Buh-Bye Bat Wings! The Secret to Snatched Sleeveless Arms

Dr. G (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. Hey everyone. It's All the B's. We're back. Dr. Gallus here and Brianna or Bri.

Bri (00:16):
Wow, that was so formal. She called me by my full name.

Dr. G (00:19):
I know.

Bri (00:19):
I feel like I'm in trouble.

Dr. G (00:20):
No. Or when you answer the phone at our office and you're like, this is Brianna, and I'm like, who's Brianna?

Bri (00:26):
It just sounds more professional.

Dr. G (00:28):
It does. So cute. Anyway, we're going to talk about arm lifts today. So we just did one yesterday. It's very satisfying.

Bri (00:37):
It really is.

Dr. G (00:40):
And I think they're going to become more common with the presence of GLP ones in our lives, all that weight loss. But first we got to hit our celebrity news or celebrity adjacent news in our first topic, which is the ASPS annual statistics about what's what in plastic surgery. And I do believe I talked about this on Instagram briefly. So every year the American Society of Plastic Surgeons does a huge survey and releases what the most popular procedures are for both reconstructive and aesthetic surgery. But this year, nothing new.

Bri (01:26):
That's crazy.

Dr. G (01:27):
It's like copy paste 2023 into 2024. So I don't know. We'll see if 2025 is any different, but as usual, the number one aesthetic procedure is liposuction, I think, because it's just easily accessible for patients to do. And then there's been almost no delta, no change in the number of procedures from year over year. So if you pick a procedure like Adominoplasty or tummy tuck, 1% change, BBLs, 0% change, labiaplasty 2% increase. It's like a hundred percent increase in our office, but 2% increase nationally speaking. Breast reductions, which had been on the upward trend are still popular, but 1% change. So you get the gist.

(02:26):
So the top five cosmetic surgical procedures, which tend to be the top five every year are liposuction, breast augmentation, tummy tuck, breast lift, and bleph, which is an eyelid lift. So the blepharoplasty has been in the top five for three years in a row, and breast lift is also remaining popular. So props. So the thoughts are that facelift is going to increase and become more popular and maybe crack the top five, but I don't know, facelifts are a little bit more expensive and a bigger commitment. So things like facelift and rhinoplasty remain popular, but not in the top five procedures just on a volume standpoint. So there you have it.

Bri (03:12):
I feel like a labiaplasty and bleph is going to go up. I feel like breast aug's going to go down. It's all about the itty-bitty titty committee nowadays.

Dr. G (03:24):
Yeah, they've been saying that, but I feel like as long as they continue to put out Love Island, we're not going to lose breast augmentation in the top five.

Bri (03:33):
Okay. Okay. That's fair.

Dr. G (03:35):
The casting for that alone is keeping that procedure afloat. It's a commercial for implants pretty much. They should just have a little placard or the little thing at the bottom, the Chiron that says 445 cc under the muscle, like a little, you could do a whole watching with their exact procedure listed. So you know how when you look at on house and you can click the button that gives you the tag and it'll say, oh, you want to buy this light or this faucet, and it would be the same thing.

Bri (04:11):
Oh really?

Dr. G (04:12):
Yeah, you can hit shop.

Bri (04:14):
That was so dumb. I was thinking of the show house.

Dr. G (04:16):
Oh no, that'd be great.

Bri (04:18):
Where he discovers all the,

Dr. G (04:20):
I meant the app.

Bri (04:21):
He was like, what?

Dr. G (04:22):
Or like LTK, where you can shop the look. You should be able to shop the look. So-and-so has four syringes of lip filler. This is the product she's using. This is what it'll cost you if you want to look ridiculous.

Bri (04:35):
Everyone's about to be transparent because of Kylie Jenner.

Dr. G (04:39):
I think it's, yeah, it's definitely people are throwing it out there. So speaking of Love Island, wow, that was a good segue, right? From ASPS statistics to this girl. I mean, yeah, you brought this to my attention, so please.

Bri (04:56):
We have, I want to almost say, been bullied over the last two weeks into watching Love Island, and neither of us have watched it. So obviously last weekend I went on this tangent and then Vanna comes in to the show and she is so beautiful, but what the fuck did she do to her face? She has so much filler and her chin from the side profile is kind of insane. And then she says she hasn't had any chin filler, but there's all these before and afters of where she was three years ago where she was absolutely gorgeous, very natural. Did not have that chin. I mean, at what point? This is just an injector can't say no?

Dr. G (05:41):
She

Bri (05:42):
Everything

Dr. G (05:43):
Insane.

Bri (05:44):
Yeah.

