Banish Bingo Wings

By: Richard Matthews
Created on 11th August 2010

Leading cosmetic surgeon Mr Richard Matthews demystifies arm reduction surgery

The dreaded ‘bingo wings’ mainly affect women of a certain age, whose body fat redistributes to leave loose folds of skin on the under surface of the arms, or people who have lost a great deal of weight. The folds are unsightly and cause a natural reluctance to expose the upper limbs above the elbow, even in fine weather.

The consequent fashion constraints and the avoidance of swimming, of beach-based holidays and of exposure of the arms to scrutiny in public places, such as changing rooms, frequently affects self-confidence and mood.

Surgical solution

The solution to the problem is surgical and requires a finely judged operation to remove the fold from the elbow to the armpit (axilla): the trade-off is a scar along the full length of the inner aspect of the (upper) arm.

The operation, which can be carried out on both arms in one procedure, or on one arm at a time with a recovery interval of two to three months, requires a general anaesthetic and is usually followed by a one-night stay.

Hospital/clinic admission occurs on the day of surgery after a pre-operative health screen and blood test a week or so before. Any pre-existing medical conditions (such as diabetes, etc) need careful assessment and may be a reason for not doing the surgery because of the threat to healing.

The same consideration also applies to smoking, which should be stopped completely for at least eight weeks before surgery.

Before surgery, the consultant cosmetic plastic surgeon will very carefully mark up the arm, gauging the amount of skin and underlying fat that can be properly removed without making the skin too tight when it is closed.

In the axilla, a horizontal section of skin is also removed to provide a smoother repair and sometimes some adjustment is also needed at the lower end, near the elbow, to get the skin to sit more neatly.

Once the general anaesthetic has taken effect, the patient is positioned on her (or his) back with the arm(s) positioned away from the body on a special board. Careful antiseptic cleaning of the upper limb, axilla, shoulder and outer chest is carried out (antibiotics are also given against infection) and sterile drapes are placed for full hygiene.

Taking care

Using the preoperative skin markings – and always erring on the side of caution – the skin (and any fatty component) constituting the skin fold is cut away, together with the additional portion in the axilla.

Great care is taken to avoid both taking too much skin away and disturbing anything deep to the fold, as important blood vessels and nerves run along the inner aspect of the arm to reach the forearm and the hand.

The same care is taken to stop any bleeding and the skin is meticulously repaired in layers with dissolvable stitches and sticky tapes on the surface. Whilst some surgeons insert a drain to remove any extra ooze or bleeding, my preference is to avoid this if possible.

A light dressing is then applied and the anaesthetic reversed, consciousness returning in the recovery area and more properly in the hospital room.

The recovery

The resting position at this stage is lying on the back with the arms kept relatively straight at the elbows and supported with pillows to be just above the horizontal. This helps to safeguard the blood supply to and from the forearm and hand. Adequate pain relief is given as required.

Even if only one arm is treated at a time, some help and support will be necessary for the first few days at home for such things as dressing, during which period the course of antibiotics will also be completed.

Monitoring progress

Review by the specialist is at two weeks or sooner and, at this stage, it is usually possible to leave the stitch line exposed.

The scar is always red to start with, usually fading to a paler colour over nine to 12 months. Sometimes it will retain a pinkish purple colour and, in brown or black skin, may end up a darker hue.

Some scars may thicken and ridge to some degree and silicone gel creams or strips or possibly laser therapy can be used either as a preventative measure or to treat scar misbehaviour of this kind. Normally, however, the scar fades and blends pretty well and is a good exchange for the original problem.

Immediately after surgery, there may be some swelling of the forearm and hand: if this does not settle relatively quickly and is accompanied by colour changes in the hand, reflecting troubled circulation, the closure has been too tight. If this happens, stitches need urgent release: careful patient observation for the first 24 hours is therefore extremely important.

Excessively tight repair can also result in wound breakdown, which will then need regular dressings and, in all probability, skin grafting to achieve full healing. Fortunately this is uncommon and, in the hands of the best surgeons, would not be expected.

Something which is quite common after arm reduction is altered or lost feeling in a strip of skin extending beyond the lower end of the scar onto the forearm. This reflects unavoidable damage to a surfacing superficial fine nerve branch supplying the affected area with its feeling. Although the effect is usually permanent, it generally does not cause significant bother.

Bye-bye bingo wings

Overall, for those sufficiently fit for a general anaesthetic and with no gross risk factors for wound healing, arm reduction provides a high level of satisfaction, restoring selfconfidence as unsightly and demoralising ‘bingo wings’ become a thing of the past.