Banish Your Batwings

With sleeveless outfits popular throughout the year, those embarrassing wobbly bits under the upper forearm are always exposed. Don’t despair; explore the latest techniques and procedures to alleviate this pesky issue that affects women of all shapes and sizes.

Why We Have Them 

Call them what you like; bat wings, bingo wings or just plain fat, saggy upper arms. When you raise your arm and the skin under your arm waves around along with your hand – you have bingo wings. Some reasons for this are either excessive weight loss or age.

When skin is stretched beyond a point, it cannot retract which is what happens after excessive weight loss and also with ageing. Over time, our body loses collagen and elastin, causing sagginess and a lack of muscle tone that can make bingo wings more obvious.

You Are What Your Habits Are 

Despite everything we do to stay fit, localised excess fat in the upper arm area is often resistant to diet and exercise. To get the arms you want, avoid weight gain by adopting intelligent portion control, avoiding sugar (that includes fruits that are high in fructose) and replacing them with plenty of lean and green, leafy vegetables, healthy oils and seasonal, low sugar fruit.


Surgical Options 

If you feel trapped in long sleeved clothes because you’re embarrassed to wear short sleeves or tank tops, it’s the right time to consider surgical interventions for yourself.

  • Brachioplasty (Arm Lift) 

The use of a revolutionary Radio-frequency Energy based device, InMode, can accomplish measurable skin tightening along with fat removal, minimal incisions, rapid recovery, and important improvement in the contour of the upper arm.

Technique:  In case of liposuction alone or combined with the InMode device, there are very small scars involved while another imparts a scar limited to the underarm area or, in cases with very lax, redundant skin, a scar from the elbow area to the arm pit in the inner part of the arm. General anaesthesia is usually recommended, however some cases can be performed under local anaesthesia combined with oral sedation and analgesia to insure patient safety and comfort.

Risks: Infection, band contraction and/or bruises, bleeding, swelling, loss of sensation, unsightly scarring, and/or asymmetry between the two arms.

Results: Yields excellent results with upper arm contour but, if liposuction alone will not produce the desired result, additional incisions will be necessary which may leave a short scar limited to the underarm area or a full incision extending from the armpit to the elbow in the inner arm which is not visible when hands are next to the body but visible when they are elevated.

  • Tumescent Liposuction 

There are two important elements to consider when selecting the appropriate procedure for bat wings. One is the amount of adipose tissue accumulated in the arms and second, is the degree of skin flaccidity in that particular individual. In cases of mild excess arm fat deposits, especially with good quality skin, liposuction could work well.

Technique: This procedure is the intervention of choice in case of predominant accumulation of fatty tissue, with limited cutaneous hypotrophy. The technique consists in infiltrating a solution that serves to facilitate the liposuction as well as deliver local anaesthesia to the area that will be treated. Then a three-millimetre cannula is inserted in the adipose tissue through small incisions at the elbow and armpit, and the suction can start. There are two types of incisions of around three to four millimetres made; one is a shorter one for milder cases and one is longer, for more severe cases. Liposuction is performed to remove the extra fat through one or two small incisions.

Risks: After the operation patients wear an elastic garment for three to six weeks. If the candidates are carefully selected, there are no major risks. You should be back to normal daily activities in a few days including going back to work and you can resume more vigorous activities at about 3-4 weeks post-operatively.

Results: An excellent improvement is always expected. The final result is fully explained and photos are shown to the patient during the consultation to ensure results match their complete expectations.

  • T-Brachioplasty (Full Brachioplasty) 

A full arm lift or T-Brachioplasty is a surgical procedure that removes loose skin from the arm where there is severe laxity. This can help to reshape the inner and posterior areas of the arm especially after significant weight loss. Sometimes,the T-Brachioplasty may be limited to an incision in the underarm area along with a short vertical incision in the skin adjacent to the underarm. This is useful in patients who have minimal laxity in the vertical direction.

Technique: This is usually performed under general anaesthesia or local anaesthesia along with oral sedation and analgesia. The amount and laxity of the excess skin determines the placement of the scars. In the case of a predominantly vertical axis laxity, a longitudinal scar is used, so in these cases more skin is removed and the scar will be placed along the inside or back of the arm. The fat will be removed through liposuction. The other is a T-shape scar for a more severe situation where there is skin laxity in both horizontal and vertical directions. Therefore, besides using liposuction to remove volume, it is necessary to remove skin in both axis, resulting in a longitudinal scar along the inside of the arm and a transverse scar in the armpit, known as a ‘T’ shaped scar.

An extended scar may also be used in cases of extreme skin laxity. Here it is necessary to combine both incisions and even extend the scar into the chest wall. In these patients, the arm lift is usually combined with other procedures, the breast lift being the more commonly associated and often, in these patients, the excess fat from the arms and from other donor areas can be used to fill the breast instead of using a silicone implant. Removal of excessive skin is frequently necessary with additional incisions.

Risks: Mostly associated with pre-existing health conditions; hypertension, diabetes, heart problems, or smoking habits. Scar visibility must be addressed with the patient during the pre-op consultation.

Results: Results are consistent and long lasting if the patient maintains stable weight and exercises.

  • InMode Radiofrequency Energy Based Brachioplasty

This new technology, approved by the FDA, produces important tissue tightening and is combined with liposuction to contour the arm with minimal incisions.

Technique: InMode Brachioplasty is performed under local anaesthesia with oral sedation and analgesia or under general anaesthesia. Through small incisions, local anaesthesia is injected followed by insertion of the bipolar radiofrequency hand piece. The fat is heated and the temperature of the skin and of the fat is constantly measured in real-time to avoid overheating of the tissues. This is followed by liposuction. The tiny incisions are closed with one or two sutures and a sterile compression dressing is applied.

Results: Impressive improvement in contour results from the production of new collagen fibres that tighten the skin. The simultaneous removal of fat provides an important decrease in the circumference of the arm.

Risks: With proper training, the risks are minimal and patient satisfaction is high. Some patients with more severe skin laxity may require a second procedure for further skin tightening.

Dr. Malcolm advises a Brachioplasty procedure custom-designed for you if:

  • You have lost the weight you desire, but are left with redundant underarm skin.
  • You have good skin quality with minimal skin laxity but with excessive fat deposit in your arms
  • You are an adult with significant upper arm skin laxity due to ageing.
  • Your weight is relatively stable and you are not significantly overweight.
  • You are a healthy individual with no medical conditions that could impair healing or increase surgery risks.
  • You are a non-smoker.
  • You are committed to a healthy diet and lifestyle

Take The Tests

Since reaching and then maintaining a healthy weight is key to preserving the integrity of any surgical procedure, understanding what weight loss approach works best for each individual, is essential. Nowadays, smart predictive diagnostics is the way to go. Eastern Biotech offers convenient tests to get you on track and keep you on track.

Malcolm D. Paul, M.D., FACS
Clinical Professor of Surgery
Department of Plastic Surgery
University of California, Irvine
Past-President and Chairman of the Board of Trustees of The American Society for Aesthetic Plastic Surgery
Past-President: The California Society of Plastic Surgeons
LaVie Clinic, Dubai


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