Back To Search Results


Editor: Ryan Winters Updated: 7/25/2023 12:45:52 AM


Brachioplasty is also referred to as an 'upper arm lift procedure.' Nearly 20,000 upper arm lifts were performed in 2019, an increase of 20% from 2015.[1] It is most commonly performed for patients following massive weight loss (MWL), and 256,000 bariatric procedures were performed in 2019, representing a 31% increase in these operations performed since 2015.[2] 

Other patient groups that may request brachioplasty include patients presenting following pregnancy and aging (senile) brachial laxity. Excess skin and ptosis can result in functional problems such as intertrigo, poor hygiene, infections, and psychosocial morbidity.[3][4] Furthermore, body contouring procedures, including brachioplasty following bariatric surgery, improve satisfaction, function, and quality of life and reduces BMI, and aid weight loss.[5][6]

Brachioplasty entails the excision of excess skin and lipodystrophy of the upper arm, which can extend onto the lateral chest wall. Patient assessment and classification of the degree of skin and subcutaneous fat excess are crucial to identify the most appropriate procedure for each patient. This is because alternatives to brachioplasty can include liposuction and liposuction combined with brachioplasty; additionally, there are variations of brachioplasty depending on the scar length and placement. Several classification systems exist, which can guide the surgeon in selecting the most appropriate procedure.[7][8][9]

Anatomy and Physiology

Register For Free And Read The Full Article
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed. Earn CME/CE by searching and reading articles.
  • Dropdown arrow Search engine and full access to all medical articles
  • Dropdown arrow 10 free questions in your specialty
  • Dropdown arrow Free CME/CE Activities
  • Dropdown arrow Free daily question in your email
  • Dropdown arrow Save favorite articles to your dashboard
  • Dropdown arrow Emails offering discounts

Learn more about a Subscription to StatPearls Point-of-Care

Anatomy and Physiology

The upper arm is the segment between the elbow and the glenohumeral joint, incorporating the axilla. The contour of the upper arm is afforded by the muscles, specifically the deltoid, biceps, and triceps. In youthful arms, the skin is taut, and there is little adiposity. The subcutaneous fat has a deep lamellar and superficial alveolar layer separated by the superficial fascial system, and it is lamellar that is prone to excess fat deposition.[10] The superficial fascial system of the arm is continuous with the clavipectoral and axillary fascia.[11]

The medial brachial and antebrachial nerves that provide sensory innervation to the inner arm and forearm, respectively, lie deep in this fascia within the deeper subcutaneous fat. The medial antebrachial cutaneous nerve branches (2-3) accompany the basilic vein from the medial epicondyle until they traverse the deep fascia of the arm approximately 8 cm proximal to the medial epicondyle. The medial brachial cutaneous nerve runs posterior and parallel to the basilic vein, and its branches terminate approximately 2 cm proximal to the medial epicondyle.[12][13] 

The deep fascia of the arm incorporates the major motor-sensory nerves (median, ulnar, radial), major vessels, including the brachial artery and its tributaries, and the muscles of the anterior and posterior compartments. The lymphatics of the upper limb accompany the venous tributaries and drain to the axillary lymph nodes. 

Appelt's classification stratifies the upper arm fat, skin excess, and lateral chest wall skin excess with corresponding recommendations.[9]

Appelt, et al., Classification[8]

Appelt et al 
Group  Clinical assessment Recommendation 
Minimal skin, moderate fat  Liposuction alone (UAL + SAL) 
IIa  Moderate proximal skin, minimal fat  Limited brachioplasty 
IIb  Moderate entire arm skin, minimal fat  Brachioplasty (possible L-shape extension) 
IIc  Moderate arm and chest skin, minimal fat  Extended brachioplasty 
IIIa  Moderate proximal skin, moderate fat  Staged liposuction or combined liposuction and limited brachioplasty 
IIIb  Moderate entire arm skin, moderate fat  Staged liposuction or combined liposuction and brachioplasty
IIIc  Moderate arm and chest skin, moderate fat  Staged liposuction or combined liposuction and extended brachioplasty 


Arm contouring procedures including liposuction [suction-assisted (SAL), power-assisted (PAL), ultrasound-assisted (UAL)], cryolipolysis, non-ablative radiofrequency, and focussed ultrasound are all suitable alternatives to brachioplasty in appropriately selected patients.[14][15] However, brachioplasty (either alone or in combination with liposuction) is most commonly employed for patients post MWL, although it may also be employed in the appropriate patient with significant skin laxity due to senile elastosis or following pregnancy. 

