Sad Umbilicus: Prevention and Treatment

Abstract

Although the navel is a functionless depressed scar, it represents an important and pleasing landmark. Any degree of umbilical protrusion and horizontal orientation or distorted shape signifies deviation from the ideal female umbilicus [1]. One of the most common and difficult problems with the abdomen is treatment of the supraumbilical wrinkling that may develop in the linea alba after pregnancies or due to aging, flaccid skin, or excessive fat aspiration, provoking a defect called ‘‘sad umbilicus.’’ (Fig. 1). Various techniques have been used to resolve this deformity. Toledo [2] tried resecting the wrinkled skin above the umbilicus through a circular periumbilical incision and with a horseshoe-shaped incision, leaving the lower pedicle of the umbilicus untouched. The results of this technique have not been gratifying. In the past, liposuction has been used because the wrinkling skin over the umbilicus can sometimes be misinterpreted as excess fat, resulting in an iatrogenic deformity [3]. Fat grafting of this area also has been done, but the results are not consistent [3]. Although the ideal shape of the umbilicus has been debated, recent studies have shown that the young thin female with an attractive abdomen tends to have a small, vertically oriented umbilicus [4]. We are proposing a new technique for prevention and correction of the sad umbilicus. Minimum undermining through a small incision in the superior part of the umbilicus using a 4-mm liposuction cannula in the midline of the upper abdomen creates a minimal superior sulcus. Interaponeurotic sutures are performed using 4-0 nylon. These sutures pull superiorly and tighten the supraumbilical skin by fixing the level of the superficial fascia to the musculoaponeurotic fascia (Fig. 2). The fixation point on the musculoaponeurotic fascia is 2 to 3 cm superiorly compared with the suture point of the superficial fascia. Two to three sutures, depending on the severity of the case, are needed. For prevention of sad umbilicus after performance of liposuction via an umbilical incision, one to two Fig. 1 Preoperative view of a 34-year-old patient with ‘‘sad umbilicus’’ deformity