Dr. G (05:45):
I mean, she looks a little bit like an anime version of herself.

Bri (05:50):
She says she looks like everyone in Utah. That was her schtick.

Dr. G (05:54):
Well, I feel like we've watched The Secret Lives of Mormon Wives, and she doesn't look exactly like them.

Bri (06:01):
No.

Dr. G (06:01):
Not even the hairs on brand for them.

Bri (06:05):
I mean, the extensions are not full on the bottom. She does not go to Jenna Styles. Or whatever. Her hair salon places.

Dr. G (06:15):
I mean, maybe the chin thing is just a dodge. Maybe she doesn't have chin filler and she got a chin implant. That's possible, right? Yeah.

Bri (06:24):
Is their side profile, because it looks insane.

Dr. G (06:31):
Let's see. There should be one that we can flash up on the screen because it's not only pointy and projecting, it's also kinda inferiorly displace. So it gives her a witch's chin, if you will.

Bri (06:46):
Can I just comment that E-News literally has a whole tab for Kardashians right next to the Royals. Okay. When you made it.

Dr. G (06:58):
Isn't their show originally produced by them? I feel like it's probably in the contract.

Bri (07:04):
Yeah. That's just so funny.

Dr. G (07:06):
Oh, here we go.

Bri (07:07):
That is not natural.

Dr. G (07:09):
No.

Bri (07:10):
Look at her chin to the left on that TikTok. That's how it looks on camera. It looks insane. It looks like she has an implant or whatever filler. It's just

Dr. G (07:21):
Whatever it is, it's migrating off her poor little face. So somebody go in there and fix that. I hope it's filler in her case, then they could just dissolve it, but it really looks crazy.

Bri (07:32):
She came out and said she doesn't want anything dissolved after people went in on her face.

Dr. G (07:41):
I mean, what are you going to say? I don't know. I feel like sometimes those things are a slippery slope, and so by the time someone points it out to you, you're gradually getting used to this new look. And so maybe it comes as a shock on a certain camera angle that it's not what you thought it was. You're not looking at your side profile ever, unless you're looking at pictures of yourself. So, well, yeah, we're the exception. A lot of people are not looking at their stuff.

Bri (08:17):
As, I was just asking for filler two seconds ago.

Dr. G (08:22):
I know. And we said no.

Bri (08:24):
Yeah, say no injectors need to say no moral the story.

Dr. G (08:29):
Okay. Alright. And then another, well, this actually wasn't brought, I was going to say brought to us by Bri, but this one was brought to us by Stella, who is one of our, OR nurses, I know from way back. She runs the AORN locally. So that's the RN mafia for surgical nurses. And she sent it to us in our group chat. This nurse got called out by a neurosurgeon. So not to profile, but neurosurgeon, because a surgeon's viral meltdown on a live stream. And I'm like, first question, what kind of surgeon? Let me tell you what kind of surgeon, a neurosurgeon

Bri (09:10):
I would have said a urologist.

Dr. G (09:12):
Specifically a spine surgeon. Yeah. No surgical oncologist is screaming. I mean maybe, but they're just running the numbers. It's going to be a neurosurgeon.

Bri (09:24):
I got yelled at pretty bad by a urologist one time, and this massive case, it was up at Camp Pendleton and there was 26 people in the room because they had all flown in for this giant case. And I was a student and I had never done holding the whatever, and he had a meltdown and he ended up getting in trouble later on.

Dr. G (09:44):
Oh really?

Bri (09:45):
Yeah. A nurse. Yeah. Said something . Pretty rough.

Dr. G (09:50):
Urologists are usually pretty chill, but I guess if it's a big cancer case, they can get a little stressed out. This guy, I think it's crazy that he was live streaming the surgery and didn't think it was out of pocket to be screaming at this nurse about suction no less. If you listen to it, it's so bad. He just keeps going, suctions should suck. I know what sucking is like, and you're like, oh my God, I can't.

Bri (10:19):
I'm trying to do revolutionary surgery here. I know what sucking is. Sucking. It's not sucking.

Dr. G (10:26):
I was like, stop saying sucking. Just start there.

Bri (10:28):
Yes. I was like, oh, can you just say the suction's not on? Yeah.

Dr. G (10:34):
And then he proceeds to totally not safe for work, just calls her a bitch over and over again. Stupid bitch. It's really bad.

Bri (10:45):
He goes off on her .

Dr. G (10:48):
Because of suction. Is something bleeding? What is even happening?

Bri (10:53):
I don't know. The suction's on, what would Jordan always say? It's on girlfriend status, not wife status.

