The Best In-Office Treatments for Tightening the Arms, Legs and Butt

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This article first appeared in the Summer 2022 issue of New Beauty. Click here to subscribe

The desire to tone, tweak and perfect our bodies goes way beyond our waistlines. What you can’t do with a thousand squats, push-ups and sessions on the Thigh Master and Peloton, you can now do in a day at your doctor’s office. While it’s hard to spot-treat one specific area with diet and exercise alone, today’s cutting-edge modalities can slenderize the arms, tone the inner thighs and smooth butt dimples in no time at all.

Bat Wings Begone

Excess fat around the arms can be very difficult to lose, and it’s a common complaint Newton Centre, MA plastic surgeon Joseph A. Russo, MD says he hears from many patients. “The two main concerns about the arms are the excess fat located in the upper part of the arm, and loose, sagging skin in the area over the triceps, which is the back of the arm,” he explains, noting that it’s almost exclusively a concern for women, who on average have 6 to 11 percent more body fat than men.

“The excess lax skin seems to be the biggest concern, and though I didn’t come up with this term, it’s written in the medical books as ‘bat wings,’” Houston plastic surgeon Courtney El-Zokm, MD says. While it can be challenging to lose stubborn fat in the arms, there are many options for getting a more contoured look, including muscle building, energybased skin-tightening devices and the more permanent surgical fix.

Slimmer + Stronger

If you can pinch a small amount of fat beneath your arms using just your fingers, doctors say nonsurgical treatments can be of help. “To add definition where skin laxity and excess fat are mild, I recommend a musclebuilding device, like Emsculpt NEO, which also has a radio-frequency function to deliver electromagnetic stimulating pulses to the muscle,” adds Dr. Courtney. “This activates your muscles and helps build strength and bulk, which contributes to a tighter look. As you’re building muscle, you’re also filling up some of that space.”

At her Delray Beach, FL practice dermatologist Dr. Janet Allenby employs CoolSculpting to debulk the arms and often pairs it with CoolTone electromagnetic stimulation or radiofrequency to safely heat the tissue. Options like EON, NuEra Tight, Emsculpt NEO and Morpheus8 Body deliver heat to deep levels to help break down fat cells. “Areas like the upper arms, back and thighs can be treated with NuEra Tight to reduce fat pockets and smooth skin,” says Grosse Pointe, MI dermatologist Shauna Diggs, MD. ”With each treatment, the radio-frequency current heats the tissue and stimulates collagen production, causing a ‘shrink wrap’ effect.” Dr. Allenby adds that it’s important to focus on fat reduction and then work on tightening the skin.

Arm Lifts

When nonsurgical treatments don’t cut it or there’s more than a pinch of excess fat or skin, the only permanent fix is surgery, which requires a long incision that can be off-putting for many patients. “If there is more excess skin, the only real treatment that will make a difference is an arm lift, or brachioplasty, which involves doing liposuction and excising the skin,” says Dr. Russo. “The biggest downside is that it can leave a long scar from the armpit to the elbow.”

However, Pittsburgh plastic surgeon Jeffrey Antimarino, MD says arm lift techniques have evolved to make scar placement less visible. “If the elliptical incision is shifted closer to the chest wall, it can then extend behind the armpit, allowing a greater amount of excess skin to be removed. I use this type of incision instead, which extends from the elbow to the upper chest wall, and is centered below the midline of the upper arm and behind the armpit.”

All of the nonsurgical and minimally invasive treatments mentioned in this story may have some benefit in the appropriate patient, but for some patients results can be unpredictable. We strongly advise seeing a board-certified doctor who practices within scope and has vast experience and knowledge on the treatments in question and the treatment combinations that work best. Of course, all cosmetic procedures can have a potential risk, which is why it’s important to see a properly board-certified aesthetic doctor.

Dr. Antimarino performed an arm lift on this 52-year-old patient, giving her a natural-looking result using a well hidden incision.

Leg Day

Three fast at-home fi xes for instantly upgraded gams: self-tanner, body-blurring makeup and body shimmer oil. Concealing problem areas are a temporary solution, but these calf-contouring, thigh-tightening and texture-resurfacing treatments can deliver results that last beyond summer.

Tighten Up

Retinol body lotions are booming today as formulators have found that the same principles used for facial skin rejuvenation also translate to the body. Dr. Allenby says one of her approaches is a bit costly, but she swears by it: “I like to use SkinMedica TNS Advanced+ Serum right above the thighs to tighten up the skin.”

High Roller

Medical aesthetician Amy Peterson says Endosphères therapy has taken over her Miami medspa and clients say it helps with imperfections all over the body, especially the legs and thighs. Using a roller device made up of 55 silicon spheres, the treatment generates low-frequency mechanical vibrations as it’s “rolled” all over the body. “By stimulating blood flow and oxygenation and improving lymphatic drainage, it treats trouble areas, like cellulite, at the cellular level,” Peterson explains.

