**5. Toning and smoothing of the skin**

• Again, we cannot emphasize enough the importance of selection the appropriate candidates. Liposuction can achieve good results in patients who have mild or moderate fatty tissue, good skin tone, and mild skin laxity. In patients who have severe skin laxity or extreme excess skin, resection based procedures might be applied alone or in combination with liposuction procedure. The biggest downside of resection based surgeries in brachioplasty is the resulted scar tissue in the long axis of the arm. In patients without severe skin laxity and skin excess, energy-based systems might be used to provide a skin contraction of the targeted area. LAL or RFAL methods may be preferred in these patients [11]. In addition, radiofrequency energy-based skin tightening technique can be combined with the liposuction procedure. It is possible to obtain a more satisfactory result by applying the second LAL session for patients with severe skin laxity or whom desired skin contraction could not be achieved in the first session. It is recommended that a gap of at least 6 months between two sessions would be feasible (**Figures 1**–**8**). All patients are undergone only the LAL. No ancillary modalities were applied. We believe patients would benefit from RFAL as well.

#### **Figure 1.**

*28 years old patient with local fat depositions in both arm. Left arm anterior view before and 2 months after laser assisted liposuction (LAL).*

#### **Figure 2.**

*28 years old patient with local fat depositions in both arm. Right arm anterior view before and 2 months after LAL.*

#### **Figure 3.**

*28 years old patient with local fat depositions in both arm. Right arm posterior view before and 2 months after LAL.*

#### **Figure 4.**

*28 years old patient with local fat depositions in both arm. Left arm posterior view before and 2 months after LAL.*

#### **Figure 5.**

*45 years old patient with local fat depositions in both arm. Right arm anterior view before and 1 year after LAL.*

#### **Figure 6.** *45 years old patient with local fat depositions in both arm. Left arm posterior view before and 1 year after LAL.*

#### **Figure 7.**

*54 years old female patient with local fat depositions in both arm. Right arm anterior view before and 6 months after LAL.*

#### **Figure 8.**

*54 years old female patient with local fat depositions in both arm. Left arm posterior view before and 6 months after LAL.*