Dr. G (11:02):
That's right. But I don't even know what I would do if you started yelling at me like that. I'd probably just give you a little throat punch or something.

(11:14):
I feel like you might walk out. Who does that?

Bri (11:17):
Think I might.

Dr. G (11:17):
I mean, I have definitely gotten upset in the or not recently, really, but not that when something's not right. Certainly in my hospital setting I could get upset, but mostly when people just did, I don't know.

Bri (11:35):
Not here, here's perfect.

Dr. G (11:36):
Sometimes it was just really stupid stuff happens and you're like, we're trying to do the right thing for patients, so maybe we could get this right. Especially if it's something over and over again. However, I think actually in terms of equipment failure, getting a skin graft, the dermatome should work because if I put that down on someone's leg to take skin and it doesn't work, then I've just given them road rash and I have to go take another piece of skin. So that kind of stuff can be upsetting for lots of reasons. I mean, my work around was to set the dermatome myself, but sometimes there was things, I literally had so many issues with it when I first started working at the Navy Hospital, I took all the dermatomes we had in-house and took them down to the cadaver lab and tested 'em because I needed to know which one was the broken one and what a better way to practice, and so that I could get rid of the ones that didn't work cuz they kept rotating them in and out. And I'm like, we're not, this isn't something to experiment with. So anyway, not on live actual patients. Yeah.

Bri (12:55):
That's crazy. And then he goes to say, oh, she has been good in the past, but she had an attitude today.

Dr. G (13:01):
I was like, what kind of working environment is this? Oh yeah. So here it is. All right, so 29 years of sucking fluids out of patients with sucking. Do you think I know if it's working or not? I'm telling you. Don't talk back to me and listen. I don't give a F how long you've been a nurse in your nursing is shit.

Bri (13:19):
I love how you bleeped out F.

Dr. G (13:23):
Well, they sort of bleeped it out.

Bri (13:25):
And even after that he goes on and on and on. The girl that was whatever said it was 50 minutes.

Dr. G (13:35):
I know.

Bri (13:36):
Yeah, 50 minutes. And she kind of gave a little breakdown. I don't know. That's just so inappropriate. I think at that point you just need to be walk out of the room.

Dr. G (13:47):
Yeah. However, comma, I feel like it's funny that people are surprised that in the healthcare setting that we're spoken to that way. I mean, people talk to residents that way or used to. It's a lot better. So when you do see this now you're like, whoa, it's not 20 years ago, bro. Knock it off. Be professional. I used to say it was one of the last settings where people could be so unprofessional and get away with it. I think some sort of high powered CEO offices and board rooms are like this, but the day-to-day you cannot, can't do that. It's rude. Anyway, they took down on the live stream, it was still up, so they edited out the part where he's screaming at the nurse. But because people are commenting as it goes, asking him questions during the surgery, that it's still referenced in there. Also, who live streams their surgery?

Bri (14:47):
Right? If it's so

Dr. G (14:49):
Intense.

Bri (14:50):
Yeah. Probably shouldn't be answering questions and taking questions while you're trying to focus on surgery.

Dr. G (14:56):
Yeah, I can't. Alright, moving on.

Bri (15:00):
Oh, also side note, he was from Florida.

Dr. G (15:03):
Oh, that's right. I was like, where's this happening, Florida.

Bri (15:09):
On brand?

Dr. G (15:10):
Yeah. We don't talk like that in California in the OR.

Bri (15:14):
Yeah, absolutely not. Although

Dr. G (15:17):
Much more inclusive.

Bri (15:19):
Yeah, you should hear, I really wish that we could put little mics on in the OR because our conversation is just absolutely riveting. It is so good.

Dr. G (15:29):
Well, girlfriend suction, thanks for announcing that to everybody.

Bri (15:32):
Yeah, girlfriend suction also, I'm pretty sure we yelled at the nurse yesterday to make sure Diddy trial alerts were on.

Dr. G (15:40):
She wasn't paying attention. We needed updates.

Bri (15:43):
We're like, can you make sure that your alerts are on for the DIDDY trial? So we don't a good segue to the Diddy trial. I cannot. Okay. I can, but I can't believe that he only got found on, what was it, transportation for prostitution or something?

Dr. G (16:01):
Yeah, because that wasn't like, duh,

Bri (16:03):
He's going to be home before he knows it. That's crazy. This whole case was crazy.

Dr. G (16:11):
New parties, I'm sure scheduling. He was having them even after he was indicted, before he was picked up after Cassie sued. He never stopped until he had to go to jail.

Bri (16:23):
Right. I mean, he's probably still having him in jail. Let's be real. Okay. He goes both ways.

