Dr Martyn King details the various options available for improving the appearance of arms
‘Bingo wings’ is the rather unaffectionate term used to describe the loose skin and fatty tissue that hangs beneath the arms in many women and some men. It is particularly noticeable when the arms are raised and then shaken such as when calling out in bingo, hence the terminology. One website reported that three in four British women stated they are more unhappy with their upper arms than any other part of their body – some to the point where they refuse to wave in public.1 The term ‘bingo wings’ covers a spectrum of concerns related to the upper arms that have been classified into separate entities by personal trainer Rich Jones.2 The classic bingo wing is caused by a lack of muscle tone in the upper arm, often in slimmer women. ‘Arm charms’ describes an extension of this, often when there has been significant weight loss and there is considerable redundant skin hanging from the upper arm. When there is a little extra fatty tissue at the upper arm and into the pectoral region, a bulging appearance is seen at the axillary fold. Finally, where there is excessive fat in the whole arm, this can create bulges and rolls under the arm leading to an unsightly appearance. Whatever the type, bingo wings cause concern and poor self-esteem for a large number of people and may even dictate what clothes a person will wear.
The upper arm contains a deep and superficial fat layer. The deep layer is thin and found in the posterior and deltoid region of the arm. The superficial fat layer is circumferential and tends to increase in size with age, particularly in the posterior one-third of the arm, resulting in a fatty appearance of the upper arm. The type of fat also has a further detrimental effect, being less thick and non-fibrous. The overlying skin of the medial aspect of the arm is thin, mobile and prone to sagging.3
There is no doubt that exercise is one of the simplest and most successful methods of toning the muscles of the upper arm and does not require any specialist equipment, meaning it can be done at home. There are many exercises recommended for treating bingo wings, including press-ups, wall push-ups, bench dips and triceps kickbacks.4 Exercise should be combined with diet so further fat loss is achieved along with some skin tightening and improved skin tone. Losing weight alone may further exacerbate the problem as it may lead to worsened skin laxity when fat is lost.
A popular, non-invasive and quick treatment for bingo wings is lipomassage. This involves mechanical rolling of the skin using suction and independent rollers whilst wearing a garment. The process folds and unfolds the skin and subcutaneous fat, triggering a biological response leading to improved blood flow, the elimination of resistant fat and the stimulation of fibroblasts.5 Although there are no specific clinical studies relating to the treatment of bingo wings, one study has suggested this technique increases lipolytic responsiveness of femoral adipose tissue in women with cellulite, having undergone 12 sessions of mechanical massage.6 Often, a course of 12 treatments twice a week is recommended. It is a very safe procedure with no downtime, although the results may be quite minimal.
Radiofrequency (RF) may be used where the main concern is mild to moderate skin laxity. There are many devices available and they may be unipolar, bipolar or even tripolar, depending on the number of electrodes used to deliver the energy to the body. The position and depth of RF energy is controlled and will travel through the skin and subcutaneous tissues, creating heat at areas of increased resistance, such as in adipose tissue. This has the effect of causing lipolysis. The frequency of RF can also stimulate fibroblasts and lead to contraction of collagen fibrils resulting in skin tightening.7 A recent study indicated a mean reduction of almost 2cm in circumference of the upper arm when treating the bingo wings using tripolar radiofrequency, without pain or complications and with good patient satisfaction scores.8 The procedure is considered safe with no downtime, although repeated treatments are likely to be needed.
A more recent treatment that is available for treating bingo wings is an injectable deoxycholate solution branded as Aqualyx. It is CE approved as a medical device and indicated for the reduction of localised areas of stubborn fat.9 Results may be apparent after a single treatment, although a course of injections is likely to produce better results. Aqualyx aims to work by liquefying the fat cells, leading to permanent destruction of the adipocyte, before the fatty contents are then removed via the lymphatic system. Sometimes it is used in combination with ultrasound to improve the dissipation of the product. There can be some discomfort following the procedure along with some swelling, redness and irritation.10 Although this treatment may be suitable for some cases of bingo wings, it does not deal with skin laxity and so may need to be combined with other modalities.
Cryolipolysis is one of the latest and most impressive technologies for non-surgical fat reduction and is suitable for treatment of excessive fat in the upper arms. It is based on the principle that low temperatures destroy fat cells in the body, whereas the skin is more resilient. There are several devices on the market which all work on the same principle of applying a suction cup to the body area, aspirating the fatty tissue and then freezing the tissue to about -5 degrees and holding at that temperature for about 45 minutes. This causes apoptosis of adipocytes, which are then removed by the body in the following weeks. The treatment has no downtime, is relatively pain free and produces a low risk of complications.11 There is also evidence that suggests cryolipolysis will lead to some secondary skin tightening. A clinical study published in 2016 demonstrated a 15.3% decrease in the fat layer thickness, as measured by ultrasound, after a single cryolipolysis treatment to the upper arms after eight weeks.12
Laser-assisted lipolysis appears to be an effective treatment for bingo wings and can not only lead to fat loss and reduction in circumference, but can also lead to a skin tightening effect. A 2015 study involving 45 patients reported a reduction in circumference of just under 5cm, as well as a reduction in skin calliper measurements.13 The pain associated with laser-assisted lipolysis is minimal during the procedure by the administration of a tumescent anaesthetic solution and as laser-assisted lipolysis is less traumatic than conventional liposuction, the pain afterwards tends to be minimal. Prolonged oedema can be a complication in up to 25% of patients.13 The results for laser-assisted lipolysis can be better than the previous methods described but the price for the procedure tends to be higher.
VASER lipolysis is a minimally invasive procedure that uses pulsed ultrasound energy to emulsify fat with minimal damage to surrounding structures and vessels. It offers similar results to laser-assisted lipolysis although there is a lack of clinical evidence demonstrating its benefit for bingo wings. Complications can include tenderness, bruising and swelling. Compression is normally required after a procedure and additional massage may sometimes be required. In my experience, most patients will see some improvements in skin laxity following treatment.
Arm lift surgery or brachioplasty is a surgical procedure that reduces the circumference of the upper arms and removes excessive skin. It can be combined with liposuction to give better results. In the US, 15,457 brachioplasty surgeries were performed during 2012, a significant increase compared with the 338 surgeries in 2000,14 demonstrating the rapid increase in demand. There are many types of surgical procedures performed including minimal incision, traditional and extended brachioplasties, although all of them involve considerable operating time and costs often in excess of £5,000. There are also significant risks with surgery including bruising, asymmetry, nerve damage, prolonged swelling, blood clots and necrosis. Following brachioplasty, there can often be a large unsightly scar, which, anecdotally, may cause almost as much distress as the problem being treated.
Although bingo wings appear to be a significant aesthetic concern, particularly for women, there are no miracle cures available either surgically or non-surgically. As practitioners, we need to be mindful that bingo wings cover a spectrum of upper arm problems and when deciding on treatment, we need to focus on whether fat or skin laxity is the predominant concern, ensuring we are realistic in what we can achieve with the most appropriate treatment. Personally, I use a layered, multi-platform treatment, such as the 3D-lipomed device that I use in my clinic, as I find it is most beneficial in order to target all aesthetic concerns relating to the upper arms. We also need more clinical trials that detail the evidence for individual treatments and outcomes, as we cannot simply rely on claims from manufacturers.
Upgrade to become a Full Member to read all of this article.