Patient selection and counseling are paramount in achieving acceptable results and a satisfied patient. MWL patients should be at least 1-year post-bariatric surgery and have a stable weight (defined as within 5kg of target weight) for at least 3 to 6 months, preferably 12 months.[16][17] 

Patients should have a current BMI<30, although many surgeons will selectively offer brachioplasty, among other body contouring procedures, to those with a BMI > 30.[18][19] Those patients with a high maximum BMI (pre-weight loss) and high delta BMI (difference between weight loss and body contouring surgery) have a greater likelihood of complications if undergoing multiple body contouring procedures in a single stage. Those with a high current BMI are at a greater risk of wound dehiscence and infection when undergoing a single procedure (e.g., brachioplasty alone).[20][18] 

Smoking cessation is critical, as smoking alone is associated with a significant risk of complications.[21] Many surgeons will recommend smoking cessation for at least four weeks, though improvements in other parameters after smoking cessation, such as nasal mucociliary clearance, can improve significantly as early as 15 days following smoking cessation.[22][23] 

Patients undergoing body contouring are unique in that they pose a greater risk of complications; thus, some surgeons recommend smoking abstinence for three months before considering body contouring surgery.[16]

The surgeon must also assess patient comorbidities and, where possible, optimize these through liaison with relevant specialties. Particular emphasis should be placed on optimizing diabetes and glycemic control, although many patients have a reversal of their diabetes following MWL. Furthermore, it is imperative to ascertain whether there is an increased likelihood of thrombosis (previous deep vein thrombosis/pulmonary embolism) and coagulopathies (either congenital or acquired through medications). The surgeon should specifically enquire about over-the-counter and herbal medications, as these are often unreported, and recommend that they be omitted at least two weeks preoperatively.[19][24]

Many MWL patients are prone to micronutrient deficiencies, including iron, folic acid, Vitamins B12, A, D, E, K, and minerals such as zinc and selenium.[25] The surgeon must assess these nutritional risks, and it is prudent to request a nutrition panel and address any deficiencies through liaison with the bariatric team, a dietician, and the patient's family doctor as appropriate to optimize their overall health before such an elective surgery.  

Finally, the psychosocial assessment of the patient should not be neglected, as it often governs whether the surgeon should proceed with the operation. Patients may have unrealistic expectations. They may have had no treatment or suboptimal treatment for any psychiatric disorders, with a reported prevalence of 40% in patients with MWL.[26]

About 15% of patients with MWL can also suffer from body dysmorphic disorder (BDD); thus, they may remain dissatisfied with the outcome of their brachioplasty, regardless of the aesthetic result and in the absence of complications.[19][27][19] Therefore, it is prudent to ask patients to complete a BDD screening questionnaire preoperatively and have a very low threshold to seek formal psychiatric consultation.


There are few absolute contraindications to brachioplasty. These include lymphoedema, peripheral arterial ischemia, and venous insufficiency, as well as those at high risk of lymphedema, such as a history of axillary dissection and radiotherapy.[28]

Relative contraindications take into account the aforementioned preoperative assessment. They include BMI>30, unstable weight, current smoking, comorbidities such as poorly controlled diabetes mellitus, nutritional deficiencies, BDD, and untreated or poorly managed psychiatric disorders.[19] 

More specifically, some patients may not be ideal candidates for brachioplasty. This may be due to little skin laxity (e.g., <5 cm ptosis) or residual excess adiposity unaddressed by MWL. Other patients may warrant a short-scar brachioplasty with limited resection, while others may be better suited to an extended brachioplasty that entails excision of excess tissue on the lateral chest wall. Decision-making on the most appropriate operation (if any) is contingent on a thorough preoperative examination and a plan tailored to each individual.


Specialist equipment is not necessary. A general plastic surgical tray and equipment will often suffice when performing brachioplasty. When combined with liposuction, however, equipment for performing liposuction should be made available; this is often dependent on the surgeon's practice and location. Additionally, infiltration solution with local anesthesia (such as Klein's tumescent solution) will often be used when performing concurrent liposuction.[29]


Working with a familiar multi-disciplinary theatre team that has operation awareness, appreciates the nuances of the procedure - the human factors - and knows the surgeon's preferences makes a tremendous difference.

