San Diego Cosmetic Surgeon Dr. Tom Pousti Talks About Arm Lift : Brachioplasty



Arm tissue relaxes with age, gravity and weight loss. The drooping of skin is from a stretching of the anchoring system of the arm and loss of supporting fat. Patients are very unhappy with this “loose hammock” appearance.

Arm Strength Training Post-Surgery 

The Surgical Procedure

Markings are performed the night before surgery to ensure a smooth surgery.

Markings are reinforced the morning of surgery for accuracy.

Brachioplasty (arm reduction surgery) can remove excess tissue and reduce the circumference of the upper arm. Surgical correction depends on the amount of extra skin and how loose the supporting tissues have become. Extra skin is removed from incisions along the inner arm. The incision must be placed where the tissue can be best tightened but the incision must be well hidden as well. Many of our post-bariatric patients benefit from the armlifting surgery after massive weight loss causes the excess skin of the arms to hang down.


Before Arm Lift

3 Weeks After Arm Lift

Before Arm Lift

3 Weeks After Arm Lift


What To Expect After Surgery 

The dressing around the arms may be extensive. You will need to protect the incisions after surgery. Limiting lifting is important. Elevation with pillows increases comfort.

Resumption of Physical Activities

Patients are back to work 2-3 weeks after this procedure.
Being careful not to lift heavy objects continues for 2-6 weeks after surgery.

Patient Testimonial

“It’s been awhile I am 4 ½ years out from my Gastric Bypass (RNY), currently I am prepping for my cosmetic Plastic Surgery!!! I have a 100lb weight loss. I analyzed my the problem areas that bothered me the most on my body.

1. Belly/muffin top/lap apron. Whatever you call it, if I purchase pants to fit the waist-ish, butt and thighs. Then I look good however I have this muffin top that sticks out over the top of my pants and am back to wearing larger loose shirts to conceal. If I wear pants to not have the muffin top then they are falling off too big.

2. Back fat everything that hangs over the top and under the armpits around the bra area.

3. Breasts! The hang too low, I get tired of gluing (roll on medical adhesive) found out I’m allergic to Hollywood Tape to keep them in lace in my bra, mostly I just use rolled up socks to keep them in place (think back to a 12 year old girl)

4. Arms or as I call them my Bat wings. They are like a shiny object to me, when I get in the front row staring at the mirror at Zumba Class I get distracted! Watching them flap.

5. Thighs, these really don’t bother me too much as I never plan to wear micro shorts, bikini bottoms or anything that hits more than 2” above my knees.

In researching for plastic surgery, I looked at multiple web sites, asked a friend or friend of a friend etc., went to the American Society of Plastic surgery (ASPS) and American Society of Bariatric Plastic Surgery (ASBPS) web sites. I wanted as much information as I could gather for my specific problem areas. I made a multiple consultations (the majority of Plastic Surgeons will provide you with a free consultation.)

After much research on types of surgery, Doctors, multiple web sites and discussion groups here at and I have decided on having,

1. Upper Body Lift; cut on the back along the bra line to remove the extra skin that pushes up and over the bra under the arms breast area also known as spillage! With the removal of those pesky love handles.

2. Breast lift MastopexyIII; without augmentation. At a later date augmentation can be combined with the lower boy lift if I don’t like the results of just the lift. Allowing my breasts to heal completely without the added weight of implants.

3. Arm lift; Removal of excess skin from the armpit to elbow (I also call this my bat wings!)

4. At a future date 6 months or so a full circumferential lower body lift., this gave me more information on types and photos of before and after of the types of surgery I was interested in. Real Self had massive information on Board Certified Doctors, links to their web sites photos of surgeries. I crossed referenced doctors from this site based on the areas I was willing to travel to with the list I had from the ASBPS.

I narrowed it to about 8 surgeons, went thru their web sites, read their reviews (got real good at reading between the lines on the reviews) picked the ones who seemed to do a lot of post Gastric Bypass patients….off to the consultations. Do not discount the personality of the surgeon or their office staff!, if you feel uncomfortable in any way get out of there. Believe me when you find the correct one, from the time you walk thru the door the staff should greet you with smiles and make you at ease. (remember they are the Doctor’s first line of Customer Service), as you are going to be nearly naked in a few and there will be a camera involved along with a doctors hands all over your saggy parts!

Here is why I choose the Doctor I did;

* Based on he had 486 reviews and a 5 Star rating. (Believe me I read hundreds of those reviews) by the time I made my 1st consultation, I had gone through his entire web site. I had an appointment 1 1/2 week later.

* I was greeted with a smile, and offer of water and a granola bar, after about 5 minutes I was brought into an exam room dressed into a gown open to the front,. GULP.

* The Office staff put me perfectly at ease, explains what we would discuss with the doctor today, showed me some photos had me fill out a survey how I found him, when we checked the Real Self web site by this time he has 604 reviews and still a 5 Star rating.

