ArticleAesthetic surgery journal. Open forum2026
New Proposal in the Approach to Brachial Remodeling: The Melfa-Anastasia Arm Laxity System (MAALS).
Article in Aesthetic surgery journal. Open forum, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Current diagnostic tools for upper arm laxity assessment-including the pinch test and two-dimensional photographic scales-fail to characterize the underlying tissue composition, leading to inappropriate treatment selection and preventable complications. Objectives: To introduce the Melfa-Anastasia Arm Laxity System (MAALS), a precision medicine framework integrating high-frequency ultrasound (HFUS) biometry with a cylindrical geometric model for objective, compositional assessment of brachial architecture. Methods: MAALS employs a noncontact stand-off technique (HFUS, 18-22 MHz) to measure superficial adipose tissue thickness (SAT) and triceps muscle thickness (M) at the mid-brachial sentinel point. Two dimensionless indices are derived: the adipose saturation percentage (%SAT = SAT/Rtot × 100) and the muscle filling ratio (MFR = M/Rtot), where Rtot is the total brachial radius calculated from arm circumference. Results: Based on preliminary anatomically rational thresholds, MAALS defines five phenotypes (0-4): normotrophic (0), adipose hypertrophy (1), mixed morphology (2), pure cutaneous ptosis with critical vascular risk zone (%SAT < 20%, SAT < 4-5 mm; liposuction contraindicated) (3), and sarcopenic/atrophic (4). Each phenotype carries specific therapeutic indications ranging from prevention to regenerative strategies. Conclusions: MAALS is presented as a conceptual precision medicine framework requiring prospective validation, not as an established clinical standard. By providing objective compositional characterization of brachial architecture, it offers a structured basis for safer, more individualized treatment planning, future multicenter validation studies, and integration with AI-based segmentation technologies. Level of Evidence 5 Therapeutic:
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