Liposuction Article for Upper Arm - American Plastic Surgery of Hawaii Hawaii

S. Larry Schlesinger, M.D.

Maui, Hawaii, USA

Abstract. A new technique for suction-assisted lipectomy of the upper arm is described. It uses four separate cannulas of varying lengths, all with an internal diameter of only 3.0 mm. Only a single incision is required. The benefits include the elimination of the complication of excessive fat suctioned from the middle of the arm, reduced scarring, and reduced surgical time. The patient recovers quickly with less bruising and more comfort. Results are pleasing with virtually no complications.

Key words: Liposuction - Upper arm - Body contouring - New instruments for liposuction

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Liposuction of the upper arm typically has been performed with multiple incision and suction sites and is often accompanied by excision of loose skin. Procedures for this approach have been described by Teimourian [2] and Asken [1]. I felt that for the younger patient a simplified technique with fewer incisions needed to be formulated. I have found enhanced results for the younger patient with a technique that uses four cannulas of varying lengths and all with an internal diameter of only 3.0mm. The benefits of this approach include the need for only one incision, reduced surgical time, and elimination of the complication of excessive fat suctioned from the middle of the arm. I have found that the indentation created in the middle of the arm that is typical of other techniques is avoided since there are four cannulas of different lengths for the four different areas on the volar surface of the upper arm. Cannulas of various lengths are used to their greatest mechanical advantage to suction from distal to proximal areas and avoid excessive suctioning of the middle of the arm. In addition, scarring is minimal because of the single incision.

Many patients who seek reduction of the upper arms express concern that their upper arms are out of proportion with the rest of the body. The best candidates for the four-cannula technique are those who tend to store excessive fat in their upper arms, have good skin elasticity, and are less than 35 years of age. Candidates who do not meet these criteria may need excision of excess loose skin and may not have as pleasing results.

Methods

Four cannulas, all with an internal diameter of 3.0mm, are used. They range in length from 8.0 to 28.0cm (Fig. 1).

Liposuction is done in the triceps or volar aspect of the upper arm. Mapping of the four areas to be suctioned is then accomplished (Fig. 2). Anesthesia is given with local infiltration of 0.5% xylocaine with 1 : 200,00 epinephrine along with IV sedation. The incision is then made with a #15 Bard Parker just proximal to the olecranon area. Once the skin is nicked, the incision is dilated with a small hemostat. Pretunneling is done with a 3.0-mm, 21-cm-long cannula. Suctioning begins with the longest cannula (28 cm) completing the most distal suctioning first. The remaining three cannulas are used in progression from the longest to the shortest. Refinements may then be accomplished as needed. Peripheral mesh undermining is then performed with a 3.7-mm solid cannula. This helps to blend the operated areas with the remainder of the arm.

Fig. 1. Four canulas of varying lengths used in suctioning the upper arm: (A) 8 cm, (B) 17 cm, (C) 21 cm, (D) 28 cm

Fig. 2. (A-D) Map of the surgical area suctioned by four different length cannulas

Fig. 3. A common complication: over suctioning of the middle portion of the upper arm

Fig. 4-5. (4A, 5A) Preoperative and (4B, 5B) postoperative views of suctioning of the upper arm

Hemostasis is then attained with a mixture of 1000 units of thrombin and 1 cc of 1 : 1000 epinephrine mixed with 100 c of saline and instilled into a red Robinson catheter through the original incision. This mixture percolates into all operated areas. The incision is then closed with 5-0 nylon sutures. Reston Foam is applied to the arm followed by a 4-in. ace wrap. I have found that the use of Reston Foam is particularly helpful in reducing bruising, enhancing comfort, and aiding in quick recovery.[3].

Discussion

One common complication of suction lipectomy of the upper arm is excessive resection of fat from the midvolar portion leading to an indention of this area accompanied by distal and proximal bulges (Fig.) Cannulas of four different lengths have been designed for ease of use in suctioning all areas of the arm from distal to proximal. The residual bulge in the proximal upper arm is eliminated by using a 8.0-cm-long cannula; the residual bulge in the distal area of the upper arm is eliminated by using a 28.0-cm-long cannula. There are four cannulas of different lengths for four different mapped areas. Our technique uses the cannulas to their greatest mechanical advantage thereby avoiding excessive suctioning in the middle of the upper arm and thus avoiding upper-arm indentations. Another problem caused by other techniques - multiple incisions resulting in excessive scarring - is avoided by our single-incision approach. We have also found this approach reduces surgical time compared with multiple-incision procedures because one incision rerquires less repositioning of the patient. With the four-cannula technique, these complications are eliminated when suctioning is accomplished in sequences, distal to proximal, from a single incision (Figs. 4 and 5).

Summary

The four-cannula technique yields pleasing results with minimal complications, enhanced patient comfort, and reduced operating time. The complications of indentations of the midvolar area of the upper arm and residual distal and proximal bulges are avoided.

References

1. Asken S: Refinements in the technique of liposuction. J Dermatol Surg Oncol 14:10, 1988.
2. Teimourian B: Suction lipectomy and body sculpturing. St. Louis: C.V. Mosby Co., 1987, pp. 163-174.
3. Grazer, F: Personal communications, 1985.



*Presented at the 7th Annual Meeting of the Lipoplasty Society of San Francisco, California, October 29, 1989. Address reprint requests to Larry Schlesinger, M.D., American Plastic Surgery of Hawaii Corporation, Suite 300 Kahului Bldg., 33 Lono Avenue, Kahului, Hawaii 96732, USA.