Dr. Pousti put us (my husband and myself) very at ease, he felt it was important to tell us about himself other than just his education. His marriage, children, family, where he was from, what he loves about what he does. We got an all around feeling about him. we discussed what I wanted, my problem areas and what bothered me the most. He is the one who suggested I do not do the augmentation at the same time as the breast lift as the healing process with the added weight of implants. Dr. Pousti explained that I may not need the augmentation as he can take extra tissue from the problem area that hangs out over my bra straps under my arms and insert it into my breast’s to make them fuller (yippie) he can do all three surgeries at the same time, as this is alot at least 5 hours worth of surgery time.

Another plus out of all the other Doctors I consulted with, Dr. Pousti’s office was the only office to have actual patients for me to see and speak with about their experience. I saw at least 2 patients each time I went into the office, I saw patients at 2, 3 and 6 weeks out from surgery. Various stages of healing scar width evenness of the incision and breast lifts all were impressive. I decided to go for it, on to the financing; I used my 401k for a loan, at 4.25% you can’t beat it and I am borrowing from and paying myself back.

I did consult with another Doctor in Upland CA, I felt comfortable with him however he had no patients to talk to or see (view his work), and he wanted to break down my 3 surgeries into separate ones recovery time of 2-3 weeks each procedure (6-9 weeks off work). And regarding my lower body lift at a later date it would be done in 2 stages front and back. At 6 weeks recovery time for each total 12 weeks off work. This would be more expensive in the long run

Surgery scheduled on JULY 3, 2014 0700:
I had all three surgeries (Arms’ Upper Body lift and breast lift w/o augmentation), at Physicians Surgical Center in La Mesa by Alvarado Hospital, Dr. Pousti’s team is amazing, the nurses put you at ease, and customer care is obviously number 1. To tell the truth the only really painful part was the IV’s in the feet, by feet I mean they did my right foot and the vein rolled and the nurse couldn’t get it in, sooo she switched to the left foot got it partway in but the needle wouldn’t go all the way and they had to stick me a third time. all I can say is WOW, the IV needed to go into my foot as due to keeping the arms free for the arm lift.

My husband and I met the “team” as they entered the post op care it. Photos were taken as Dr. Pousti went over the “markings” from the night before on my body discussed and made changes with his blue marker! On the advice of Dr. Pousti I hired a nurse for the first 5 hours after surgery to help care for me in the hotel room. She also taught my husband about keeping my medication schedule, emptying my drains. She even sent him away to go eat while she was there to take care of me.

Those first 3-4 days were a bluuuurrrrrr, good pain meds, lots of sleep, Dr. Pousti even came by the hotel that first night after surgery to check on me on his way home from work….. I stayed in a hotel down the road from Dr. Pousti’s office for 6 nights from marking night (the night before surgery) and checked out the morning after my 1st post op appointment.

Dr. Pousti’s office called me EVERY DAY to follow up on how I was doing, again great customer service, caring people.
The pain from what I remember is manageable, more major discomfort than pain except the arms, you do not realize how much you use your arms to get in and out of bed, til you can’t.

By the third day I was maneuvering around to and from the bathroom ok, my problem was getting into and out of bed, could not use my arms to lift myself up. Thank god for Zumba and squat challenges, I even texted my Zumba instructor and thanked her. Advice time, Pillows pillows pillows!!!! You sleep sitting up, pillows placed under each arm. Propped on your sides to keep you from tilting to the side. And you kinda walk like a Zombie in a B grade movie.

July 7, 2014 – First post-op day 4;
First off Dr. Pousti told me my surgery was a success; I am going to be so pleased and showed me that even trussed up like a turkey with all the bandaging, he points out how smooth my area is from my hips up (love handles) – I had my bandages removed on my arms ! SUCH a difference even with the swelling.

Unfortunately they did not remove any bandaging from around my upper body lift or breast lift area. I so wanted to see my new improved boobies! My arms felt and looked so much better no bruising at all. The stitching was nice and even, straight line and I measured when I go home and there was a 3 inch difference in one arm and 3.5 inches in the other. And that was with swelling. The tape did irritate a bit no matter what kind I used and I changed the dressings twice a day sometimes.

July 17, 2014 Second post-op day 14
Ok catching up I am 9 days out and have my second post op tomorrow ( it’s like waiting for Christmas I get to be unwrapped!) so far all I have seen are my arms. Woooo hoooo the bandages on my arms, breasts and body lift areas (in other words the incision circling all around me) were removed! I have breasts! The nipples are 3 inches higher than they were (yes I measured). They are fuller and firm.

My incision for the upper body lift starts right in the front center under my breasts it circles around my body and ends approximately 1 inch from the beginning of the circle.

I no longer have love handles on my back, the tissue from under my arms the stuff that spills out over the top of my bra is now filling my breasts. My breasts are very firm I have swelling in that area. I am hoping not too much is swelling but Dr. Pousti, is pleased. My discomfort level at this time is much better mostly when I try to sleep. Or forget and reach for something.

