The harsh reality is that after successful dieting or bariatric surgery, you may be left with unattractive excess skin. Although exercise, which is heartily recommended, can strengthen and tone muscles, improving your appearance, it has zero impact on loose skin. This is very obvious in the upper arm, especially when steamy summer days invite bare arms.

The Pittsburgh Post-Gazette reported earlier this month that now, American women are no longer tolerating loose under arm skin. Instead, they embark on the second stage of personal remodeling: brachioplasty.

There is no shortage of role models for beautiful toned arms, starting with Michelle Obama. According to the American Society for Aesthetic Plastic Surgery (ASAPS) there has been a whopping 812 percent increase in brachioplasty since 1997 even though most procedures leave an incision from the armpit to the elbow on the inner upper arm.

"The key with this (surgery), the really important message, is that the scars vary," Leo R. McCafferty, past president of ASAPS, told the Pittsburgh Post. "Some turn out great, some don't. It's unpredictable. The [ideal] patient is really someone who is trying to look good in jackets and tops."

Dr. Dennis Hurwitz, clinical professor of plastic surgery at the University Of Pittsburgh Medical School says that ideal candidates have a lot of thin, sagging skin that hangs from the upper arm.

Brachioplasty facts

• Brachioplasty is usually done outpatient with the patient under local anesthetic.

• There's not a lot of postoperative discomfort, but patients must limit upper arm activity for about two weeks.

• The national average cost for brachioplasty is $4,000, which is usually not covered by insurance.

• Your lifestyle and commitment to exercise determine the success of your surgery. The arm will look better if there are some toned muscles underneath the skin.

• If you don't have further weight gain and loss, brachioplasty is a permanent fix.

• If you have excess fat but good skin tone, liposuction may be an option, but it is not uncommon for women to undergo liposuction first and then go back for brachioplasty.

If you are unhappy with the appearance of your upper arms, it is advisable to get treatment suggestions from a board-certified plastic surgeon.