Dr. G (16:32):
Yeah, I think it's a little disappointing. I don't know. This is not a legal podcast, so I can't comment what the burden of proof is for sex trafficking. I know the burden of proof for racketeering is pretty high. He obviously transported people for prostitution that was not questioned. I mean, they had the receipts. But yeah, it's just disappointing for the women who went ahead and testified. I also feel sorry for future women who maybe end up with him, although you should be eyes wide open in what you're getting into, but if he continues to abuse women, you can just consider that you'll never be able to press charges because he's already been accused of all these things. So to go into a relationship with him right now and not expect to be treated like dirt and have to do these freak offs, you're never going to argue to anybody that you didn't know. So he sort of smoothed out any future plans.

Bri (17:41):
I mean, what happened to blowing up a car and assault and all of that, that 's just like.

Dr. G (17:49):
They didn't have enough evidence. I guess.

Bri (17:51):
All the drugs, all the guns, nothing. And Diddy, I'm not against you, but I am absolutely not for you.

Dr. G (18:00):
Yeah. I feel like I just wonder how long it'll take for him to rehabilitate his image and be back in the spotlight. I feel

Bri (18:07):
He's 55.

Dr. G (18:09):
No, he'll circle back around. This is America. People reinvent themselves all the time. Will Smith's back making movies? Come on.

Bri (18:20):
He's going to come out at church or something.

Dr. G (18:22):
Diddy will end up with Kanye doing something and then

Bri (18:25):
Oh, a hundred percent. I'm pretty sure they already have something going on. I read it when Kanye showed up for his court appearance wearing all white. I think he was trying to get the Diddy parties back.

Dr. G (18:36):
Yeah,

Bri (18:37):
Kanye's like, now's my time.

Dr. G (18:39):
It'll be the kind of the celebrities who stands with them, who doesn't, who's super relieved that none of their dirty laundry got aired.

Bri (18:51):
Yeah. Crazy.

Dr. G (18:54):
A little disappointing. Not as disappointing as this poor woman dying after surgery in where? Turkey, but go to Turkey. It's cheap. Knock yourself out.

Bri (19:07):
And she partied with her doctor the night before.

Dr. G (19:10):
Which is crazy. So yeah. So this is out of England. This for some reason on our breaking news, we're also seeing the Idaho trial, which is not even remotely adjacent to plastic surgery. So we're just going to skip. But yeah, this influencer, Anna, Barbara Buhr Buldrini dead at 31. She went to Turkey for her surgery. She went out drinking with her doctor the night before and partying and then died during surgery.

Bri (19:44):
How did she die?

Dr. G (19:46):
Crazy. I feel like it was an anesthesia thing, which I don't know what she partied with. I just want to say if you're going to have surgery the next day,

Bri (20:02):
A little percocet. Woo.

Dr. G (20:04):
Yeah. You don't want to be still high on drugs and under the influence of alcohol and whatever it is that she was doing that night. So makes, not a great candidate for general anesthesia and local anesthesia, and she was getting breast augmentation, liposuction and a rhinoplasty all for free. So nothing's ever free. She looks like she had already had a breast aug, probably already had a rhinoplasty. Definitely already had liposuction. This was not her first rodeo, so I think she was just getting a little cavalier about the risks of surgery. And due to scheduling issues, the surgeon decided to bring it forward to Sunday. So I think she was supposed to be operated on Wednesday. She goes out Saturday night and they're like, oh, we'll just do it tomorrow because everybody operates on Sunday. Jesus.

Bri (21:03):
Okay. I have a theory, this is from my detective theories, back to the guy that pushed his wife off a cliff. He was in fling with her. He knew what he was doing. He was like, we're just going to do it now after we partied. He knew it was going to happen. He was upset with her. They got in a fight, went to the clinic Sunday instead of Wednesday without her being prepared. I mean, it sounds kind of sus to me. No cap dead ass.

Dr. G (21:36):
Thanks for your Gen Z input. No, I think she was there traveling with her fiance or husband or something

Bri (21:44):
That don't matter. We have proven time and time again. That doesn't matter.

Dr. G (21:48):
Yeah, I think it's a little, yeah, they went to the clinic on Sunday just to see the place, but the doctor wanted to perform the procedure, so she's hung over and they proceed without even knowing that you're going to have the procedure that day. It's weird.

Bri (22:05):
Crazy. Is there staffing on a Sunday?

