Classification of Brachial Ptosis: Strategy for Treatment

Background: The author presents a clinical classification of brachial ptosis based on the amount of adipose tissue deposit and the degree of ptosis. This system offers guidelines for graduated treatment of fat deposit and brachial ptosis. Minor modifications to previous techniques are reported to keep the scar short, as low as possible, and not wide, and to avoid postoperative contour deformities. Five groups of upper arm problems are described, as follows: stage 1, patients with minimal fat deposit and no ptosis; stage 2a, patients with moderate fat deposit and grade 1 ptosis; stage 2b, patients with severe fat deposit and grade 2 ptosis; stage 3, patients with severe fat deposit and grade 3 ptosis; and stage 4, patients with minimal or no fat deposit and with grade 3 ptosis. Methods: Between 1996 and 2005, four modalities were used to treat 60 patients with brachial deformities: single-stage liposuction, staged liposuction, suction-assisted short scar brachioplasty, and conventional brachioplasty. Age at operation ranged between 24 and 56 years. All patients were seen and the author reviewed their medical charts during the follow-up period (12 to 38 months). Results: All patients who underwent liposuction-assisted arm dermolipectomy (stages 2a and 3) were free of incorrectly placed incisions and postoperative contour deformities. Postoperatively, skin laxity and ptosis in the axillary regions were encountered in two stage 4 patients. One patient experienced widened and hypertrophied scar secondary to wound infection. One stage 3 patient and one stage 4 patient developed postoperative distal edema. Conclusion: The clinical classification and treatment guidelines reported are designed to provide simple procedures with minimal complications that tremendously rejuvenate the arm.