When Maokai steps on the sapling, it then comes out from the face on his left arm then go back to his right hand across his shoulders (implying there might be a hole under his foot somewhere, and hollow passage inside his body), and same goes for when Maokai "eats" the sapling where the sapling will also emerge from the face on the left arm iirc. It may seem strange, but it seems to just be how Maokai has fun with his kids I suppose.
As for the face on his left arm, it's implied to be sentient to at least some extent on its own given it laughs along with Maokai and the sapling when he laughs, though Maokai seems to dislike the face on his left arm doing things on its own and would hush it after it laughs. Yeah it's weird.
Let's just say Maokai's body works differently and thus holds a different outlook about it than humans would about their body.