Dr. G (22:09):
I mean, I suppose. I don't know. It's really bad. And it's sad that people make these all she was doing the surgery in exchange for posting, which just to be clear is pretty not illegal, but against ethical rules in the US. So if you do that as an ASPS member, you could potentially be kicked out. But in Turkey, they just don't have the same standards. I don't even know who the surgeon is, but yeah, that's terrible. Anyway, so you need to vet your surgeon. I would not say just showing up after partying with them to just say, oh yeah, let's just do it now. That seems like a terrible, terrible, terrible idea.

Bri (23:06):
Yeah.

Dr. G (23:07):
So many red flags. Red flags.

Bri (23:10):
Oh, she was married.

Dr. G (23:12):
Yeah, so sorry about your sleuthing. But she did not.

Bri (23:18):
You never know. You never know.

Dr. G (23:19):
I feel like the one guy who did knock off his wife after hours in Florida doing liposuction that you could see how there might've been some intent there.

Bri (23:29):
He's like, baby, just come in. Just come in for a little something, something. I know you want a divorce, but let me give you a little pre-divorce treat.

Dr. G (23:36):
Yeah, right. And solve my problems. Okay, so we're going to talk about arm lift. And if you remember when Michelle Obama was first lady, arm lifts went up apparently 4000% because everyone was requesting the Michelle Obama arms.

Bri (23:57):
Interesting. Let's see those arms.

Dr. G (24:00):
I mean, she had amazing arms. So you could do an arm lift and it depends on whether you have loose skin or not. So that sometimes your age, whether you've had weight loss, if you have sun damage and if you skin's too loose, then we generally recommend that you have a brachioplasty. So that is excision of that skin under your arm. You can do something called a mini brachioplasty where the incision is just limited to your underarm area. I always like to say many surgeries give many results. So you just have to accept the fact that you're not going to get the full result of people always pull on their skin, you're just going to do this, but you pulling on your skin is not the same thing as excising and closing and fighting gravity. So you cannot get that tight of a result with that little mini lift. But it can be helpful in certain patients. I mean, if you want Michelle Obama arms, I suggest that you get her genetics and whatever she does for diet and exercise, those are also helpful. Yeah, she had flipping. It's really, I feel like her delts set it off. Her shoulders are,

Bri (25:21):
It really does. And she has that clavicle that I want with the little

Dr. G (25:26):
Pointy achromion.

Bri (25:27):
Yeah, yeah, yeah.

Dr. G (25:29):
She just has,

Bri (25:30):
Yeah, she looks great.

Dr. G (25:32):
Yeah, great shoulders. Great arms. Yeah. So sometimes our patients are definitely asking for that.

Bri (25:41):
I feel like a lot of people come in and they want, of course all of the non-invasive stuff or the least invasive stuff first. And at what point do you just say you are not a good candidate for this? You just need an arm lift.

Dr. G (25:57):
I mean a lot of the time. Right, okay. So it depends. If you have fat and no loose skin, then liposuction might be the answer. You can get some pretty decent retraction with that. If you have a little bit of fat and a little bit of loose skin or you're a little older, then I generally recommend liposuction with Renuvion, which we've talked about before. So that's the helium based plasma energy that's delivered to tighten the subcutaneous tissue underneath. And we do that at the same time as liposuction. When we do that, you can get some retraction, like 30%. It really depends. I like to liposuction the whole arm because I think creating that kind of trauma to the upper arm and the tricep area and all of that helps tighten the whole thing overall. And then same with the Renuvion, you really want to Renuvion, treat the whole area, not just spot treat.

(26:59):
Also, sometimes just offloading the weight of the fat that's on the lower part of your arm will let everything spring up and tighten up. So the downside of doing that of Renuvion especially is that you can sometimes get crepey skin on your arm, or if you have crepey skin because you're older and you have sun damage, it can make this crepey skin worse. Tightening up the subcu and the epidermis on top is not getting tightened. So it's like pulling the sheet straight, but the comforter is still wrinkly. I don't know. There's a good way to describe that. That's not it. But anyway, you have two layers and the bottom layer is getting pulled a little tight and the top layer is not. So the top layer ends up being relatively more wrinkly. So if you have just a crepey skin, there's not a lot of great options.

(28:01):
Sunscreen's probably the best one, a lifetime of sunscreen. So you need to turn back time and start wearing sunscreen. Or you can do radio frequency microneedling. The results are not as dramatic as most people would like, and it gets a little expensive. And you can also do Radiesse, which I like to do to those areas to help stimulate collagen. So what you're trying to do is strengthen that top layer of skin that dermis, epidermis and thicken it up a little bit so it's not as crepey. So Radiesse is usually my answer for that, dilute Radiesse. You sprinkle it in there and wait four to six weeks and maybe do it again, and you can get some decent results with that. There is no magic eraser. So yeah.

