**9.5 Seroma**

The lymphatic system in the arm courses alongside the venous system and is enveloped by the deep fascial system. With any excisional surgical approaches, superficial dissection is essential to preserve the lymphatic network and prevent issues with seroma formation. Although energy-based minimally invasive devices tend to produce more postoperative serous drainage, the lymphatic system is not compromised. Dayan et al. [12] demonstrated the safety profile of subdermal RF application using indocyanine green lymphatic imaging, which demonstrated no compromise of lymphatic channels, peristaltic function, or subclinical lymphedema post-treatment. Instead of circumferential treatment of the arm (360-degree liposuction with or without skin tightening), we advocate leaving behind a bridge of undisturbed skin and subcutaneous tissues at least 5 cm wide along the lateral border of the arm to decrease postoperative swelling. Gravity-based drainage of fluid from the elbow incision is sufficient, although drains are occasionally used.
