Shoulder lift (brachioplasty) - no more "pelicans"

What are "pelicans" and why do they arise?

"Pelicans" is a colloquial, though commonly used, name for sagging shoulder skin that hangs below the triceps (triceps) muscle, most often in the area from the armpit to the elbow. Although it is not a medical term, it captures well the nature of the aesthetic problem that many people face - especially after the age of 40 or after significant weight loss.

The main causes of sagging shoulders are:

• age-related loss of skin elasticity - as the body ages, it produces less collagen and elastin, the proteins responsible for skin tone and firmness. The result is its stretching, loss of density and increased susceptibility to sagging;
• gravity - a natural process that affects the sagging of soft tissues with age, especially where the skin is thinner and less supported by muscles, as just in the back of the arms;
• sudden or significant weight loss - when the skin has been stretched by excess fat for a long time, it does not always have the ability to shrink. After weight loss, its excess remains, which creates visible folds;
• Lack of physical activity and underdeveloped muscles - insufficient tension in the muscles of the arms (especially the triceps) means that the skin does not have the proper "scaffolding" and begins to droop;
• genetic predisposition - some people have more fragile and flabby skin, which increases the risk of "pelicans" regardless of lifestyle.

Although they do not pose a health risk, sagging shoulders affect psychological comfort and self-confidence - many people avoid sleeveless clothing and are reluctant to show their shoulders in summer or during physical activity. Fortunately, modern plastic surgery offers effective methods to correct them, such as shoulder lifts(brachioplasty).

Also find out how to deal with excess skin after weight loss?

What is an arm lift (brachioplasty)?

Brachioplasty, or arm lift, is a plastic surgery procedure to permanently remove excess flabby skin and fatty tissue from the upper arms. The surgery is intended for people who have developed significant skin flaccidity and are unable to improve the appearance of their arms with exercise.

During the procedure, the surgeon makes appropriate incisions along the inside of the arm, removes excess skin and often subcutaneous fatty tissue, and contours and tightens the remaining tissues to restore a slender, firm contour.

The surgery is performed under general anesthesia and usually takes between 1.5 and 3 hours, depending on the extent of the lesions and the extent of the incision. In some cases, the procedure is combined with liposuction for better proportions and smoother arm lines. The result is slender, taut and aesthetically shaped arms, free of sagging skin. Importantly, the result is visible as soon as the wounds heal, and can last for many years if weight is kept constant.

Types of cuts and scars

A standard arm lift involves an incision from the armpit to the elbow, guided on the inner (or posterior-inner) side of the arm - in the least visible spot with the arms down. This placement allows the scar to remain relatively discreet, although it is not completely invisible.

After the procedure, the scar is initially red and convex, gradually fades and flattens over the course of several months or so, and becomes lighter over time, but never disappears completely - its presence is an inevitable trade-off for a marked improvement in the contour of the arms. In some cases, if the excess skin is small and located mainly in the armpit area, the surgeon may propose a minibrachioplasty. Then the incision is limited to the axillary area, which is associated with a smaller scar, but also a limited lifting effect. This type of technique is used rarely, only in patients with a very mild degree of skin laxity.

Skin excision and liposuction

In cases where sagging skin is also accompanied by excess fat (especially in the upper arm), the surgeon may decide to combine a lift with liposuction. In this case, liposuction, or liposuction of fat from selected areas of the arm, is performed first, and then the surgeon removes the excess skin, tightening the tissues into a new shape. The advantage of this approach is that the contour of the arms is natural and smooth, and the skin is better adapted to the new volume of tissues. 

After the procedure, internal and external sutures are placed, often dissolvable, eliminating the need for removal, but in some cases surgical drains are used to drain excess fluid for 1-2 days, reducing the risk of complications and swelling. The entire healing process usually takes several weeks, and the full effects of the surgery are visible after about 2-3 months, when the skin settles and the scars begin to remodel.

Read also: How to slenderize and firm the arms? Proven methods for body shaping

How to prepare for an arm lift procedure?

