In younger patients with taut skin, the results of arm suction are usually gratifyingly smooth and homogenous. Older patients, on the other hand, often end up with hanging skin, irregularities and bumpy areas. Fatty deformities of the arms often seen in association with regular obesity are the primary indication. Patients with large fat deposits and hanging skin will only respond to an arm lipectomy with a large excision. All patients, especially the older ones, should be warned that irregularities and incomplete removal can be observed after suction. Preoperative markings are of extreme importance. Circumscribe the desired area with the patient standing with the arms in the victory position. Complications in the arm usually consist of hanging skin, irregularities, bumpy arms and insufficient removal. Fat excess with insufficient removal and irregularities are the most common problem.