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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: "Now, we're going to, we're going to mark the arms for a brachioplasty, and brachioplasty can be done going this way, so the incision goes up, it's hidden completely in the underarm, but that is only going to bring the skin closer, and she wants this to be tight like this. So, in order to really get rid of this excess skin, we need to remove this fat, and then we also need to remove the excess skin, and the excess skin will be removed from a seam coming right down here, the same, same way you would take out excess skin from a, sorry, the same way you take out excess material, okay, turn it around here, in a, if we're tailoring a blouse, the sleeve of a blouse or a jacket. So, I'm going to mark, I'm going to mark the excess skin here, and this, this skin that I'm grabbing that I've marked is going to go, and then when I close everything up, it will close like that. So, I'm going to make some cheat marks here, and this will help me in the repair, so I'll know where the, where the two sides come together. All righty, so there's our brachioplasty, and that will leave the scar going just along the inside of the upper arm. So, now we're going to move to the brachioplasty. I've made the incision here in the arm, and you can see the hanging skin right here. So, this is the skin and the fat we're going to remove, so I'm going to make this incision first, dissect down through the adipose tissue, or fatty layer, and then we'll confirm the amount of tissue we're going to be able to remove before we actually commit to the incision on the other side. So, as we dissect with the caudery through this skin here, this is the dermis. We can see the adipose tissue layers, and if you look carefully, you can see this connective tissue, and as I cauderize through the connective tissue, the lobules of adipose tissue, or fat, I'm going to bulge a little bit here, and I'm going to cut through it squarely, so I have a nice even incision and can maintain the orientation of the dissection. And we're going to restrict ourselves to just going through the subcutaneous plane.
Here, you can see, can I have that debater? Here, you can see this little blue structure right here is a vein, and I'm going to just isolate that vein, and then we'll cauderize it, so we don't have any bleeding from that. And people often wonder, when you cauderize small vessels and veins, does that affect the circulation? And yes, it can, and that's why the surgeon needs to be aware of the anatomy and what structures are being sacrificed, to be sure that it is a redundant vein, or vein that can be sacrificed without any significant consequence. You can see, as we're doing this brachioplasty, that all I'm going to do is take off the extra skin and the fatty layer, and I'm not even going to visualize the muscle because I really don't need to be down at that level anatomically, but the muscle, the tricep, is just below, bicep is just above, the deltoid is way over here, and if those muscles bulk up, then we can take up some of this looseness of the skin, but you're never going to be able to take up this much loose skin, that's just not going to be possible. So, working out will help firm up arms if you just have a little bit of looseness, but if that skin is hanging like a banner, no, working out is not going to work. You can become a milkmaid with huge arms, and it's still not going to be enough, and the only way to really tighten it up is with a surgical procedure. Okay, top clip please. Just one, and then the staple gun. So, now I'm going to put a temporary clip here on the skin, so that I can see that I've got, okay, we'll put a staple here, and now this gives me a good idea that that's not too tight, that I can resect the amount of skin that I had planned, and still not be overly tight, so that's all good. I'll take a knife, please. So, I'll complete the incision through the skin with the cautery, so we have less bleeding. I'll come up some of this loose fat, and I'll take the knife again. And that cautery, please. So, show that no, so these are the two flaps that Dr. Aronowitz has removed now.
And he's just working on going to be one side now. We can see how much extra we have, and I'll just hold that, and I will cut that off. And if you hand me the staple gun, I will show how this works. So now, my dog ear is gone, and the price of removing the dog ear is, is that the scar, the incision gets extended. But it's helpful to remember, if you are sewing a long incision, you have a dog ear at the end. Sometimes, you can adjust it by moving one side up or down a little bit, but if you're stuck with the dog ear, the patient would always rather have a little longer incision than a dog ear. So, word to the wise. So, Vicki, we're all done with. We snip this off, and then we've sewn it up, so that the scar goes just along the inside of the arm here. So when the arm is down, you don't see it from the front, and you don't see it from the back. But you do need to wear long sleeves if you're wearing, if you're outside and your arm is exposed, the scar will be exposed. But typically, it will heal with a fine faded line. She'll have no lifting for about six weeks. There'll be a little bit of pain. She'll have some narcotics for the pain, but usually, only a few days of narcotics is necessary. Pretty fast recovery from tracheoplasty, typically. And then, it is possible to do the scar going this way in the upper arm, by pulling the skin. But as you can see, that's not the best way to tailor this excess skin. When there's a lot of skin, when there's only a little bit, we can go this way, but otherwise, it's going to cause gathering, and really not be an ideal way to tailor the skin of the upper arm. So, hope you enjoy the tracheoplasty, and we'll show you some post-op results later. So till then, we'll be here in Aronowitzland, doing what we do.”
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