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Surgery to reduce the sag in arms increases 4,000 percent

| Thursday, May 30, 2013, 7:46 p.m.
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After Charlene Stewart of East Hills underwent gastric bypass surgery, she “lost a whole person,” with more than 100 pounds of fat gone. But her skin didn't shrink in some stubborn problem areas, particularly her upper arms.

“My arms were always a big embarrassment to me, because I call them bat wings,” says Stewart, 65. “I would never wear anything sleeveless, and no tank tops. ... I had to wear long-sleeved blouses and shirts all the time.”

Stewart went to Dr. J. Peter Rubin, a plastic surgeon, for an upper-arm lift, which removed much of the sagging skin on the underside of her upper arms. Nearly two months after the surgery, Stewart says she is happy with the way her arms look, and she finally can wear shirts without long sleeves.

In 2000, only 300 American women had an upper-arm lift — typically an outpatient surgical procedure known as brachioplasty — but the operation's popularity has skyrocketed in recent years. According to new statistics from the American Society of Plastic Surgeons, 15,000 women got the surgery in 2012, an increase of more than 4,000 percent. Although a recent poll by the society suggested that a desire for the toned, sleek arms of some celebrities, such as Michelle Obama, Jennifer Aniston, Jessica Biel, Kelly Ripa and Demi Moore, is fueling this trend, local doctors and patients cite other reasons for the surgery, namely shaping saggy arms after a significant weight loss.

The majority of brachioplasty patients have lost significant amounts of weight, whether on their own or through bariatric surgery, says Dr. Michael S. Kluska, who runs the Center for Plastic & Cosmetic Surgery in Greensburg. Kluska has not heard any patients reference celebrity arms, a motivation that he suspects is more common on the West Coast.

“People here, in this part of the country, are realistic in their expectations, and they just want to look the best they can,” Kluska says. “After being heavy for so long, the skin loses its elastic properties, even when they lose weight and lose beneath the skin.”

Rubin — who runs the Life After Weight Loss program at the UPMC Aesthetic Plastic Surgery Center in Oakland — says that the upper arms often contain extra skin and can be a pocket for body fat, even in people, particularly women, who otherwise are at an ideal weight.

Tricep exercises can help eliminate fat in that area and tone, but the exercise can't eliminate extra skin, he says. About 90 percent of brachioplasty patients are female, ranging from 20-somethings to people in their 70s — but most are age 30 to 50, he says.

“The upper arm is an area of great interest to many, many patients who we've seen,” says Rubin, a professor and chair of the Department of Plastic Surgery at the University of Pittsburgh's School of Medicine. “The key for us as plastic surgeons is to be able to have the experience and the knowledge to understand the different kinds of patterns that we see of extra skin and fat and discuss with patients the risks or benefits.”

A classic brachioplasty — where the surgeon removes skin along the biceps muscle — will leave patients with a scar, but it's on the inner part of the arm and not very visible, plus it fades over time, Rubin says.

A less invasive form of the surgery leaves the scar in the patient's armpit, but patients don't get all the benefits of the operation that leaves the larger scar. For patients who have mostly fat in their upper arms, not extra skin, ultrasonic liposuction works well.

The ideal candidate for an upper-arm lift is someone who is close to ideal weight, Rubin says. “These are never, never procedures that are substitutes for weight loss,” he says.

Doctors — who should be certified by the American Board of Plastic Surgery to be considered — need to understand their patients' goals and motivation, Rubin says. Patients also need to research the cost: Insurance hardly ever covers a brachioplasty, which can cost from $3,000 to $6,000. The risk of complications is very low: Patients may get a rare infection at the incision site, or an area may be slow to heal.

“It's something that has to be very thoughtful,” he says. “I don't want people to think that anything about plastic surgery should be fad-driven.”

Although upper-arm lifts aren't nearly as common as tummy tucks and breast surgeries, Kluska and Rubin say they are doing many more brachioplasties than they were several years ago. Patients are delighted with the results, the doctors say.

“They come back a year later wearing tank tops,” Rubin says. “Once the scar has faded, they feel very comfortable showing their arms.”

For Hope Elias, 51, of Jefferson Hills, sculpted celebrity arms had no role in her decision to get the surgery in 2004. She had lost about 100 pounds, and her skin sagged so much she would never wear sleeveless shirts. Doing tricep exercises didn't help.

“It did a lot for your body image,” she says.

The results of the surgery with Rubin, Elias says, are “amazing.”

“You can't even see the scar; they're underneath,” she says. “It really does make a world of difference. It made me a lot happier. ... I don't have to worry about hiding my arms when it gets hot outside.”

Kellie B. Gormly is a staff writer for Trib Total Media. She can be reached at or 412-320-7824.

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