Upper-arm tightening is requested increasingly by women over the age of 60. It is often surprising that women of this age do not have a facelift; instead they are more bothered by their flabby upper arms when they want to wear a bathing suit or sleeveless clothes. The only way of eliminating the surplus skin and the wrinkles in the long term is cutaneous excision. The art of the surgeon in doing this is to position the incision in such a way that it is on the medial side of the upper arm and to ensure that the resection of the skin is carried out so generously that the entire upper-arm region is tightened.
Upper-arm tightening is not technically difficult. The thick skin/fat flaps are dissected off the fascia, protecting the nerves and vessels, following exact marking of the incision line. The same basic principle applies to all operations to tighten the skin, namely, that the flap is mobilized and, following appropriate measurement, is then fixed in place in stages with key sutures so that neither too much nor too little skin is removed. Mang's principle always applies: I can measure ten times but only cut once. This should always be kept in mind so that each resection border is measured precisely. The resection border will then be sutured without tension and no surplus.
As cutting too far towards the olecranon process during upper-arm tightening often causes problems in patients with poor healing, we developed the "fish-mouth" incision in our department. This means that an incision in the shape of a fish mouth is made in the axilla, stretching to the middle of the medial side of the upper arm. This leads to a scar in the axilla and in about the upper third of the medial side of the upper arm, which is not so obvious. Furthermore, the fish-mouth incision also achieves tangential tightening in the axilla and vertical tightening in the upper-arm area, so the troublesome surplus skin and the folds of skin in the axilla and upper third of the upper arm when wearing sleeveless clothes are eliminated.
1. Basilic vein
2. Cubital fossa
4. Sup.lat.brachi.cut. nerve, axillary nerve
5. Axillary fossa
6. Brachial plexus
7. Medial brachial cutaneous nerve
8. Medial bicipital sulcus
10. Medial epicondyle
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