Many, if not all, surgeons will elect to perform brachioplasty amongst other body contouring operations with staff known to them who are familiar with the operation. It enhances patient safety, reduces surgeon stress, and has better camaraderie in the workplace. At a minimum, there will be a surgeon, an anesthetic provider (whether the procedure is performed under general anesthesia or with conscious sedation), and an operative/circulator nurse. Additionally, there may be a scrub nurse or technician and a surgical assistant or co-surgeon.


Perioperative safety enables safe surgery and mitigates adverse events. Patients following MWL often require multiple body contouring procedures, and it is recommended that such procedures are staged appropriately. This staging or separation of procedures into multiple operations, at least three months apart, reduces operative time, anesthesia time, blood loss, personnel fatigue, and complications.[19][30] 

The number of stages required will vary between patients and depends on several variables, including the number of surgeons operating, the number of theatre staff and availability of multiple teams, and the risk assessment of the patient. If brachioplasty is the only procedure intended, then this lessens the perioperative risk considerably but can be mitigated further if two teams are operating simultaneously, one on each arm. 

Intraoperatively, other than essential management of the patient under GA and optimizing their comorbid risk factors, specific attention must be paid to patient positioning, patient warming, and risk management of venous thromboembolism (VTE).[19]

In brachioplasty, patients are positioned supine, with the arms abducted on arm boards and elbows flexed 90 degrees. The forearm and hands should be covered in a sterile drape or equivalent circumferentially and secured; this offers flexibility in moving the arm as desired intraoperatively.[11]

Pressure points at bony prominences should be protected using gel pads to curtail the risk of nerve injury. Preventing hypothermia is imperative and may be achieved using several measures, including a heated gel pad, limiting exposure to the operative site, Bair huggers, warming blankets, and administering warmed intravenous fluids.

Venous thromboembolism is a serious and highly undesirable complication. Prudent measures to curtail its risk include using a sequential compression device (SCD) placed on calves intraoperatively, administering low molecular weight heparin or equivalent following thrombosis/bleeding risk assessment as per local policy, and most importantly, encouraging early mobilization after recovery from general anesthesia. Patients should be counseled preoperatively about the benefits and rationale for early mobilization in the postoperative period.[19]

Technique or Treatment

There are several techniques for performing a brachioplasty, specifically concerning scar placement and the extent of tissue resection. The patient is positioned supine, with the arms abducted and elbow flexed to 90 degrees. Pressure points are protected with gel pads, and SCDs are placed on calves to mitigate the risk of VTE.

Patient exposure is limited to the arms, axilla, and lateral chest, and the patient is warmed during the operation. A single dose of amoxicillin-clavulanate (or similar medication per local protocol) at least 30 minutes before skin incision is often routine antibiotic prophylaxis. No further antibiotic prophylaxis is employed unless the procedure is prolonged beyond 4 hours or there is >10% volume of blood loss.[31]

The preferred approach is to assess and offer excision site liposuction before proceeding with a brachioplasty. The scar can be placed medially in the bicipital groove with cross-hatch marks to guide accurate wound closure later; this is the conventional approach. Surgeons have employed different scar designs when performing brachioplasty, including straight, "W," "S," "L" shapes, and a Z-plasty in the axilla to mitigate skin contracture.[11] 

A short-scar brachioplasty, where the incision is limited to the axilla, has also been reported. For the limited scar, or minimally invasive brachioplasty (MIB), the patients selected should have skin ptosis of < 12 cm from the mid-humerus to the most dependent part of the hanging skin with arms abducted. Reed reported a 12% revision rate utilizing this technique in a series of 1,200 patients at one year, with scar revision being the most common revision procedure required.[32] 

Other authors prefer a posterior incision brachioplasty, such that the scar sits in the brachial sulcus; some authors prefer this because the scar is less perceptible anteriorly with arms abducted, although it can be seen posteriorly with arms adducted (at rest).[33][34]

