For reasons not totally known, women often accumulate fat and, usually, loose skin on their arms, even if they are basically thin.

Those with lots of sun damage will have even more loose skin and wrinkly arms.

Weight gain, sun damage, smoking and hormonal changes contribute to these arm problems that we see with aging. And virtually every woman hates this problem.

Take heart, because this problem is treatable.

According to the amount of fat that needs to be removed, the procedure can range from a simple liposuction (a minor procedure) under local anesthesia if there is no excess loose skin, to the surgical option called a brachioplasty.

A liposuction is a much less invasive procedure that leaves one or two small, puncture-mark scars that are barely visible.

A brachioplasty, on the other hand, is a more invasive, very effective procedure when indicated, but leaves a scar from the axilla (armpit) to the elbow.

This is mostly indicated when there is a large amount of fat and-or loose skin (“bat wings,” according to one patient) to be removed.

A new micro-invasive procedure called ThermiTight (a radio frequency procedure that accurately delivers and monitors radio-frequency heat to the tissues) can be used alone or also combined with a liposuction, according to how much fat needs to be removed.

The ThermiTight tightens the skin and removes volumes of fat as well. The procedure with or without a liposuction can be quite effective.

ThermiTight is also effective for the neck, love handles, abdomen, thighs, knees – even for cellulite. It can be used efficaciously for virtually any part of the body, and only one treatment is required.

The newest of the ThermiAesthetic (radio frequency using the “Science of Heat”) procedures is the Thermi-Smooth250, commonly called simply the ThermiSmooth.

This technology diminishes fat and tightens excess skin and is completely non-surgical.

Generally three to four treatments are necessary. There is no pain, and no recovery time needed.

It has recently been FDA approved for the treatment of cellulite.

Remember the ThermiTight is one treatment, but does involve a recovery time of a few of days.

A brachioplasty, the surgical procedure, usually requires general anesthesia. Both a liposuction and a ThermiTight require tumescent local anesthesia (infiltration with normal saline with a local anesthetic medication) and oral sedatives, if requested by the patient.

Patients actually say that the ThermiSmooth feels good, like a hot stone massage, and it requires no anesthesia.

All of these options can be confusing, and a consultation with your plastic surgeon can answer your questions and determine the procedure best suited for you, including concerns about your budget and required time off.

Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand