What is a breast lift (Mastopexy)?

As a result of breast feeding, gravity, weight changes and ageing breasts sag and lose their shape. A breastlift raises and shapes your own breast tissue reducing and tightening the sagging skin and moves your nipple to a higher position. It can even out differences between the breasts and reduce areola size. Combined with a supporting breast implant volume may be enhanced.

Who is the ideal candidate for breast lift surgery?

Performed after the age of 18 years, one or more of the following conditions may indicate that you are a good candidate;

· Breasts that are pendulous, but of satisfactory size,

· Breasts that lack substance or firmness,

· Nipples and areolas that point downward, especially if they are positioned below the breast crease.

How long does a breast lift last?

Results are long lasting however breasts will continue to sag with age, weight changes and future pregnancies. (Best performed after child birth or weight loss has finished);

How is breast lift procedure performed?

Usually using the ‘vertical mastopexy’ technique or the ‘lollipop’ (Le Jeur) technique an incision is made around the areola which extends vertically downwards to the natural crease under the breast. Excess skin is removed from around the areola and at the base of the breast. Nipples are moved to a higher position. Remaining breast skin is tightened and used to lift and shape breast tissue into new, shaplier and higher positioned breasts.

Duration of operation; 1-1.5 hours (under general anesthesia).

Hospital stay – 1 night.

What to expect immediately after surgery?

You will usually leave the hospital with elastic bandages covering your breasts which will be swollen and tender for several days. A soft support bra will replace these bandages within 3 days which should be worn for several weeks. There may be loss of feeling at the nipples and breast skin which is normal and usually passes within 4-6 weeks.

How long will it be before I can get back to my normal life?

This should not be rushed and will usually take 3-4 weeks. 7-10 nights staying is recommended in Turkey following the procedure and most return to work within 2 weeks if it does not involve physical activity. Results from a breast lift can usually be seen between 3-6 months.

Can breast lift surgery be performed without scar?

Scars are the results of any surgical procedure and should be expected. With minima scarring from the lollipop method the vertical and scars around the nipples will fade to become barely visable 9-12 months after surgery.

What is the difference between a breast lift and a breast reduction?
Techniques are similar but a breast lift leaves the breast the same size or smaller that before surger with minimal scarring. In a breast reduction more breast tissue (fat, glands) and excess skin are removed to make the breasts smaller in size.
Lifting is also performed during a breast reduction creating more youthful looking breasts however longer scars will be placed under the breasts.

A breast lift can be performed as a single procedure to lift and firm up your breasts giving them a more youthful and shapely contour. In many cases it is performed as part of a body shaping procedure often with liposuction and a tummy tuck (mummy makeover!) for the best overall improvement in appearance.

What is a breast reduction surgery?

Large, heavy and hanging breasts can be a burden preventing you from enjoying sports, buying the clothes you want, being the brunt of many jokes. Breast reduction can remedy these and other concerns helping you to feel more comfortable with yourself.

Who is a suitable candidate for breast reduction surgery?

Those over 18 years who have physical and emotional pain, neck and back ache caused by large breasts. Assymetries in shape or size of large breasts may be treated at the same time.

How long does a breast reduction last?
Results are long lasting however breast size and shape will change with any future preganancie, hormonal changes, weight-fluctuations, age and going braless too often.

How is breast reduction procedure performed?

Usually performed with an ‘anchor-shaped’ incision that circles the areola, extends downwards to and along the natural crease of the body below the breasts. In most cases the nipple stays attached to their blood vessels and nerves but if the breasts are very large they may then need to be removed and grafted into a higher position. The skin is then brought from both sides of the breast down and around the areola shaping the new contour of the breast.

Duration of operation – 1,5/2 hours (under general anesthesia).

Hospital stay – 1 night.

What to expect immediately after surgery;
You will usually leave the hospital with elastic bandages covering your breasts which will be swollen and tender for several days. A soft support bra will replace these bandages 4-5 days later to be worn for upto 8 weeks.
A loss of feeling at the nipples and breast skin is normal and usually passes within 4-6 week during which time activities should be restricted. Drains may be left in place to remove excess fluid from the body usually removed 2-4 days later.

How long will it be before I can get back to my normal life?

Not a simple operation recovery should not be rushed. 7-10 nights staying is recommended in Turkey following the procedure and most can return to work within 2 weeks. Limit exercise until enegry levels increase and avoid anything other than gentle contact with your new breasts for upto 6 weeks. It will take 6 months for the breasts to settle into their new size and shape.

Can breast reduction surgery be performed without scar?

The removal of skin and necessitates the creation ofextensive scars at and under the breasts. Most scars are conspicuous initially, they may be lumpy and red for some months but with the right care over the next 12 months they will fade in appearance.

Does breast reduction affect breast feeding?

A breast reduction removes many of the milk ducts leading to the nipples therefore breast feeding may not be possible after this procedure.

Performed to bring the breasts into proportion with the rest of the body and ease discomfort, breast reduction is also performed as part of a body shaping programme with a tummy tuck and liposuction and other cosmetic procedures.

Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Besides breast reduction is an aesthetic surgical intervention, it is also an intervention performed for health reasons to improve the quality of life.
Breast reduction, technically known as reduction mammoplasty, is a reduction and lifting procedure of hormonally or congenitally large breasts. The operation is performed under general anesthesia and will last for 3 hours with a night of hospitalization. Usually it is performed with a technique called vertical mammoplasty.

This recently worldwide used technique will leave after the operation an incision line that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast.

The scar tissue often remains lumpy and red for months, than gradually becomes less obvious within a year, sometimes eventually fading to thin white lines. Your doctor will demonstrate these scars on his computer for you. On the 4th. day after the operation you’ll be able to go back to work.

Detailed Information;
The enlargement of the breasts according to developmental, pregnancy or weight gaining reasons is one of the frequent problems. This is not only an aesthetic problem, but also leads to a shoulder ache, a back ache, skeletal deformities, and skin irritation. Patients who are seeking solutions for such problems should read the following information:

Investigate if the breast enlargement is due to a hormonal problem.
Ask if the enlargement is a continuing problem.
Investigate if there is a palpable mass with or without pain at the breast examination.
Investigate if there is a previous breast operation or infection.
Your doctor will ask you several questions and inform you regarding the above mentioned items. Usually a surgical procedure is appropriate for enlargements not related to a hormonal problem or breast stopped enlarging for at least 6 months. For patients above a certain age and those with a mass in their breasts, a test like a mammography is relevant prior to the intervention. Afterwards, you and your doctor will decide for the appropriate technique due to the specifications of your skin and breast tissue.

Prior to the intervention you will undergo some laboratory investigations, a detailed physical examination, and a skin drawing of the operation plan according to the selected operation technique. The operation will be performed under general anesthesia. The operation period will last between 2-4 hours depending on the selected technique. You’ll have to stay 1 or 2 days at the hospital. On the 4th hour after the operation you’ll start to eat and walk. On the first couple of days there will be a suction bag called a drain placed into the operation area to collect excessive fluids and blood. Depending on the collected material, the drain will be removed in 1-2 days. It is appropriate to restrict excessive arm movements on the first days. At the first week you’ll have a bandage wrapping your chest. This will be removed on the 7th day after the operation and replaced with only a thin strip covering the incision line, which will stay for an additional week.

Enlargement is usually together with pendulous breasts. If the shape of the breast is good but only the size is big due to fat accumulation, the breast reduction can be performed with only a liposuction method. If the surgeon has to reshape your breasts while reducing the size, the following steps are performed.

What is a tummy tuck(Abdominoplasty)?

A popular procedure removing and tigjtens excess skin and fat at the middle and lower tummy, usually abdiminal wall muscles area are tightened at the same time. Often combined with liposuction at the tummy, abdomen, hips, waist and thighs gives best results.

Who is a suitable candidate for tummy tuck surgery?
If you have excess abdominal skin, a sagging tummy, bulging of the abdomen or muscle weakness, a tummy tuck will improve your appearance.Genetics, child birth, skin type weight loss/gain often stretch the skin to the point and it no longer contracts, a tummy tuck is the only option. If excess skin and lax muscles are limited to below the navel then you may be a more suitable candidate for a mini-tummy tuck with a shorter scar, no belly button repositioning, shorter scars and a quicker recovery.

How long does tummy tuck last?

Results are permenent but must be accompanied by a regular sports programme and a healthy life style.

How is the tummy tuck procedure performed?

This usually involves an incision made across the lower abdomen just across the pubic area from here skin is seperated from the abdomial wall upto your ribs, the excess removed and tightened. Muscles may be pulled closer together and stitched into their new position. Often a second incision is made to remove the navel from surrounding tissue and thi sis then replaced at the right position.

Duration of operation – 1,5/2 hours (under general anesthesia).

What should I expect immediately after surgery?

Expect minimal bruising but signigicant swelling (especially if performed with liposuction). Temporary discomfort and pain may be experienced especially if muscle tightening has been performed. Drains may be left in place for between 3-5 days to help speeed up recovery by removing excess fuids from the body. Leakage, assymmetry, lumps, surface irregularities, hardness, discomfort and discolouration are normal at this time and will disappear within the first few weeks. A 7-14 night stay in Turkey is recommended. Bruising and swelling can exist upto 6 weeks and final results will not often be seen for upto 12 months after surgery.

Will I wear a support garment after liposuction?

A specially designed surgical, elastic binder will befitted immediately after surgery to be worn for upto 6 weeks after the surgery. This garment minimalises swelling, improves skin retraction, protects the treated areas and keeps you comfortable.

How long will it be before I can get back to my normal life?

This should not be rushed. Walking is recommended from early after the operation but vigorous exercise avoided for upto 6 weeks after surgery. A 7-10 night stay is recommended in Turkey following the procedure and most can return to work within 2 weeks. It will take upto a year before the scar flattens, softens and fades and final results seen.

Can a tummy tuck surgery be performed without scar?
A tummy tuck involves removal of skin and necessitates the creation of a scar that runs almost from hip to hip however placed as low as possible it can be concealed by underwear in the future. Most scars are conspicuous initially and take upto 12 months to develop completely.

By removing excess skin and fat a younger, trimmer, more contoured and slimmer appearance can be gained. Often performed as part of a body shaping procedure it is performed wit breast surgery, thigh and arm lift.

What is a mini tummy tuck?

Often after child birth or weight changes it results in loose, excess skin at the lower abdomen area. Exercise and diet may have no effect tightening this loose, excess skin. Whilst a full tummy tuck removes larger quantities of skin and fat whilst tightening the deep layer of stomach muscles the mini tummy tuck works on the lower stomach area only removing the excess skin and fat that rolls over the top of the jeans!

Who is a suitable candidate for a mini tummy tuck?

If your skin laxity, sagginess and muscle weakness are limited to the area below the belly button you may be suitable for this procedure.

How long does a mini tummy tuck last?

Results of a mini tummy tuck can be seen immediately and results are long lasting providing it is supported by a healthy diet and lifestyle and no massive weight changes in the future.

How is the mini tummy tuck performed?

This procedure is similar to that of a standard abdominoplasty however the incision only extends to include excision of the excess skin and fat from the lower abdominal area. Many expect a scar of only 4-5cms but this is not possible, it must be long enough to include the excess skin. (Usually 14-20 cms)

Duration of operation – 1/1,5 hrs. (under general anesthesia).

Hospital stay – Often a stay is not necessary however we recommend 1 night in hospital.

How is a mini tummy tuck performed?

This usually involves an incision made across the lower abdomen just above the pubic area, from here excess skin and fat are removed and tightened.

What should I expect immediately after a mini tummy tuck?

Your tummy may feel tight, sore and discomfort. These are normal and will pass within 2-4 days. Expect minimal bruising and swelling and the wearing of a medical wrap garment for upto a month following the procedure. Recovery from a mini tummy tuck is a lot quicker than that of the standard abdominoplasty as muscles are not treated, minimal liposuction is usually necessary and the belly button is not repositioned.

How long will it be before I can get back to my normal life?

Recovery as always after any cosmetic surgery procedure should not be rushed and anyone undetgoing this should listen to their body, when it hurts or tells you that you are tired, rest!
Light exercise may commence after 1 month and a full routine after 3 months. Although visable immediately final results can be seen after 6 months. A 7 night stay is recommended in Turkey following the procedure and most can return to work after a week.

Can a mini tummy tuck be performed without scar?
A tummy tuck, mini or otherwise leaves a scar, the results of a cosmetic surgery procedure however the scar from the mini tummy tuck is a lot shorter than that of a full tummy tuck, made as low as possible above the pubis it can usually be hidden by underwear until fully recoverd 12 months after surgery.

