000 to $6,000.