**Abstract**

The visibility of arm contour in both men and women has been a source of discussion throughout time. Arm strength and athleticism is not limited to the male physique only. Iconic women such as Madonna and Michelle Obama have made discussions about arm contour more and more commonplace. Over the years arm contour has been a difficult area to address due to the thinness of the skin which often required surgical excision and unsightly scars. Liposuction of the arm has advanced to not only allow for improved contour but also options of refining muscular definition. With the addition of energy-based technologies such as radiofrequency, we can offer less invasive options to patients who may have previously only been candidates for excisional procedures. Liposuction of the arms can be performed under local anesthesia. This chapter introduces a new algorithm for assessment and treatment of arm contour which incorporates newer energy-based devices along with surgical options.

**Keywords:** Arm contouring, Liposuction, VASER, Ultrasound-assisted Liposuction, High-Definition Liposuction, Radiofrequency, Skin Tightening, Brachioplasty

## **1. Introduction**

According to the 2019 Aesthetic Plastic Surgery National Databank Statistics [1], close to 20,000 upper arm lift procedures are performed annually. Although the appearance of the arms is a common concern among plastic surgery patients, with increasing emphasis placed on arm contour and definition in popular and social media, arm contouring via brachioplasty is consistently ranked as one of the least popular body contouring procedures. This is in no doubt owing to the conspicuous brachioplasty scar which is typically tolerated only by post dramatic weight loss (PDWL) patients or those with significant skin laxity from aging [1, 2]. At the other end of the treatment spectrum, non- or minimally-invasive treatment options such as liposuction are available to patients with mild to moderate arm fatty excess but good skin contractility and quality [3]. Until recently, there has been a large treatment gap between the two ends of the spectrum for patients with mild to moderate skin laxity, or even those with significant skin laxity who are intolerant of the brachioplasty scars. With the advent of energy-based devices that can be coupled with liposuction and excisional surgeries, treatment algorithms can now be broadened to serve the full range of patients with various levels of adiposity, skin laxity, and photoaging. In this chapter, we outline our preferred approach to arm contouring, which combines Vibration Amplification of Sound Energy at Resonance (VASER) liposuction with radiofrequency (RF) skin tightening treatments and other

complementary treatments as needed to address adipose excess, enhance muscular contour, and improve skin tightening and quality.