Following the skin incision, the subcutaneous fat resection is limited to the superficial fat, leaving a layer of fat over the brachial fascia of the arm.[35][32] This also preserves the medial brachial cutaneous and medial antebrachial cutaneous nerves. The extent of skin resection is tailored by determining the laxity and pulling the wound edges together along the wound - tailor tacking with the use of towel clips placed along the wound allows the surgeon to determine the safe placement of the posterior incision for excision of excess skin. The anterior incision can be extended along with the axillary dome in a curvilinear fashion and onto the lateral chest wall as in an extended brachioplasty "L" shape.[11][36] 

The same approach using tailor tacking can be employed to determine the extent of skin resection. Following hemostasis, meticulous wound closure is performed in layers. The superficial fascial system layers along each wound edge are approximated by the inclusion of the floor of the brachial fascia in a 3-point closure technique.[35] This reduces dead space and tension on the skin closure. No drains are used. The wound is dressed with steristrips, and micropore tape and postoperative compression garments are applied, including the palm/forearm and arm. The procedure is then repeated on the contralateral arm.

Multimodal analgesia in the form of local anesthetic in the wound site during infiltration before liposuction and postoperative oral analgesia (paracetamol, codeine, or equivalent) is recommended. 

Postoperatively, patients are discouraged from any strenuous activity for a minimum of 2 weeks and refrain from driving for this period. The use of compression garments is recommended for four weeks. Nearly all patients are discharged on the same day and followed up in the clinic in 1 week, and patients are encouraged to wet the wounds as desired, provided there is no evidence of wound dehiscence or infection in the 1st outpatient clinic review.


Patient counseling, preoperative discussion, and informed consent are paramount. It mitigates dissatisfied patients, provides realistic expectations, and prepares patients for potential complications and revision surgery. Patients following MWL often undergo several procedures to address excess skin and lipodystrophy in many areas not limited to the arms, chest, back, abdomen, and thighs. As a result, these patients are at a greater risk of complications, especially when such procedures are combined in 1 operation.[37] Massive weight loss achieved through bariatric surgery confers even higher risk to these patients.[20]

In a meta-analysis of 29 studies including nearly 1600 patients, the most common complications included unfavorable scarring (9.9%), recurrence of skin ptosis (7.8%), and wound dehiscence (6.9%).[28] 

The incidence of seroma (collection of fluid in the upper arm) and infection was 5.9% and 3.6%, respectively. Less common complications were nerve-related (2.5%), lymphoedema or lymphocele (2.5%), skin necrosis or delayed healing (2.3%), and hematoma (2%). Revision surgery was required in 7.5% of patients to improve the aesthetic outcome, whilst re-operation for non-aesthetic reasons was uncommon (1.6%). Furthermore, combining liposuction with brachioplasty reduced the incidence of complications (p<0.05).[28] 

In a prospective study of nearly 2,300 patients undergoing brachioplasty, the authors intended to capture major complications; they reported that hematoma (1.7%) and infection (1.1%) were the most common major complications.[38]

Further insight from their study revealed that male gender and having combined procedures were associated with increased risk of hematoma, whilst a BMI = or > 30 was independently associated with increased infection risk. Therefore, judicious patient selection and informing patients about the increased morbidity as appropriate facilitates thorough preoperative counseling and tailors expectations.

Clinical Significance

Most patients are pleased with the aesthetic and functional outcome of their brachioplasty. Yet, as mentioned earlier, the most common reason for revision operation is to enhance the aesthetic outcome.[28] Nevertheless, it is important to warn patients about unfavorable scarring, and that scar maturation and fading are prolonged following brachioplasty; it may only mature adequately after one year, unlike other anatomical sites.[35]

Enhancing Healthcare Team Outcomes

Brachioplasty is a body contouring procedure that can be performed in various approaches, guided by surgeon preference. As a result, there is limited robust evidence to recommend specific techniques or approaches to brachioplasty for all patients; as with many plastic surgery procedures, the tailoring of a surgical plan to each individual patient offers the best chance of a successful outcome.

The most recent meta-analysis of complications of brachioplasty identified the most common complications are unfavorable scarring, recurrence of skin ptosis, and wound dehiscence.[28] Other complications are less common. Patient selection and optimization are crucial to maximize safety and mitigate the risk of both procedure-specific and general complications.

Preoperatively, patients should have an adequate review of their weight stability, BMI, and nutrition profile assessed in consultation with a bariatric dietician or nutritionist. Their comorbidities should be identified and optimized by liaising with relevant specialist colleagues, for example, endocrinologists, cardiologists, and pulmonologists, as appropriate.

