The skin of the medial area of the arm: morphometric study of interest to liposuction

Three-dimensional circumferential liposuction of the overweight or obese upper arm

Due to recent trends in liposuction, anatomic consideration of the body's fatty layers is essential. Based on this knowledge, a circumferential approach to achieving maximal aesthetic results is highlighted. In the upper arm, aspiration of fat from only the posterolateral region can result in skin flaccidity and disharmony of the overall balance of the upper arm contour. Different suction techniques were applied depending on the degree of fat accumulation. If necessary, the operation area was extended around the axillary and scapular regions to overcome the limitations of the traditional method and to achieve optimal effects. To maximize skin contracture and redraping, the authors developed three-dimensional circumferential liposuction (3D-CL) based on two concepts: circumferential aspiration of the upper arm, to which was applied different fluid infiltration and liposuction techniques in three anatomic compartments (anteromedial, anterolateral, and posterolateral), and extension of liposuction to the periaxillar and parascarpular areas. A total of 57 female patients underwent liposuction of their excess arm fat using this technique. The authors achieved their aesthetic goals of a straightened inferior brachial border and a more slender body contour. Complications occurred for five patients including irregularity, incision-site scar, and transient pigmentation. Through 3D-CL, the limitations of traditional upper arm liposuction were overcome, and a slender arm contour with a straightened inferior brachial border was produced.

LEVEL OF EVIDENCE IV

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Lipectomy of arms and lipograft of shoulders balance the upper body contour

Lipodystrophies of upper limbs are less significant than lipodystrophies affecting inferior limbs, and the results of liposuction in that area are not always aesthetically acceptable. The authors topographically studied the amount of fat in a lipodystrophic arm of seven cadavers, and found that the zone located over the humerus' trochiter frequently presents lipodystrophic cumuli. In these cases, the maximum width is not the bideltoid width, but the bitrochiteric width. Intermediate and deep liposuction was performed only over the posterior and external aspect, because superficial and circumferential liposuction may result in multiple irregularities on the anterior and internal surfaces. During the same medical act, fat-graft injection in deltoid region was performed to balance the contour of the scapular belt. With this technique, an aesthetically balanced zone was obtained. The results for 48 patients treated with arm liposuction and fat-graft injection in the deltoid area were very satisfying.