Preoperative marking is performed. The arm is first treated with ultrasonic liposuction to remove extra fat and also develop a tissue plane to make removing the skin easier.

The Incision

An elliptical incision is used to cut out the extra loose skin. This ellipse is positioned over the back ("posterior") margin of the upper arm. This way it is not conspicuous when the arm is in a resting position at the patient's side. The scar ends up as a line running down the inseam of the arm from the armpit to just above the level of the elbow.