Patients with poorly managed or untreated psychiatric disorders should have a consultation with a psychiatrist to optimize their mental health, and similarly, those with BDD or with unrealistic expectations should be reviewed by a clinical psychologist and may not be candidates for brachioplasty or other body contouring procedures. A preoperative assessment for anesthesia with the anesthesiologist is essential to minimize the risk of GA and optimize patients for surgery. Coordinated activity and sharing of information between all interprofessional healthcare team members will facilitate successful outcomes in brachioplasty procedures.

Nursing, Allied Health, and Interprofessional Team Monitoring

Brachioplasty can often be performed as a day-case operation, although high-risk patients (BMI>30, other comorbidities) may warrant overnight admission and monitoring. Pain management can be guided in consultation with the anesthesiologist, and a multi-modal approach is preferable to reduce opiate dependency. The use of closed suction drains is surgeon-dependent, but current evidence does not indicate that the use of drains reduces seroma incidence.[39] 

Many surgeons will recommend postoperative compression garments to reduce swelling and provide comfort, but there is no robust evidence that they reduce the incidence of any complications.[11]



. The Aesthetic Society's Cosmetic Surgery National Data Bank: Statistics 2019. Aesthetic surgery journal. 2020 Jun 15:40(Suppl 1):1-26. doi: 10.1093/asj/sjaa144. Epub     [PubMed PMID: 32542351]


English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, Morton JM. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2020 Apr:16(4):457-463. doi: 10.1016/j.soard.2019.12.022. Epub 2020 Jan 3     [PubMed PMID: 32029370]


Koller M, Schubhart S, Hintringer T. Quality of life and body image after circumferential body lifting of the lower trunk: a prospective clinical trial. Obesity surgery. 2013 Apr:23(4):561-6. doi: 10.1007/s11695-012-0849-z. Epub     [PubMed PMID: 23338048]

Level 2 (mid-level) evidence


Modarressi A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B. Plastic surgery after gastric bypass improves long-term quality of life. Obesity surgery. 2013 Jan:23(1):24-30. doi: 10.1007/s11695-012-0735-8. Epub     [PubMed PMID: 22923310]

Level 2 (mid-level) evidence


Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H. Does Body Contouring After Bariatric Weight Loss Enhance Quality of Life? A Systematic Review of QOL Studies. Obesity surgery. 2018 Oct:28(10):3333-3341. doi: 10.1007/s11695-018-3323-8. Epub     [PubMed PMID: 30069862]

Level 2 (mid-level) evidence


ElAbd R, Samargandi OA, AlGhanim K, Alhamad S, Almazeedi S, Williams J, AlSabah S, AlYouha S. Body Contouring Surgery Improves Weight Loss after Bariatric Surgery: A Systematic Review and Meta-Analysis. Aesthetic plastic surgery. 2021 Jun:45(3):1064-1075. doi: 10.1007/s00266-020-02016-2. Epub 2020 Oct 23     [PubMed PMID: 33095301]

Level 1 (high-level) evidence


Teimourian B, Malekzadeh S. Rejuvenation of the upper arm. Plastic and reconstructive surgery. 1998 Aug:102(2):545-51; discussion 552-3     [PubMed PMID: 9703097]


Appelt EA, Janis JE, Rohrich RJ. An algorithmic approach to upper arm contouring. Plastic and reconstructive surgery. 2006 Jul:118(1):237-46     [PubMed PMID: 16816702]

Level 3 (low-level) evidence


El Khatib HA. Classification of brachial ptosis: strategy for treatment. Plastic and reconstructive surgery. 2007 Apr 1:119(4):1337-1342. doi: 10.1097/01.prs.0000254796.40226.92. Epub     [PubMed PMID: 17496609]

Level 2 (mid-level) evidence


Avelar J. Regional distribution and behavior of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic plastic surgery. 1989 Summer:13(3):155-65     [PubMed PMID: 2801296]


Miotto G, Ortiz-Pomales Y. Arm Contouring: Review and Current Concepts. Aesthetic surgery journal. 2018 Jul 13:38(8):850-860. doi: 10.1093/asj/sjx218. Epub     [PubMed PMID: 29546270]


