I decide this by evaluating skin recoil and redundancy, and by predicting whether volume reduction alone will leave a fold. If the skin envelope is the limiting factor, ignoring it does not "avoid scars." It often trades one problem for another, because the remaining fold becomes more noticeable when the arm moves. On the other …
I decide this by evaluating skin recoil and redundancy, and by predicting whether volume reduction alone will leave a fold. If the skin envelope is the limiting factor, ignoring it does not "avoid scars." It often trades one problem for another, because the remaining fold becomes more noticeable when the arm moves.
On the other hand, removing skin in a high-mobility area creates a scar that must be justified. So the decision is not automatic. It is a balance between contour benefit, skin behaviour, and scar acceptance.
In some patients, the skin adapts well after contouring. In others, the skin is not cooperative, and an excision-based plan is the more honest method. The correct plan is the one that respects tissue behaviour rather than forcing a preferred technique.
Op. Dr. Mert Demirel
European Board Certified Plastic Surgeon (EBOPRAS)
ISAPS & ASPS Member
Istanbul, Turkey
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Dr. Mert Demirel
Dr. Mert Demirel is a European Board Certified Plastic, Reconstructive and Aesthetic Surgeon based in Istanbul, with over 20 years of medical experience and a strong focus on natural, balanced outcomes.
He approaches aesthetic surgery as a medically guided decision process, prioritizing anatomical suitability, long-term safety, and individualized treatment planning for each patient.
