NEW ORLEANS - It can be caused by the genes you inherit, by losing a lot of weight, or from years of tanning which damages the skin.
Loose, wrinkled skin under the arms, or the combination of fat and hanging skin there, is a common complaint, especially from women who say diet and exercise have not helped.
But there are safe solutions.
Megan Zander can tackle a tough job. At 25 year of age, she's a doctor's office assistant, but she's also just back from Iraq. There she was an Army National Guard logistics specialist, tracking military vehicles and equipment. But it was when she got back from a beach vacation with her little girl, that she realized she could not tackle another tough assignment.
"It's the frustration behind being a very active person, being heavily into the gym, knowing how to workout right, eating properly and still not being able to get this area to be, to go anywhere," Zander said pulling on the skin on the underneath part of her arms.
The excess skin under her arms never tightened up like the rest of her body did after losing 85 pounds with diet and exercise. She even participates in triathlons, so she is in shape.
At 42 years of age, Gina Rogers of Destrehan wanted to change her upper arms too. A body builder since she was 16, Gina even won a competition in 1998, and recently shed six pounds, but still couldn't address the loose skin and thickness surrounding her solid, lean muscles.
"I was definitely self conscious about it because of the fact that I am so petite and I had these really big arms for somebody who is so small. So I did kind of curtail what I would wear and I would also kind of shy away from pictures," said Rogers.
"This is a major complaint among women. You know, you can exercise and diet until you are blue in the face, but if you have that kind of skin that hangs there, that is a huge cosmetic problem," said Metairie Dermatologist Dr. Patricia Farris.
Dermatologists and plastic surgeons say patients have options to fix the hanging, wrinkled skin, or combination of skin and fat underneath the arms. But the treatment depends on the patient. Some people, especially if you've had bariatric surgery and lost 100 or more pounds, may need surgery in an operating room, like a face lift of the arms. There can be a small scar in the arm pit, or for those with a lot of excess skin, a scar down to the elbow. Pick your surgeon wisely, making sure he or she is board certified in plastic surgery because removing too much skin could cause worse scaring and the need for skin grafting.
"In terms of the full brachioplasty (arm lift) which is done under anesthetic, I did a lady, I think she's 72 and she had it on a Thursday and went to the opera on Friday night. So I don't think there's a lot of down time," said Metairie plastic surgeon Dr. Cynthia Mizgala.
For people who don't have as much skin and fat, a more simple office surgery can help. Laser liposuction called SmartLipo, uses a small cannula while you're awake in the doctor's office. The arms are numb while the doctor removes some of the fat, then passes the laser tip to tighten the skin from the inside.
"They would respond better to the laser lipo which basically is almost scar-less because the incision is so small it's almost not visible," explained Dr. Mizgala.
You can go back to work the next day wearing compression sleeves for six weeks. Zander is having the laser lipo procedure. But Rogers is the perfect patient for treatments with noninvasive radio frequency. It's called Exilis. For nine minutes on each arm, she will feel a warm massage and the hand device is rubbed over her skin. If the tip feels like it's getting too hot, she tells the technician in advance so she can turn it down.
"If you've got a small volume of fat, the safety of the radio frequency melting is, I don't think you can beat it because you really can give that element of safety to the patient without risk of nerve damage, numbness and tingling and things like that," said New Orleans dermatologist Dr. Mary Lupo comparing the non-invasive device to liposuction and surgery.
The Exilis can be set to just tighten skin or to tighten skin and melt fat. Dr. Lupo says it's not uncommon to have the circumference of your arm decrease by a half inch after three to four treatments.