Myers PL, Bossert RP. Arm Contouring in the Massive-Weight-Loss Patient. Clinics in plastic surgery. 2019 Jan:46(1):85-90. doi: 10.1016/j.cps.2018.08.011. Epub 2018 Oct 22     [PubMed PMID: 30447832]


Chowdhry S, Elston JB, Lefkowitz T, Wilhelmi BJ. Avoiding the medial brachial cutaneous nerve in brachioplasty: an anatomical study. Eplasty. 2010 Jan 29:10():e16     [PubMed PMID: 20165546]


Chia CT, Theodorou SJ, Hoyos AE, Pitman GH. Radiofrequency-Assisted Liposuction Compared with Aggressive Superficial, Subdermal Liposuction of the Arms: A Bilateral Quantitative Comparison. Plastic and reconstructive surgery. Global open. 2015 Jul:3(7):e459. doi: 10.1097/GOX.0000000000000429. Epub 2015 Aug 10     [PubMed PMID: 26301148]


Stevens WG, Pietrzak LK, Spring MA. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthetic surgery journal. 2013 Aug 1:33(6):835-46. doi: 10.1177/1090820X13494757. Epub 2013 Jul 15     [PubMed PMID: 23858510]

Level 2 (mid-level) evidence


Herman CK, Hoschander AS, Wong A. Post-Bariatric Body Contouring. Aesthetic surgery journal. 2015 Aug:35(6):672-87. doi: 10.1093/asj/sjv008. Epub 2015 Apr 22     [PubMed PMID: 25902949]


Soldin M, Mughal M, Al-Hadithy N, Department of Health, British association of Plastic, Reconstructive and Aesthetic Surgeons, Royal College of Surgeons England. National commissioning guidelines: body contouring surgery after massive weight loss. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2014 Aug:67(8):1076-81. doi: 10.1016/j.bjps.2014.04.031. Epub 2014 May 10     [PubMed PMID: 24909630]


Marouf A, Mortada H. Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis. Aesthetic plastic surgery. 2021 Dec:45(6):2810-2820. doi: 10.1007/s00266-021-02315-2. Epub 2021 May 20     [PubMed PMID: 34018015]

Level 1 (high-level) evidence


Kokosis G, Coon D. Safety in Body Contouring to Avoid Complications. Clinics in plastic surgery. 2019 Jan:46(1):25-32. doi: 10.1016/j.cps.2018.08.004. Epub 2018 Oct 22     [PubMed PMID: 30447825]


Coon D, Gusenoff JA, Kannan N, El Khoudary SR, Naghshineh N, Rubin JP. Body mass and surgical complications in the postbariatric reconstructive patient: analysis of 511 cases. Annals of surgery. 2009 Mar:249(3):397-401. doi: 10.1097/SLA.0b013e318196d0c6. Epub     [PubMed PMID: 19247025]

Level 3 (low-level) evidence


Coon D, Tuffaha S, Christensen J, Bonawitz SC. Plastic surgery and smoking: a prospective analysis of incidence, compliance, and complications. Plastic and reconstructive surgery. 2013 Feb:131(2):385-391. doi: 10.1097/PRS.0b013e318277886a. Epub     [PubMed PMID: 23358000]


Krueger JK, Rohrich RJ. Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery. Plastic and reconstructive surgery. 2001 Sep 15:108(4):1063-73; discussion 1074-7     [PubMed PMID: 11547174]


Ramos EM, De Toledo AC, Xavier RF, Fosco LC, Vieira RP, Ramos D, Jardim JR. Reversibility of impaired nasal mucociliary clearance in smokers following a smoking cessation programme. Respirology (Carlton, Vic.). 2011 Jul:16(5):849-55. doi: 10.1111/j.1440-1843.2011.01985.x. Epub     [PubMed PMID: 21545372]

Level 2 (mid-level) evidence


Byard RW. A review of the potential forensic significance of traditional herbal medicines. Journal of forensic sciences. 2010 Jan:55(1):89-92. doi: 10.1111/j.1556-4029.2009.01252.x. Epub     [PubMed PMID: 20412155]


Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C, Endocrine Society. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism. 2010 Nov:95(11):4823-43. doi: 10.1210/jc.2009-2128. Epub     [PubMed PMID: 21051578]