An arm lift is a surgical procedure that (like any surgery) requires proper preparation. Good planning not only increases the safety of the procedure, but also improves the patient's comfort and promotes a quick recovery. The first step is a consultation appointment with a plastic surgeon. During the meeting, the doctor takes a detailed medical history, assesses the degree of skin flaccidity and the quality of the shoulder tissues, discusses the patient's expectations and possibilities for an aesthetic result, and informs about possible scarring, limitations and risks of complications.

During the consultation, the surgeon can take documentary photos to help plan the course of the surgery and compare the "before" and "after" results.

Immediately before the procedure, the surgeon makes markings on the skin (known as cut mapping), and the anesthesiology team conducts an evaluation and qualifies for general anesthesia. The patient is then taken to the operating room, where the procedure takes place.

Arm lift vs. other procedures

An arm lift is a procedure that can be performed as a stand-alone operation, but is very often part of a broader body contouring plan - especially in patients after significant weight loss. Losing a lot of weight is usually associated with excess loose skin not only on the arms, but also on the thighs, abdomen or back.

Therefore, brachioplasty can be:

• combined with thigh plasty - to firm the inner side of the legs,
• performed together withabdominal plastic surgery(abdominoplasty) - especially for so-called "post-weight loss" facelifts,
• supplemented with liposuction of other areas, such as the back, flanks or underarm area, for a consistent and natural slimming effect.

In some cases, the surgeon may also propose additional cuts in the axillary region or back, if there is also excess sagging skin there (so-called back pelicans). Their correction significantly improves the proportions and overall aesthetics of the upper half of the body.

It is important that each treatment plan is developed individually - depending on the patient's needs, condition and expectations. During the consultation, the surgeon may suggest performing several procedures simultaneously (if there are no medical contraindications), or stagger them. The goal is always a harmonious and proportional effect of the whole silhouette, which will not only improve the appearance, but also the comfort of daily functioning and self-confidence.

Also check out the other available weight loss and body contouring treatments - effective support in the fight for the ideal figure.

Frequently asked questions about how to get rid of pelicans (FAQ)

Do very visible scars remain after an arm lift?

Shoulder plastic surgery scars are quite long, but positioned to be as inconspicuous as possible. They lead from the armpit area along the inner side of the arm. They are red/pink for the first few months, gradually fading and flattening over 6-12 months. In most people after a year, they are narrow, bright lines. With daily activity or even in a short sleeve, they often go unnoticed by those around them, because they hide when the arms are lowered. Modern suturing techniques and care of the scars (silicone, sun protection) make the scars quite discreet after a while.

How much skin can be removed during such a facelift?

It depends. Sometimes a few centimeter fold of skin along the entire length of the arm is removed, and in patients after very large weight loss, even several centimeters of skin and tissue width are removed. Before the procedure, the surgeon assesses how much he can safely cut out - so as to achieve significant smoothing, but not to cause excessive tension in the wound (as this impedes healing). In any case, all visible excess is removed - after the operation, the skin is tightened, without folds, which immediately gives a spectacular improvement.

Does an arm lift also remove fat or just skin?

Normally, during an arm plasty, the surgeon removes both excess skin and a certain amount of subcutaneous fat that is in the excised area. If the arms are more massive, liposuction of the shoulder area is often additionally performed before the skin is cut out - this allows the arm to be modeled more. Thus, it can be said that the procedure removes "everything unnecessary," that is, both skin and fat. On the other hand, it does not affect the muscles - these remain intact (although they seem more defined after the operation, because the overhang is gone).

How long does the effect of the surgery last?

The effect is permanent, as long as there are no major weight changes. Skin removed will not return. Of course, with natural aging, it may sag again after many years, but not to the same extent as before the procedure, assuming a stable weight. Most patients treat brachioplasty as a one-time solution and enjoy the result for life. It is important to maintain a fairly constant weight - large fluctuations can stretch the tissues again. Regular exercise of the arms after the recovery period helps maintain a nice shape (muscles fill out the arms from the inside).

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