Bri (28:49):
When you do an arm lift, I know a lot of people just think of giant incisions. Is that the only way to do an arm lift or what kind of incisions? Is there a mini arm lift, regular arm lift?

Dr. G (29:03):
So yeah, I alluded to the mini arm lift, which is an incision that's in your underarm area. So it kind of hides in your armpit, but you're definitely just pulling that proximal, that skin that's closest to your underarm area tight. So if you have loose skin down around your elbow, we're not going to get that by pulling from up by the armpit. I always say when you're pulling anything, the area that's farthest away from where the incision is, is least likely to respond. So when you're doing a facelift, unfortunately the center of your face is the least likely to respond if you are just pulling skin back. And with thigh lifts, if you're pulling up from the groin crease, that area by the knees is getting the least amount of effect. And so the same thing goes for a mini arm lift. I'm going to pull, and maybe the upper third of your arm will be a little bit tighter, but we're not, it's not like pulling a sock up.

(30:07):
We're not getting your whole arm tight. So if you want more than that, then the trade-off is an incision that goes down your arm. I like to put it kind of where your bicep is on the inside of your arm so that when you're talking to people and your arms are by your side, the incision isn't visible. Alternatively, some people will do it on the very posterior aspect of your arm. I've seen that presented. It's certainly not the most common way to do it because it's completely visible from the back. There's a guy who argues you can get a tighter result, but I don't think the trade-off is worth a visible scar. So yeah, if you hold your arms up and out, you're going to be able to see the incisions, but they do heal really well and can be imperceptible after a couple of years in most patients with good scar treatment.

Bri (31:04):
I feel like all the ones I've seen look really good. I would not want that on the back of my arm though.

Dr. G (31:09):
No, not like a seam, like a silk stocking seam. It's weird, but whatever. Like I said, I've seen it presented. So for full disclosure, you can do it that way. There's nothing wrong with it, it's just a trade off. And then I always do this in conjunction with liposuction because I use the really what's kind of gnarly to watch technique, it's called an avulsion technique.

Bri (31:37):
I try to get our anesthesiologist to watch it every single time, and he refuses to.

Dr. G (31:41):
He hides behind the curtain when I do it.

Bri (31:47):
It's so cool. I mean, I don't know. You cut this out, but she just rips off the skin, makes the incision, takes a little clamp and rips off the skin. And it's really cool if you like that kind of stuff. But if you don't, don't watch.

Dr. G (32:05):
You need to look away.

Bri (32:07):
Yeah, because of all the liposuction, it makes it easy.

Dr. G (32:12):
Right. So the idea is to liposuction the area that you're planning to excise so that there really is just skin left and then the underlying muscle, and then the little nerves and veins and blood vessels are all there because the liposuction cannula has left them behind and is just taking out the fat. So then when you do that, you can excise that, make a little dermal incision, and then you pull off the skin and you have just the nerves and the lymph vessels and all those things left behind. And then you can close, bonus, no drain required because I'm not directly excising that tissue, I'm not hitting any of the nerves or vessels, so the swelling's a lot less once you heal and you don't need a drain. So once I started doing it that way, I never went back.

Bri (33:05):
I didn't even know they use drains for,

Dr. G (33:07):
Oh yeah, if you do direct excision, if you just make a cut and then kind of try to dissect all that tissue off until you feel like you can pull it tight and then make the counter incision and then pull it all together, you really need a drain excised, all the vessels and lymphatics and everything in that area. I mean, I didn't invent the avulsion technique. It's generally credited to Dr. Huntstead. So props for trying that out the first time because I don't know, can you imagine? He's like, I'm just going to rip her skin off instead after I lipo the hell out of it. I mean, it's literally you just have skin left in the area that you're going to excise. And I usually lipo the whole arm. He's also done that and made, he's retired now, but at first he was worried about liposuctioning the rest of the arm because all that fluid and then you're not using a drain, but it works out great. So I lipo the whole arm and then the area of skin that we're going to remove or the area of tissue that we want to remove or excise, we lipo to just the skin, which you normally wouldn't do in liposuction. It would look terrible. And then cut it out, rip it out, rip it off. It's very Buffalo -ill ish.

Bri (34:25):
I love it. Now I've met some doctors who only really like to lipo the posterior tiny part of the arm. Why is that? Because you've done my arms and you lipoed all around it.

Dr. G (34:38):
All the way around.

Bri (34:39):
Fabulous. After I had only got them done posteriorly, and I was like, oh, that was not it.

