My answer to Bingo Wings and Ageing hands

12 February 2013

By Plastic Surgeon Dr Dirk Kremer

Last Monday on The Alan Titchmarsh Show we discussed bingo wings and ageing hands. Here is my advice as a professional plastic surgeon:

Dr Kremer's live consultation on The Alan Titchmarsh Show

Bingo wings:

Laser liposuction

There are several brands of laser fat removal devices on the market with varying applications. They all really have the same goal - to melt or damage the fat cells so they break away, whilst stimulating the formation of collagen which helps the skin to spring back.
Note: 'spring back' doesn't mean the arms will be left taught. It is a relative term that is very difficult to measure, and depends on variable factors such as chronological age, degree of skin laxity, amount of loose skin to be targeted…
Some of these devices enable melted fat to be suctioned out, and others rely on the body's metabolism to remove the debris. The laser liposuction works only to a certain extent and will not remove skin excess after a weight loss. 

Indeed, liposuction removes fat, but chances are high that skin will hang even looser, having lost its elasticity because collagen fibers don't have the strength anymore to hold everything together. This is why liposuction must be assisted with heat delivering devices in the form of laser or ultrasound (like Vaser). The idea behind is that the laser will heat up the patient's skin and make collagen fibers shrink and contract, supporting the tightening of the skin. On top of that, as mentioned above it might induce collagen fibers to grow. 

But it is mainly the contraction of collagen fibers that gives the skin some of its tightness back.

Brachioplasty - the surgical option

The American Society of Plastic Surgeons defines brachioplasty, also called arm lift, as a surgical procedure that “reshapes the under portion of the upper arm, from the underarm region to the elbow”. This plastic surgery procedure is used to remove or reduce the excess skin and fat in the underarm, for a more proportionate appearance and smoother skin.
Interestingly the numbers of women coming to see me with concerns about their bingo wings are steadily increasing.
I think the main reason for this is large weight gains and fast weight losses. We all know that our population is becoming increasingly overweight, and it's a very good thing that the majority are aware of this and are trying very hard to lose the extra pounds. BUT whilst losing weight is great for relief of most medical complaints, the skin is another matter!
Skin stretches to accommodate weight gain and, whilst it does contain mechanisms that enable it to contract, weight swings and fast weight losses take their toll. Add this to the natural loss of collagen (scaffolding) during the ageing process and extensive skin drooping can result.

A plastic surgery procedure to approach with caution

As with all cosmetic procedures there is really only one solution for effective bingo wing removal and this is surgery. Not to be taken lightly, a brachioplasty can leave a scar running on the inside of the underarm, from elbow to armpit. Plastic surgery scars can often be hidden, but for this surgical procedure there is nowhere to hide it…
Even though this scar is rarely seen due to its position, and fades to a thick white line within a year, I always caution my patients to think long and hard about this procedure. (Even my mother who keeps badgering me to help sort out her bingo wings! I tell her to cover up instead!)

Ageing hands

Plastic surgeon Dr Kremer talking Ageing hands on Alan Titchmarsh Show

Why do hands betray our ageing?

Do you know why hands are the first body part to show signs of ageing? It is because hands are the most used body part but it gets the least care. We put sun protection on our faces but we forget our hands. Three main factors are linked to ageing hands:

  • Age spots

Age spots are caused by photo damage to the skin. They are easily removed by Fraxel laser treatment. However to me prevention is better than cure: sun protection is of vital importance to avoid wrinkly hands. Always use the right Sun Protection Factor (SPF) on every part of your body that is exposed to the sun. Remember to use sunscreen not only when sunbathing but also during your outdoor activities. Alan would tell you that gardening season is starting!

  • Fat tissue loss

It is natural to lose fat tissue with age. Loss of volume shows more tendons and vessels, which is the sign of ageing hands. However, another reason for losing too much fat tissue is extreme dieting. We've all seen pictures of the hands of Madonna or Sarah Jessica Parker in magazines. Their hands are wrinkly because of a very strict diet more than because of age. 

The loss of fat tissue can be treated with fat transfer, however whether you use fat transfer of dermal fillers like Radiesse, there is no permanent solution. Fat transfer has to be repeated every 8 to 10 months.

  • Loss of elasticity

Wrinkly skin can also be caused by a reduction in collagen and hyaluronic acid, which induces a lost of elasticity. This can be caused by photo damage, just like age spots. I would also advise to use sunscreen to prevent this. The best way to fix this problem is with serums, Dermaroller or mesotherapy (micro-injections).


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