Only suitable to those with minimal excess skin and fat at the lower abdominal area when combined with liposuction which removes excess fat a mini tummy tuck restores good contour, a trimmer, thinner waistline and a slim, younger appearance. Performed as a single procedure a mini tummy tuck is also be combined with breast shaping, eyelid and facial surgery.

What is a Gynecomastia?

The medical term gynecomastia means “woman-like breasts.” A common condition in one or both breasts affecting an estimated 40-60 percent of men often a result od hormoneal changes, hereditary conditions, disease or the use of certain drugs. Male breast reduction procedure surgically removes fat and/or glandular tissue from the breasts, and in rare cases, excess skin to obtain a flatter, firmer chest consistent with a masculine body contour.

Gynecomastia is characterised by the following in one (unilaterally) or both breasts (bilaterally);
– Excess localised fat,

– Excess glandular tissue development,

– A combination of both excess fat and glandular tissue,

– Self consciıousness concerning the breast area.

Certain lifestyle factors can contribute to this condition. Overweight men should first attempt to correct their enlarged male breasts through weight loss and exercise. In some instances overweight men may be discouraged may be discouraged from making the surgery. Best candidates are those who have firm, elastic skin that will reshape to the body’s new contours in some instances.

How long does gynecomastia surgery last?

No guarantee can be given but results are permenent. It is rare but a second operation may be necessary to achieve desired results.

How is the gynecomastia performed?

Enlarged male breasts can be reduced by liposuction and/or by cutting out excess glandular tissue. If excessive glandular tissue, fat and skin is present, it will be removed surgically. If on the other hand fatty tissue alone needss to be removed liposuction only may be performed.

Duration of operation – 45 minutes/1 hour (general or sedation anaesthesia).

Hospital stay – 1 night.

What to expect dirrectly after surgery:

There may be temporary loss of breast sensation, numbness and burning after the gynecomastia procedure which may last even upto a year. Swelling, however, should subside within six months. A support garment will be worn post surgery for 4-6 to assist healing.

How long will it be before I can get back to my normal life?

3-10 nights stay is recommended in Turkey following gynecomastia. Most men can return to work within 3-10 days however final results will take longer to be seen due to swelling.

Can gynecomastia be performed without scar?

Scars are part of the healing process following an operation but by following the surgeons guidelines scars around the nipple with time will fade becoming barely visable.

What is a breast augmentation surgery?

Bresat augmentation using ‘implants’ increas breast fullness, replaces volume & changes the position of breasts for women who have lost this after pregnancies, breast feeding, ageing & weight loss & feel that their upper body is not in proportion to their lower body.

Who is a suitable candidate for breast augmentation surgery?

Those who are unhappy with their breast size and would like to increase this resulting in a boost in both self esteem & confidence.

How long does a breast augmentation last?

We use American FDA certificated implants (Mentor) which includes cohesive jell. You don’t need to change them.

How is breast augmentation procedure performed?

An incision is made usually in the crease under the breast, lifting the breast tissue creating a pocket in the breast area for the implant which may be placed either under the chest muscle or directly under the breast tissue. (A decision made together with the surgeon for best results).

Duration of operation; 1 hour (under general anesthesia).

Hospital stay – 1 night.

What to expect immediately after surgery; Initially your breasts may be taped high on your chest or you will be wearing a surgical bra to support, hold & protect you for the next weeks. Some discomfort & pain may be experienced especially from submuscular augmentation. Your breasts will feel tight, firm & swollen however as swelling reduces the breasts will drop into a more normal shape & position.

How long will it be before i can get back to my normal life?

Some People can leave hospital the same day as surgery although a one night stay is recommended. You can return to work within 1 week if it does not involve physical activity, this should be restricted for upto 3 weeks post surgery & heavy exercise not before 3 months.

Can breast augmentation surgery be performed without scar?

Breast augmenttaion involves an incision & necessitiates a scar however using the crease under the breast leaves minimal scarring which is then hidden under the new breast. These scars are conspicuous initially but after 6 months they will be remarkably improved.

At what age can you have breast augmentation?

Generally it should be left until a girl has stopped growing (FDA approval of silicone implant is for breast augmentation for women aged 22 and over).

