"I have absolutely no regrets whatsoever. I'd do it again."
That's what a 49-year-old Pittsburgh-area woman said about her upper-arm lift, also known as brachioplasty.
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In 1995, she had gastric bypass surgery and eventually lost 200 pounds. She kept most of the weight off, but was left with a tremendous amount of excess skin. While exercise can strengthen and tone muscles, it cannot tighten excess skin, and women are left with "bingo arms" or "bat wings."
Many women are opting to go under the knife, and, according to an American Society of Plastic Surgeons report, the number of such surgeries is up more than 4,000 percent since 2000. The report also presented a poll that showed first lady Michelle Obama and actresses Jennifer Aniston and Jessica Biel were the most influential celebrities with great-looking arms.
The Pittsburgh-area woman, who asked that her name not be used, wanted to get rid of the loose skin and went to Dr. Dennis Hurwitz, a clinical professor of surgery (plastic) at the University of Pittsburgh Medical School and former director of the Aesthetic Plastic Surgery Center, for a consultation. She originally wanted breast-reduction surgery, but realized that her upper-arm flab was also an issue.
She said Hurwitz, who founded the Hurwitz Center for Plastic Surgery in Pittsburgh, walked her through all of the steps and suggested that she have the surgeries simultaneously. He came in on the Sunday night before her surgery to draw the incision marks on her arms and to talk about it one more time, because he wanted to make sure it was what she wanted to do.
"There's definitely a lot of TLC that happens over there," she said.
In December 2011, she had an upper-arm lift and breast reduction. Just 2½ weeks later, she went back to work. She works a desk job in management and has an assistant, which she said sped her recovery. In six weeks she felt 100 percent and in 12 weeks she was back in the gym. She is pleased with the results. Unless she has her arms raised above her head, her scars aren't noticeable, she said.
But that's not the case for everyone. The usual arm-lift scar runs from the armpit down to the elbow, but modifications can be made based on the patient.
"The key with this, the really important message, is that the scars vary," said Dr. Leo R. McCafferty, who has a state-licensed surgery center in his Pittsburgh office and also performs surgeries at Shadyside Hospital. "Some turn out great, some don't. It's unpredictable."
Dr. Suzan Obagi, an associate professor of dermatology and plastic surgery at the University of Pittsburgh School of Medicine, said: "The problem is, even with the best technology, some patients are just not good wound-healers."
The national average cost for the surgery (both arms) is $4,000. The vast majority of arm lifts are not covered by insurance, McCafferty said.
Hurwitz has performed the surgical procedure at least 60 times in the past decade and said the ideal candidates are people who have a lot of thin, sagging skin that hangs from the upper arm. In more severe cases, it could extend into the armpit and chest. Brachioplasty reshapes the under portion of the upper arm. Most procedures have an incision from the armpit to the elbow on the inner section of the upper arm.
It's typically done under local anesthetic in an outpatient procedure. McCafferty noted that there's not a lot of postoperative discomfort, but the patient must be careful with upper-arm activity for about two weeks after the surgery.
McCafferty said that it's not chronological age that determines how successful the surgery will be; it's the patient's lifestyle and commitment to exercise. "Assuming that the patient doesn't go through body changes again, it should be permanent fix for them," he said.
Revisional surgery, to remove more skin or to fix scars, is sometimes necessary. Possible complications include significant scarring, nerve damage, numbness and pain, chronic swelling and fluid accumulation.
Obagi said surgery is not effective without lifestyle change. "The biggest heartbreak is when patients undergo surgery and think it's going to cure everything, only to watch over the next five to eight years that they've gained the weight back."