Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation is the foundational step where the surgeon evaluates the patient’s anatomy and goals. The surgeon examines the arms with the patient standing and the arms abducted to assess the full extent of the ptosis. They pinch the skin to determine elasticity and palpable fat thickness.
Key measurements are taken, including the arm circumference and the redundancy length. The surgeon identifies the location of the bat wing apex to determine the necessary incision length. They also assess the axilla and the lateral chest wall to determine whether an extended lift is required.
A comprehensive medical history is vital for safety. The surgeon reviews a history of wound-healing issues, keloid scarring, or bleeding disorders. Specific attention is paid to any history of lymph node surgery, as this can compromise lymphatic drainage and increase the risk of lymphedema.
The surgeon also evaluates comorbidities such as diabetes or hypertension, which can affect microcirculation. For post-bariatric patients, nutritional status is reviewed to ensure protein and vitamin levels are sufficient to support wound healing.
The surgeon discusses the trade-off between contour and scarring. Patients must understand that a significant improvement in shape requires a long, permanent scar. The surgeon shows before-and-after photos of previous patients with similar anatomy to illustrate typical scar placement and healing.
This discussion includes the potential for asymmetry. No two arms are identical, and minor differences in healing can occur. The goal is improvement and harmony, not perfection. The surgeon ensures the patient accepts the scar as the price for the new contour.
Nicotine is a potent vasoconstrictor that severely impairs blood flow to the skin. In brachioplasty, where long skin flaps are created, smoking can lead to disastrous complications like skin necrosis and wound dehiscence.
Surgeons enforce a strict zero-tolerance policy for nicotine. Patients are required to stop smoking, vaping, or using patches for at least 4 to 6 weeks before and after surgery. Urine cotinine tests may be administered to verify compliance before proceeding.
Patients should be at a stable weight for at least six months before surgery. Fluctuating weight can compromise the results. Losing weight after surgery can lead to recurrent looseness, while gaining weight can stretch the scars and alter the contour.
For post-bariatric patients, the surgeon ensures that the weight loss has plateaued and that the patient’s Body Mass Index is within a safe range for elective surgery. This stability indicates that the patient’s metabolism is normalized and ready for the stress of surgery.
Standard preoperative tests are ordered to ensure fitness for anesthesia. This includes a Complete Blood Count to check for anemia and infection, and a metabolic panel to assess kidney and liver function.
For patients over a certain age or with cardiac history, an EKG is required. Nutritional labs are crucial for weight-loss patients to confirm they have adequate protein stores to support healing of long incisions.
Patients are provided with a list of medications to avoid. Blood thinners, anti-inflammatory drugs, and herbal supplements must be stopped 2 weeks before surgery to reduce the risk of hematoma.
Essential medications for chronic conditions are reviewed. The anesthesia team dictates which medications should be taken on the morning of surgery. Patients may be prescribed antibiotics or anti-nausea medication to have ready at home.
To promote optimal healing and reduce the risk of wound complications, patients are encouraged to follow a high-protein diet in the weeks leading up to surgery. Protein is the building block of collagen, which is essential for closing the incisions.
Hydration is also emphasized. Proper hydration improves blood volume and circulation, aiding in the delivery of nutrients to the surgical site. Alcohol consumption should be minimized or eliminated to prevent dehydration and inflammation.
Recovery from an arm lift restricts arm movement. Patients must plan for assistance with daily tasks. Driving is prohibited while on narcotics and restricted until the full range of motion returns.
Patients need to arrange for a responsible adult to drive them home and stay with them for the first 24 hours. They should prepare their home by placing essential items at waist level to avoid reaching overhead, which can pull on the incisions.
Compression garments are a critical part of recovery. During the preparation phase, patients are measured and fitted for arm compression sleeves. These garments reduce swelling and support the skin as it heals.
The surgeon explains how to wear the garment and for how long. Ensuring the garment fits correctly—snug but not constricting circulation—is vital to preventing complications like venous congestion.
A final visit is scheduled 1 to 2 weeks before surgery. The surgeon reviews the surgical plan, confirms the incision placement markings, and takes standardized preoperative photos. Consent forms are signed.
This is the opportunity for the patient to ask final questions and for the surgeon to reiterate the postoperative instructions. The surgeon ensures the patient is mentally and physically prepared for the procedure.
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For patients who have lost significant weight, checking nutritional levels is key. Surgeons look at Albumin and Prealbumin to see if you have enough protein in your body to heal a large wound. They may also check iron and vitamin levels to prevent anemia and poor healing.
Yes, but it must be well controlled. Uncontrolled high blood pressure increases the risk of bleeding and hematoma during and after surgery. You will likely need clearance from your primary care doctor or cardiologist.
Move everything you use daily to a counter height. You will not be able to reach up into cupboards or down to low shelves without pain or risking your stitches. Stock up on easy-to-prepare meals.
Your surgeon will give you specific instructions. Usually, they ask you not to shave the underarms for 48 hours before surgery. Shaving can create microscopic cuts that harbor bacteria, increasing the risk of infection. The surgical team will clip hair if necessary.
Brachioplasty is typically an outpatient procedure, meaning you go home the same day. However, if you are having multiple procedures done at once, your surgeon might recommend an overnight stay for monitoring.
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