Level 1 (high-level) evidence


Mitchell JE, Selzer F, Kalarchian MA, Devlin MJ, Strain GW, Elder KA, Marcus MD, Wonderlich S, Christian NJ, Yanovski SZ. Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2012 Sep-Oct:8(5):533-41. doi: 10.1016/j.soard.2012.07.001. Epub 2012 Jul 14     [PubMed PMID: 22920965]


Crerand CE, Franklin ME, Sarwer DB. Body dysmorphic disorder and cosmetic surgery. Plastic and reconstructive surgery. 2006 Dec:118(7):167e-180e. doi: 10.1097/01.prs.0000242500.28431.24. Epub     [PubMed PMID: 17102719]


Aljerian A, Abi-Rafeh J, Ramirez-GarciaLuna J, Hemmerling T, Gilardino MS. Complications in Brachioplasty: A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery. 2022 Jan 1:149(1):83-95. doi: 10.1097/PRS.0000000000008652. Epub     [PubMed PMID: 34936607]

Level 1 (high-level) evidence


Hanke C, Dent M. Tumescent Anesthesia: A Brief History Regarding the Evolution of Tumescent Solution. Journal of drugs in dermatology : JDD. 2021 Dec 1:20(12):1283-1287. doi: 10.36849/jdd.6212. Epub     [PubMed PMID: 34898147]


Almutairi K, Gusenoff JA, Rubin JP. Body Contouring. Plastic and reconstructive surgery. 2016 Mar:137(3):586e-602e. doi: 10.1097/PRS.0000000000002140. Epub     [PubMed PMID: 26910703]


Carlesimo B, Cigna E, Fino P, Rusciani A, Tariciotti F, Staccioli S. Antibiotic therapy of transaxillary augmentation mammoplasty. In vivo (Athens, Greece). 2009 Mar-Apr:23(2):357-62     [PubMed PMID: 19414427]


Reed LS. Brachioplasty with limited scar. Clinics in plastic surgery. 2014 Oct:41(4):753-63. doi: 10.1016/j.cps.2014.06.009. Epub     [PubMed PMID: 25283460]


Aly A, Soliman S, Cram A. Brachioplasty in the massive weight loss patient. Clinics in plastic surgery. 2008 Jan:35(1):141-7; discussion 149     [PubMed PMID: 18061808]


Nguyen AT, Rohrich RJ. Liposuction-assisted posterior brachioplasty: technical refinements in upper arm contouring. Plastic and reconstructive surgery. 2010 Oct:126(4):1365-1369. doi: 10.1097/PRS.0b013e3181ebe23c. Epub     [PubMed PMID: 20885260]

Level 2 (mid-level) evidence


Egrari S. Brachioplasty: A Personal Approach. Aesthetic surgery journal. 2016 Feb:36(2):193-203. doi: 10.1093/asj/sjv146. Epub 2015 Sep 29     [PubMed PMID: 26420773]


Hurwitz DJ, Holland SW. The L brachioplasty: an innovative approach to correct excess tissue of the upper arm, axilla, and lateral chest. Plastic and reconstructive surgery. 2006 Feb:117(2):403-11; discussion 412-3     [PubMed PMID: 16462319]


Coon D, Michaels J 5th, Gusenoff JA, Purnell C, Friedman T, Rubin JP. Multiple procedures and staging in the massive weight loss population. Plastic and reconstructive surgery. 2010 Feb:125(2):691-698. doi: 10.1097/PRS.0b013e3181c87b3c. Epub     [PubMed PMID: 20124854]


Nguyen L, Gupta V, Afshari A, Shack RB, Grotting JC, Higdon KK. Incidence and Risk Factors of Major Complications in Brachioplasty: Analysis of 2,294 Patients. Aesthetic surgery journal. 2016 Jul:36(7):792-803. doi: 10.1093/asj/sjv267. Epub 2016 May 23     [PubMed PMID: 27217588]


Zomerlei TA, Neaman KC, Armstrong SD, Aitken ME, Cullen WT, Ford RD, Renucci JD, VanderWoude DL. Brachioplasty outcomes: a review of a multipractice cohort. Plastic and reconstructive surgery. 2013 Apr:131(4):883-889. doi: 10.1097/PRS.0b013e3182827726. Epub     [PubMed PMID: 23542260]

Level 2 (mid-level) evidence