Dr. G (34:45):
It didn't do anything. I mean, it does something, but I do think, again, I feel like you want to address, there's always a little bit of fat on the back of the arm and over the shoulder cap. And if you're going to do it, do the whole thing. And then also I think by going all the way around, you stimulate some more skin tightening. So we're using power assisted liposuction. I'm using that exploded tip. All of that's creating just enough trauma to the tissues that it induces collagen. And so then you get more tightening that way. And obviously if you need it, you can add Renuvion. But yeah, I think by going all the way around, you're sort of shrink wrapping the whole arm instead of just that little area. And then everything else is just loose still. So just a little bit more effort. But I mean, not many surgeons, plastic surgeons, I don't know many that love doing liposuction. It's a little tedious. So I think that's why sometimes people try to do the least amount.

Bri (35:44):
It's the number one procedure from ASPS.

Dr. G (35:47):
I know, right? I mean, there's those people that go all in and do high def, which I don't usually do. Those patients are not the patients that seek me out. But that's liposuction plus just very, very, very detailed liposuction and tedious.

Bri (36:07):
Now, is there anyone that would not be a candidate for an arm lift?

Dr. G (36:12):
The person getting a thigh lift that day?

Bri (36:15):
Don't do anything arm and leg related. Have one or the other, have your upper extremities or your lower extremities available because you'll be miserable.

Dr. G (36:24):
Yeah, so I often do arm surgery combined with breast surgery. I don't love doing it with a tummy tuck, but it can be done, I guess. But I prefer to do arms and breasts together and tummy tuck and legs together because if you do the arms, we wrap you up in ACE bandages for those first few days, and then your arms are out and elevated for as much as possible. So you're a little walking around Frankenstein and you can't do too much with your arms. They're just sore. They hurt. I think having your legs also injured or sore is a lot. It's a lot

Bri (37:06):
Too much.

Dr. G (37:07):
Nobody is, I guess if you've had maybe breast cancer and you've had lymph node surgery before, doing an arm surgery might give me pause because we don't want to create lymphedema or swelling of the arm. That's a permanent problem. Really feel like there's no contraindications. Honestly, really bad Keloid scarring. Yeah, everyone's a candidate.

Bri (37:34):
Yay. We love that.

Dr. G (37:36):
And I think with GLP ones being so popular and everyone losing weight, and we live in southern California where a lot of people wear tank tops or arm short sleeves, it becomes more of a thing. It really is though a woman thing. I don't know that I've ever seen a guy present with that

Bri (37:57):
Because men

Dr. G (38:01):
Don't care?

Bri (38:02):
They don't care, but they just want to, build muscle and they don't get those chicken wingy.

Dr. G (38:11):
Yeah, the chicken wings. My mom calls chaitas for some reason, I feel like in one of the articles they got quoted as angel wings, we're like, who is calling those angel wings? Nobody.

Bri (38:23):
I'm just an angel.

Dr. G (38:25):
On God, no one's calling.

Bri (38:26):
On God. Yeah, absolutely no woman is calling them angel wings. But yeah, I think men just don't care. They just have bigger muscles though. They don't have that.

Dr. G (38:38):
Yeah, they don't really lose skin there. If they're going to lose something, they get that.

Bri (38:44):
That's a lie.

Dr. G (38:44):
Flat butt. But yeah, I think we're seeing more tightening of skin and skin excision for are patients in the coming years because of the advent of GLP ones. So we're seeing a lot more of it.

Bri (39:02):
What is the recovery like for an arm lift?

Dr. G (39:06):
So as per usual two weeks and not doing anything strenuous. So no getting your heart rate or blood pressure up, no heavy lifting. After two weeks you can get your heart rate up. So you can do cardio per se, but you need to take tension off the incision. So no lifting anything or doing press pushups, pull-ups, weight lifting with your arms for four weeks. Then once the incisions are pretty well healed, then you're going to be able to do kind of everything. I just think you might want to wear a compression garment for a while. So once we take the ACE wraps off and your swelling goes down a little bit, we put you in what I call the most ill-fitting bolero ever because it has to come. It's like a mini vest. It's awful. And we've tried different ones. They always seem to bother you in the underarm area and whatever.

(40:01):
It's just what it is. But wearing those sleeve compressions really helps the swelling go down and stay down for that first three to six month period of time. And you can go to the gym to make your arms look better. If you make your muscles look better, that can make your arms look better. But if you have that loose skin, it's not going to cause the skin to retract. You'd really have to bulk up. And I'll just say that it's hard for women to bulk up their biceps and triceps. You can get a lot stronger, but most women don't put on muscle like you would think enough to expand any space created by the weight loss.

