19.  Your patient lost 150 lbs and wants her arms to look better.  Review brachioplasty.  How is it done and are patients happy?

Answer:
(From Grabb and Smith CD-ROM:)

About 10% of patients undergoing liposuction have treatment of the arms. Results are subtle but are usually satisfying to the patient. Unfortunately, many patients seeking improvement in arm contour have significant skin excess and require skin excision for optimal contour improvement. Even the most skillful brachioplasty, however, results in a longitudinal scar along the inner aspect of the arm from the axilla to the elbow. Because most patients want surgery in order to be more comfortable showing their arms in public, it is the rare patient who will accept the scarring attendant on a brachioplasty as an acceptable trade-off for reduced contour. In fact, brachioplasty accounted for only 0.16% of all cosmetic surgery procedures performed in the United States in 1994. Patients willing to accept brachioplasty scars are almost always those with severe degrees of skin excess secondary to massive weight loss or senile skin laxity. For readers seeking more information on brachioplasty, the work of Guerrerosantos is central to an understanding of this topic. More recent contributions on brachioplasty are also available.
 

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