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Obesity is a disease rather than a state, and metabolic bariatric surgery (MBS) is its most effective treatment. Body contouring surgery (BCS) is an integral part of the continuum of care following MBS, provided that the body mass index (BMI) has stabilized for an adequate period. This study is an attempt to capture the current status of BCS following MBS in Greece, based on data from one of the country's highest-volume hospitals. We recruited patients from the Bariatric and Plastic-Reconstructive Surgery registries who had undergone both MBS and BCS and invited them to answer a structured questionnaire with components on demographics, safety and effectiveness of previous operations, quality of life (QoL), body image, social activity, sexual activity, and doctor-patient communication. Twenty-four patients participated in the survey (response rate 88.1%). The mean BMI pre-MBS was 43.8 kg/m2 and that pre-BCS was 28.6 kg/m2. Based on the Bariatric sub-cohort, only 2.5% of post-bariatric patients underwent BCS. The mean interval between MBS and BCS was 2.9 years. The distribution of patients by MBS was as follows: sleeve gastrectomy 8 (33.3%), gastric band 7 (29.2%), gastric bypass 5 (20.8%), and gastric plication 2 (8.3%). The distribution of patients by BCS was as follows: abdominoplasty 23 (94.7%), breast contouring 8 (33.3%), thigh contouring 3 (12.5%), and arm contouring 5 (20.8%). Most positive components (70.6%) regarding QoL were appraised by >80% of the participants, indicating overall satisfaction after BCS. Conversely, only 12.5% of negative components were endorsed by >20% of patients. In conclusion, BCS has a low prevalence after MBS, although it is related to an improved quality of life and body image.

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BACKGROUND: Brachioplasty of deflated arms following massive weight loss (MWL) often results in too slim arms. These slimmer arms lack the natural proportion and contour. This study presents a novel method for such arms through standard skin excision and autoaugmentation by dermofat flap. PATIENTS: During a period of 2 years, 21 women complaining of severe deflation deformity of upper arms following MWL were operated. At time of surgery, the BMI ranged from 20.5 to 33. 4 with a mean of 26.2 kg/m2. The mean value of weight loss was 47.8 kg over a mean period of 18 months. METHODS: A de-epithelialized dermofat flap was preserved underneath the dissected and advanced anterior and posterior arm skin flaps. The bulk of the flap was tailored as to give an appropriate girth with balanced proportion and contour of the upper arm. RESULTS: During 14 months of follow-up, all patients reported a high satisfaction. Objective evaluation was based on measurement of the mid-upper arm circumferences (MUAC) and its ratio with the mid-forearm circumferences (MFAC) which was compared with those of arms of healthy volunteers with normal BMIs. CONCLUSION: Augmentation of the upper arm by autologous dermofat flap provides a well arm contour in appropriate balance with the forearm in women having severe arm deflation deformity following MWL. The findings were supported by the objective anthropometric measurements of the MUAC/MFAC of a normal weight healthy women which reached to a mean value of 1.366. The normal girth of upper arm should equal 1[Formula: see text] that of the forearm. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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BACKGROUND: In attempting to overcome the challenges associated with arm contouring, arm liposuction has been an area of focus in recent years. In appropriately selected patients, circumferential liposuction is the procedure of choice. The objective of this study is to describe our experience with the four-position four-entry site circumferential arm liposuction technique. METHODS: All consecutive circumferential liposuction procedures that took place at our ambulatory surgical facility from January 2015 to November 2019 were retrospectively reviewed. The four-position four-entry site circumferential arm liposuction technique is described, and photographs as well as videos are presented. RESULTS: A total of 35 patients underwent circumferential bilateral arm liposuction via the four-position four-entry site technique. All patients were female, and their average age was 43 years. The average BMI was 28.4 kg/m2, and the average follow-up was 481 days. The average volume of lipoaspirate was 1,514 ml per patient, and the average volume of aspirated fat was 1,052 ml per patient. There was no incident of infection, seroma, bleeding event or venous thromboembolism. CONCLUSIONS: For the right candidate, the four-entry site four-position circumferential arm liposuction is an efficient and reproducible technique, which produces predictable and pleasing results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Brachioplasty, in addition to several nonsurgical interventions (e.g. cryolipolysis, noninvasive radiofrequency, and intense-focused ultrasound) have been described as efficacious in the elimination of excess skin laxity from the upper arms. Recently, fractional CO2 ablation has gained attention for its ability to reduce rhytids and improve skin texture on the face, neck, and hands. In this article, we report the first successful case of fractional CO2 ablation for upper arm contouring.

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Brachioplasty is an increasingly popular procedure performed for improved arm contour in the massive-weight-loss population. There are challenging deformities presented in this population, such as redundant skin, posterior arm lipodystrophy, and loosening of fascial layers of the upper arm and chest wall that must be addressed to achieve successful contour of the arms. Common complications can be minimized with meticulous technique and knowledge of surgical anatomy. Additionally, brachioplasty can be combined with liposuction of the posterior arm as a safe and effective method for arm contouring without a higher risk of complications.

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Objective@#To describe an extended whole upper limb liposuction technique and evaluate its clinical effect.@*Methods@#34 patients who underwent upper limb liposuction from February 2018 to February 2019 were selected and the clinical data were retrospectively summarized. Patients were treated with upper arm ring/upper arm ring + forearm 1/3 rings/whole arm ring aspiration combined with accessory mammary gland, armpit, scapula and other adjacent aesthetic parts of extended liposuction. The preoperative and postoperative maximum circumference, thickness of the anterior and posterior subcutaneous tissue and skin laxity were measured and compared. analysis of complications, and evaluation of patients′ satisfaction through satisfaction questionnaire.@*Results@#The arm shape of all patients was significantly improved, the maximum circumference of the arm was reduced (16.2±4.0)%, the distance of the upper arm was reduced (29.5±8.9)%, the thickness of the posterior subcutaneous tissue was reduced (56.6 ±6.2)%, and the thickness of the anterior subcutaneous tissue was reduced (44.7±9.6)%. There were three cases of mild anemia after operation, and no other serious complications occurred. Patient satisfaction was very high.@*Conclusions@#This is an innovative arm liposuction technique with hidden incision. The effect of improvement is remarkable. The patient′s satisfaction is high.