Bri (40:44):
So we have a question. Does anyone ever regret arm lift surgery? And I'm going to answer that because I know it's a no. I feel like everyone, we've done, everyone's so happy and so excited. I mean, you don't have the angel wings.

Dr. G (40:57):
Yeah, your angel wings are gone.

Bri (40:58):
Yeah. You're now part of the devil's spawn.

Dr. G (41:05):
Yeah. I don't know what that means. Now what happens? Your angel wings are removed.

Bri (41:09):
I dunno. Now you're just a baddie.

Dr. G (41:13):
Oh my gosh. Yeah. I've had one patient that had, well, I've had one patient of mine that's had some pretty bad scarring that was a setup for keloids and we were revised, but she still appreciates the contour of her arm. And I've had another patient that had pretty bad scarring from her brachioplasty done that we've revised and improved. But I think if you're going to get fixated on anything, if there's any regret, it's the incision if it doesn't heal as you expected it to. But I think patients who are having the surgery understand that the scar is a trade-off. Just like a tummy tuck, you're going to have a scar. So if you understand that and aren't worried about it, then you're going to be pleased. We are going to make your contour look a lot better. I mean, I have a patient that was otherwise pretty overweight, had a high BMI, but her arms really did. She couldn't find normal clothes to fit because her arms hung down so much. And so even though we didn't give her Michelle Obama arms, she's happy because the actual reduction in the size of her arms is enough that she can now find regular clothes to fit.

(42:27):
We love that. Slay.

(42:29):
And of course, she healed well. So that always is a win. Yeah, if you're going to have issues, it's usually that area by the axilla or underarm area that has some healing problems. And that's because it's just in a tough spot. It's under a lot of friction with the garment. It's just moving all the time. So yeah,

Bri (42:53):
Just extra patient.

Dr. G (42:57):
If you're having an arm lift and nothing else, do you still have to go under anesthesia? A hundred percent, yes. You do not want me r

Bri (43:05):
Ripping the skin off awake.

Dr. G (43:07):
No, I don't think so. Yeah. So if you're doing liposuction just to your arms and or Renuvion, I have done that. Obviously for patients awake, you have to have a decent pain tolerance. Bri had it done that way. I've done a handful of patients awake. Most times people are combining it with something else. So we end up doing it under general anesthesia. But we have somebody coming up who's doing liposuction to her arms and Renuvion awake. She just doesn't want to do general anesthesia, which is fine. And then, but for an actual excisional surgery, yeah, you have to be asleep. No, can do. I mean, no, thanks.

Bri (43:55):
It's not worth it. I feel like we have done the very, very mini one where you can take out a section, under local.

Dr. G (44:03):
Absolutely. That's tolerated. But again, mini surgery, mini results. So you have to be accepting of that. And I think if you're not sure where you fall into with your arm questions like whether it's going to be surgery or it's going to be liposuction or it's going to be liposuction plus, then the best way to do it is to come in for a consultation and get evaluated, because we really do to see you in real life, talk to you about what your goals are, what the trade-offs are. So some people will take everything else just to avoid the incision. And some people are like, screw it, I'll just take it all. I don't care. And then, yeah, and you're right, recovery, recovery after liposuction is uncomfortable, but after a week or so, you can kind of do whatever you want. You just wear your garment so you can go back to work. You can lift weights if you feel like it. You're not going to hurt anything. It's just you're going to be swollen. So the recovery is different for the arm lift. And so recovery time is a factor as well in addition to the scars. So if you're thinking about addressing your arms loose skin or just some extra chub you want removed, come in and see us.

Bri (45:21):
Come get that extra chub taken off.

Dr. G (45:25):
It's a little subcu. It can go.

Bri (45:28):
Yeah, we love that.

Dr. G (45:29):
It's very rewarding.

Bri (45:31):
It really is.

Dr. G (45:32):
Yeah. Get those arms for the summer. Where's the beach arms?

Bri (45:36):
Exactly. You're going to be in a tank top. You're going to be at the pool.

Dr. G (45:40):
I mean, just adjacent to the arms are the chicken nuggies. So that little axillary fat pad that sits right on top of your bra, that's a common area to liposuction. So you can just do that if that's your only issue. And that's a win under local.

Bri (45:57):
Chicken nuggy lipo.

Dr. G (46:00):
If you're interested or you have questions, reach out to us on any of the platforms we're on, or give us a call at the office and we can talk more about it. If not, that's okay too. We're going to scrub in.

Bri (46:13):
And scrub out.

Dr. G (46:16):
Bye. If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, apple Podcast, Spotify, or wherever you like to listen to podcasts.