There is a growing interest in upper arm aesthetic surgery but many patients do not accept the visible inner arm scar. Minimal incision brachioplasty using a shorter scar, concealed in the axilla, produces results equal to that of the traditional approach in comparable cases. Patients with massive weight loss may not meet the criteria for surgery. Patient selection and careful preoperative markings are critical to the success of the procedure. The author describes the technique he has been using for more than 30 years along with refinements. Minimal incision brachioplasty is an alternative to the traditional long scar approach in selected patients. It is a less involved procedure, with a low complication rate and high patient satisfaction.