Radio Frequency + Long-Lasting Filler

Radio-frequency treatments are an in-office go-to for melting fat and treating mild skin laxity. Dr. Allenby also employs this method of deep tissue heating and tends to combine it with the collagen-stimulating injectable Sculptra Aesthetic, used off-label to treat lax skin on the knees and thighs. “To get a little more quadricep shape, I’ll use an energybased treatment to tighten up the loose tissue and then administer Sculptra injections on top, like in the anterior thigh, and that fills in the gaps left behind from skin laxity. It will also continue to stimulate more collagen and improve results over time,” she explains.


Dr. Russo notes that just like with upper arm fat, excess fat and loose skin on the legs and thighs are also typical concerns for women. “The most common surgical treatment for contouring the legs is liposuction,” he says. More than just a fat-reducing procedure, it can also reshape and recontour the calves, tighten the inner thighs, fix hip dips, and smooth the area above the knees.

“Many patients come in requesting an inner thigh gap,” adds Dr. Courtney. “It’s not something we can do for every patient, but for those who have a small amount of fat and not much excess skin, liposuction is the best option and results are permanent, as the fat cannot return to this area. This can be easily done in the office and can also be combined with liposuction in other areas of the body.”

To address hip dips and give this 23-year-old patient a shapelier look, Louisville, KY plastic surgeon Chet Mays, MD performed liposuction on her hips, back and lateral thighs.

Thigh High

If there is extreme skin laxity, then a thigh lift or a lower body lift may be the best bet, notes Dr. Russo. “This procedure involves cutting out skin and removing fat.” The downside of this is the possibility of scarring, however, it’s a permanent procedure and rarely redone.

+63% Body Procedures have increased more than any other area in the last year.

Source: The Aesthetic Society

Booty Call

The latest trend in butt enhancements is seeking Brazilian Butt Lift (BBL) alternatives that lift, tone and plump the derrière without the downtime or risks. Common treatments include the same gamut of modalities that help redefine other parts of the body: muscle stimulators; radio frequency, collagen-stimulating fillers, and new options for smoothing cellulite.

Butt Builders

“I have found that the biggest concerns my patients have about their butts have less to do with shape and more to do with size,” says Dr. Courtney. “Patients tend to actually want toning, tightening and lifting, and we have treatments now that do all of these things.”

For a nonsurgical lift, muscle-builders like Emsculpt NEO and TruBody can increase definition to make the butt pop, giving it a higher, tighter look. The energy-based portion targets fat while electro-magnetic stimulation increases muscle mass. Multiple sessions may be needed and periodic maintenance can be done throughout the year to help results last longer than the expected six to 12 months.

“Sculptra always works to some degree, and results can last for a good year and a half,” shares Dr. Allenby. A series of injections of the poly-l-lactic acid-based filler is often used for the BBL alternative “Sculptra Butt Lift.” The treatment is known to help retexturize skin and provide a foundation for more collagen to grow. “I always pair it with muscle-building to help strengthen the area so that it looks toned, plump and healthy.”

Texture Smoothers

To give skin a more youthful glow and improve its texture, Dr. Allenby also recommends a full-body professional chemical peel, which relies on chemical exfoliation from clinicalstrength, concentrated ingredients like salicylic, trichloroacetic, lactic, and glycolic acids. “It can also help with lymphatic drainage because, as the practitioner does it, they use about 4 pounds of pressure with their hands. It really does help push all the liquid up and out into the lymphatics in the middle of the body.”

Cellulite Combos

When it comes to dimple erasers, two new FDA-approved options have entered the game: an injectable treatment and a high-frequency sound-wave device, both of which help break down the fascia to restore smoothness without downtime.

“Qwo is an injectable that is done over a period of three treatments,” explains Dr. Courtney. “It helps to break up fiborous bands under the skin and gives a nice, smooth result.” Side effects from the injections include temporary bruising, pain and hardness.

“Resonic uses Rapid Acoustic Pulse technology, or sound waves, to break up fibrous bands,” adds Dr. Allenby, who has seen impressive results with just one treatment alone. “You can treat large or small areas on any part of the body, which makes it versatile. It can be uncomfortable for some, but tolerable.” These cellulite treatments are often combined with injections of Sculptra Aesthetic or microdiluted Radiesse, off-label, to “fill in” areas of lax skin. New York dermatologist Ellen Marmur, MD says Renuva, an allograft adiopose matrix, can also smooth contours and “pop out the dents.”

This 41-year-old patient leads a healthy lifestyle, but was unable to reduce her cellulite on her own. Dr. Allenby used Resonic to smooth dimples on the thighs and glutes.


The most common surgical procedure performed to reshape the butt is fat grafting to increase its size. “Known worldwide as the Brazilian Butt Lift, this technique requires taking fat from one part of the body and then reinjecting it into the buttocks to add volume and shape,” Dr. Russo explains. However, this super popular surgery does come with its own set of risks, including fat embolism, which can be fatal. To help minimize the risks, The Aesthetic Society released guidelines for surgeons to ensure the placement of fat over the muscle, and not in the deeper muscles where large blood vessels exist.

Dr. Courtney adds, “While a BBL can give your more volume, I still like to pair it with radio frequency, like the Morpheus8, to help shrink-wrap the skin and give a nice tone, but with a new shape.”

Body Guards

Head-to-toe skin-fi rming and perfecting treatments to try on your arms, legs and butt at home.

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