July 24, 2014 – Third post-op day 21
Still wearing my surgical bra! It is holding the surgical pads in place. Some of my stitches were removed in my arms. They seem to be doing well the swelling has gone down much more. The rest of my stitches by my elbows and armpits as well as my back over the spine area are going to be left in for another 2 weeks as I go back to work at 25 days out from surgery.

The swelling has gone down under my arms no more spillage over my bra! Even the swelling has gone down in my breasts, I was told if I wanted to walk around topless in the house to get some relief from the heat, trade in the surgical bra and wear a sports bra (NO Underwire.)

August 21, 2014 Fourth post-op day 35
I was a little worried my arms look horrible the stitches left in were coming loose; there were gaps up near the armpits. yellow oozing, redness and very sore, still taking my pain meds as I need them. (this is normal according to the papers I read) changing my dressings twice a day, I was afraid that since I went back to work I was doing too much. According to Dr. Pousti and his staff they didn’t blink at the state of my arm, this apparently is normal. The skin under the arms is some of the thinnest on our bodies and do not take well to stitches. This is where the compression sleeves come in. I attempted to put them on 2 weeks earlier but the swelling was still too much and the pain and agony, phew. But Daisy just put new Xeroform strips and gauze with tape to cover the incision then rolled up the compression sleeves and hooked them together! No pain, I was relieved.

As for the other incisions, my back and breasts, no discharge from the upper body lift minimal form the underneath of my breasts. They by the way look fabulous! The way I am healing is so surprising the scabbing is falling off and the scars are fading and will continue to get smaller based on what I‘m told and have seen.

I only am allowing myself to drive 20 miles each way to catch my carpool, the gentlemen I work with have been taking great care of me, I even bought a new lunch box and carry a small wallet that holds driver’s license, credit card and medical card, this way they don’t get laughed at by carrying a girly purse and lunch box! They open the heavy doors and don’t let me reach or carry anything. They have been a terrific support group for me.

Today August 11, 2014
I have had to replace the Xeroform and bandages form my last post op appointment, after 4 days and the putting on and off of the sports bras have caused slippage and the Xeroform strips have dried out rubbing me raw. Today I removed the compression sleeves to wash and dry them out. I’ll put them back on later today. The bandaging from my last appointment have stayed put with no problem.

My next post-op appointment is in in 10 days. Dr. Pousti told me I should be all healed by then. I trust this will be true and can restart going back to my Zumba classes slowly!

Lastly; this was not a picnic, you must prepare yourself mentally, there is pain everybody has a different tolerance. at 6 weeks out today, I am down to taking 1/2 a Vicodin one to 2 times a day and still take 1 Valium to help me sleep through the night as my arms are sore at the end of the day around my armpit incision. You are going to get up close and personal with multiple people, especially the person who will take care of you for the next 3-4 weeks. For me it’s has been worth it. I am still planning on having the lower body lift within 6 months.

So here is my review and suggestions:
Dr. Pousti and staff: 5 Stars
Customer service / Patient Care: 5 Stars
Knowledge base of staff: 5 Stars
Time of employment of Doctors staff: 5 Stars
Surgical team: 5 Stars
Surgical Center: 5 Stars
Holiday Inn, La Mesa – (Doctors discount given): 5 Stars

Post surgical wear; large armholes, try 2XL men’s t-shirts, try thrift stores go for softest fabric.

Washing your body; you cannot get the incisions wet! I’m still waiting for that day I’m 5+wks out. Take od towels and cut them into 4×4 squares to wrap around your finger, to put soap and water just where you want them. Keep an oscillating fan on while washing the bathroom counter, this helps dry you off.”

Patient Testimonial:

In 2011 I had gastric bypass surgery. Dr. Pousti had performed a tummy tuck about 10 years earlier and I was amazed at how well my stomach area looked and felt after my bypass surgery. I still felt as if I had a girdle on under my skin and if I punched myself in the stomach my hand bounced off. What didn’t look so great after an 80 pound weight loss was my arms. At the age of 67 the muscle tone was gone and my underarms sagged and wattled back and forth. For years a wardrobe rule of thumb was that I only wore long sleeves or ¾ length sleeves every day. One year after the bypass surgery Dr. Pousti performed a brachioplasty on my upper arms, also known as an arm lift. The results have been amazing. I went from covered arms every day of the year, no matter the weather, to being very comfortable in sleeveless dresses. My upper arms are slim and tight, matching the rest of my body. I am so thrilled with the results. This is a fairly significant surgery and the follow up can be challenging. Plan on having someone with you at all times for a couple of days because you will experience some pain and may need help with eating and reaching things. You won’t be able to bend your arms well for a couple of days. This surgery was life changing – I feel very good about looking in the mirror at me in my new sleeveless and short sleeved tops. I love the difference.

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Prime Plastic Surgery
8851 Center Drive, Suite 300
San Diego, CA 91942
Phone: 619-466-8851
Fax: (619) 466-8858
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