Purpose: Brachioplasty has become a popular procedure to rejuvenate the upper arm. The major complication of the procedure is undesirable, visible scarring. An ongoing, unresolved debate in the brachioplasty literature is the optimal placement of the brachioplasty scar. This study attempts to resolve the question of where and how to place the scar based on population surveys.

Methods: Photographs were taken of a model with her arm progressively abducted at the shoulder to a level of 90 degrees, with the elbow progressively flexed to 90 degrees and the arm externally rotated. A brachioplasty scar was digitally created and placed on the arm first medially in the bicipital groove, then posteriorly in the brachial sulcus. An online survey was then created and distributed and included multiple variables: position of the scar, length of scar vs residual deformity, and acceptability based on phase of scar in time (early vs late result).

Results: Electronic surveys were distributed to and completed by the general public (n=117), local plastic surgery residents and attendings (n=10), and patients who had undergone or were seen in consultation for brachioplasty (n=9). Across age groups, gender, plastic surgeons, and patients, the medially based straight brachioplasty scar is more acceptable than the posteriorly based straight scar (4.00 vs. 3.14, p < 0.001). If the scar shape is made sinusoidal, a posteriorly based scar is favored over a medial one (2.61 vs. 2.03, p<0.001), yet this is still not as aesthetically pleasing as a medial straight scar (4.00 vs. 2.61, p<0.001). Furthermore survey participants accepted a longer scar over a residual deformity (58.8% vs 41.2%).

Conclusions: Based on the preferences of the populations surveyed, we conclude that the medially based straight scar is the most aesthetically acceptable option when performing a brachioplasty.