I have absolutely no regrets whatsoever. I'd do it again."
That's what a 49-year-old North Hills woman said about her upper-arm lift, also known as brachioplasty. 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 North Hills woman, who asked that her name not be used, wanted to get rid of the loose skin and went to Dennis Hurwitz, 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 Dr. Hurwitz, who founded the Hurwitz Center for Plastic Surgery in Oakland, 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 2 1/2 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 Leo R. McCafferty, who has a state-licensed surgery center in his Shadyside office and also performs surgeries at Shadyside Hospital. "Some turn out great, some don't. It's unpredictable. The [ideal] patient is really someone who is trying to look good in jackets and tops. It's not really for someone who wants to look good in sleeveless [tops]," he said.
Suzan Obagi, 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." She said patients who have excess fat but good skin tone can usually get by with liposuction.
The national average cost for the surgery (both arms) is $4,000. The vast majority of arm lifts are not covered by insurance, Dr. McCafferty said.
Dr. 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. Dr. McCafferty noted that there's not a lot of post-operative discomfort, but the patient must be careful with upper arm activity for about two weeks after the surgery. It's possible to get back into significant exercise within three to six weeks. Recovering patients can continue regular exercise routines, but they must limit their arm motion.
Dr. 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.
"Most plastic surgeons are having less complications because they are doing more of them," Dr. McCafferty said.
Dr. 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."
To tone the arm muscles (biceps, triceps and deltoid), she suggested that women strap a 1-pound weight to their arms when they go out for a walk. "You don't want to carry anything heavier than a can of soup," she said.
"I do recommend that they exercise early on. Get some one-on-one with a certified personal trainer and talk about the areas they want to address," said Dr. McCafferty. "There are ways to tone specific muscle groups that can help. The muscle and the skin are intimately related. The arm will look better if there are some toned muscles underneath the skin."
Dr. Obagi, the director of the UPMC Cosmetic Surgery and Skin Health Center, has offices in Sewickley and in Shadyside. She said people in Pittsburgh are slower to try such surgeries than people who live on the East and West coasts. She said many women think about arm lift surgery but ultimately shy away from it because of the scars. Some opt for liposuction first, then go back later for brachioplasty.
Judy, 64, a business owner from the city's western suburbs, is contemplating an arm lift. She's had two face-lifts (in 1989 and 2005) and said she aggressively pursues maintenance. In her youth, she was a fitness trainer, and she has defined muscles in her arms. But she has gained some weight there and has loose skin she can't get rid of it. She's consulted with a few doctors about arm lift surgery but had reservations when they described the scar from the incision. She had liposuction in her upper arms as a temporary solution.
"A modified arm lift is probably the direction I will go because you get a scar, but it's mostly up in your armpit," she said. "I'm obviously a person who spends a lot of time thinking about my physical appearance and how it impacts my life. Unfortunately, we live in a society that makes it so important."
She hopes that working with Dr. Obagi will allow her to maintain her current results and gracefully move into her 70s and 80s. "I don't want to be Joan Rivers, you know? That's important to me."
Katie Foglia: email@example.com or 412-263-4903. Twitter: @ktfogs.