his surgical procedure will leave a scar extending generally from the armpit to the elbow, and is reserved for cases in which liposculpture alone will not suffice. Much of the problem stems from the sheer weight of the fat in a loose skin envelope, which allows excessive bowing and sagging. By dramatically reducing the fat and the weight of that fat evenly under the skin, there will be, in most, a dramatic contraction of the skin. Taking into account the amount of sagging skin and fat of the upper arm, as well as the requests and expectations of the patient, Dr Gershenbaum will often discuss performing only his defining liposculpture as he has been able on many patients to reduce dramatically the amount of fat and effect excellent skin contraction, thus avoiding the scar.