Can breast implants look normal?

Yes! With today’s naturally shaped implants, techniques & a choice in size type of implants final results can look perfectly normal.

Breast augmentation is one of the ways to enhance your breasts, it is one of the most popular procedures performed worldwide & can have a big positive effect on both morale & self confidence.

What is liposuction?

One of the world’s most popular procedures liposuction reduces the overall number of fat cells enabling you to change your body’s contours and flaws. Being more about fat than skin it is an effective way to remove the stubborn fat deposits around the body that are not helped by sport and diet.

Who is a suitable candidate for liposuction?
Those who are moderately overweight can benefit from liposuction which in women can usually be applied to the abdomen, hips, thighs, inner knees, upper arms and back. In men the areas usually treated are the chest/breasts, abdomen and flanks.

How long does liposuction last?

Results are permenent as long as you keep a stable weight. If you gain weight after after liposuction it will show in the areas not treated where the fat cells will continue to expand. Possible from the age of 18 years liposuction offers best results for the young who have elasticity in the skin (There are different procedures that address excess and saggy skin eg tummy tuck that can be performed in combination with liposuction to obtain best results).

How is liposuction procedure performed?

Tiny incisions (3-6mm) are made and a wetting solution infused with a cannula (hollow thin, tube like instrument that traps the fat.) to anaesthetise, reduce bleeding and improve fat extraction. The cannula is inserted under the skin, moved backwards and forwards within the fat pushing it aside whilst protecting the vessels and nerves. Fat is then suctioned out and your body checked for symmetry.

Duration of operation – 1/1.5 hours (under general anesthesia / sedation).

Hospital stay;
Depending on type of anaesthetic and amount of fat removed yhepatient may go home the same day or stay 1 night at the hospital.

Will I wear a support garment after liposuction?

A specially designed surgical, stretch, support garment will be fitted immediately following the procedure and will be worn for between 4-10 weeks. This garment minimalises swelling, improves skin retraction, protects the treated areas and keeps you comfortable.

What shall I expect after surgery?
Expect significant swelling and even a weight gain initially after liposuction. Your face, hands and feet may swell up from the fluids pumped into you during the procedure. Swelling travels downwards so you may expereince puffiness even in untreated areas! Leakage, assymmetry, lumps, surface irregularities discomfort and discolouration will disappear within the first few weeks. A 3-7 night stay in Turkey is recommended after liposuction, swelling can exist upto 6 weeks and final results will be seen between 6-12 months after the procedure.

How long will it be before i can get back to my normal life?
Most patients do not experience a large amount of pain from liposuction & although advised to restrict activities for the first 7 days.

Can liposuction be performed without scar?

Minimal scars for liposction are placed within a natural fold of the body and although visable initially, usually within a 6-12 month period they should be almost invisible.

Can you gain weight after liposuction?

Liposuction removes some of the fat cells, if you gain weight after treatment you may gain weight in other areas.

Does liposuction remove cellulite?

Cellulite is a different type of fat, it lives deep in the septa where the liposuction cannula cannot reach. Liposuction can make your body look smoother but it isn’t a cure for cellulite.

In many cases liposuction is performed as part of a body shaping programme performed with additional procedures for maximum benefit, these may include tummy tuck, thigh and arm lift. Results from liposuction vary from person to person and a second session may be necessary for further improvement. It should be understood that liposuction is not a substitute for diet and exercise and the goal should be improvement, not perfection.

What is an upper arm lift(Brachioplasty)?

As a person ages, experiences weight shifts or due to genetics upper arm skin can become loose and flabby. Tightening and removal of the excess skin comined with liposuction to remove excess fat will give a more shaplier, firmer and a youthful appearance.

Who is a suitable candidate for arm lift surgery?
Those who have loose, flabby skin and fat that often gives the upper arms the name ‘bingo wings’ and ‘bat wings’. Although exercise will help increase appearance often surgery is the only alternative. Liposuction only will reduce the overall volume of fat but wont remove excess skin. A combination of both will usually give best results.

How long does arm surgery last?
No guarantee can be given by anyone and whilst the results are permenent upper arms will start to sag again with ageing and if weight is lost and gained.

