The incision is marked and placed slightly posterior to the bicipital groove, running along the inner (posteromedial) aspect of the arm from the axilla to just above the elbow. This positioning keeps the scar discreet when viewed from the front, unlike scars placed directly on the groove which remain visible. I also avoid the textbook Z-plasty in the axilla, as it often performs poorly in practice, instead using a fishtail-type closure that distributes tension more effectively.

Liposuction is carried out first to decompress the area and define contour, leaving a thin layer of fat to preserve lymphatic drainage and nerve integrity. I then perform tailor-tacking and progressive excision, cutting and closing in stages to limit wound exposure, minimise infection risk, and prevent oedema build-up - a key factor behind hypertrophic scarring in brachioplasty, as closure under tension increases this risk.
 

The operation is performed under general anaesthesia as day surgery, with a light compression garment applied immediately after (patients often look a little like the Michelin Man at this stage).