How is the arm lift procedure performed?
The surgical approach depends on the droopiness of skin however usually incisions are made on the inner arm from the elbow to the axilla (armpit).
A short scar version of the lift can be performed with the scar being placed in the armpit, this approach tightens the loose skin but doesn’t remove much, it is only for those with a limited amount of slackness and with good skin tone.

Duration of operation – 1/1,5 hours (under general anesthesia / sedation)

Hospital stay – 1 night.

What should I expect after surgery?
Some surgeons prefer to wrap the arms or use compression garment and the arms should be elevated for a few days, above the heart. It is important to protect and support the area of incision to ensure proper healing. Discomfort and soreness will be experienced during the first days after surgery but this is temporary and will pass during the next weeks.

How long will it be before I can get back to my normal life?
This should not be rushed and will usually take upto a month. A 7-10 night stay is recommended in Turkey following the procedure and most can return to work within 2 weeks if it does not involve physical activity with the arms.

Can arm lift surgery be performed without scar?
Upper arm reduction involves the removal of skin and necessitates the creation of a scar that starts near the elbow to the arm pit. Most scars are conspicuous initially and take upto 12 months to develop completely. The scar may be on the inner arm so that it is not visible when the patient’s arm is by their side or a bit more towards the back of the arm so that it is not visible from the front, especially when the patient is observed from the front while moving the arm.

In many cases an arm lift is performed as part of a body contouring programme and is combined with such procedures as a tummy tuck, thigh lift and breast surgery to create an overall, improved appearance.

What is a tummy tuck(Abdominoplasty)?

A popular procedure removing and tigjtens excess skin and fat at the middle and lower tummy, usually abdiminal wall muscles area are tightened at the same tme. Often combined with liposuction at the tummy, abdomen, hips, waist and thighs gives best results.

Who is a suitable candidate for tummy tuck surgery?
If you have excess abdominal skin, a sagging tummy, bulging of the abdomen or muscle weakness, a tummy tuck will improve your appearance.Genetics, child birth, skin type weight loss/gain often stretch the skin to the point and it no longer contracts, a tummy tuck is the only option. If excess skin and lax muscles are limited to below the navel then you may be a more suitable candidate for a mini-tummy tuck with a shorter scar, no belly button repositioning, shorter scars and a quicker recovery.

How long does tummy tuck last?
Results are permenent but must be accompanied by a regular sports programme and a healthy life style.

How is the tummy tuck procedure performed?

This usually involves an incision made across the lower abdomen just across the pubic area from here skin is seperated from the abdomial wall upto your ribs, the excess removed and tightened. Muscles may be pulled closer together and stitched into their new position. Often a second incision is made to remove the navel from surrounding tissue and thi sis then replaced at the right position.

Duration of operation – 1,5/2 hours (under general anesthesia).

What should I expect immediately after surgery?

Expect minimal bruising but significant swelling (especially if performed with liposuction).
Temporary discomfort and pain may be experienced especially if muscle tightening has been performed. Drains may be left in place for between 3-5 days to help speeed up recovery by removing excess fuids from the body. Leakage, assymmetry, lumps, surface irregularities, hardness, discomfort and discolouration are normal at this time and will disappear within the first few weeks. A 7-14 night stay in Turkey is recommended. Bruising and swelling can exist upto 6 weeks and final results will not often be seen for upto 12 months after surgery.

Will I wear a support garment after liposuction?
A specially designed surgical, elastic binder will befitted immediately after surgery to be worn for upto 6 weeks after the surgery. This garment minimalises swelling, improves skin retraction, protects the treated areas and keeps you comfortable.

How long will it be before I can get back to my normal life?
This should not be rushed. Walking is recommended from early after the operation but vigorous exercise avoided for upto 6 weeks after surgery. A 7-10 night stay is recommended in Turkey following the procedure and most can return to work within 2 weeks. It will take upto a year before the scar flattens, softens and fades and final results seen.

Can a tummy tuck surgery be performed without scar?
A tummy tuck involves removal of skin and necessitates the creation of a scar that runs almost from hip to hip however placed as low as possible it can be concealed by underwear in the future. Most scars are conspicuous initially and take upto 12 months to develop completely.

By removing excess skin and fat a younger, trimmer, more contoured and slimmer appearance can be gained. Often performed as part of a body shaping procedure it is performed with breast surgery, thigh and arm lift.