The Cosmetic Umbilicus: A Review of Aesthetic Features and Surgical Methods

Abstract

Introduction: The umbilicus (commonly called the belly button or navel) is an important part of the appearance of the abdomen. It must be carefully reconstructed during abdominoplasty to achieve the best cosmetic result. Features important to aesthetic appearance of the umbilicus include size, shape, depth, and position on the anterior abdomen. A variety of techniques, from simple to complicated, are available to attempt to achieve umbilical beauty. The objective of this review is to describe the characteristics of the ideal umbilicus and several available techniques surgeons can use to obtain ideal results when resetting or reconstructing the umbilicus. Methods: The literature was reviewed for umbilical reconstruction and umbilicoplasty procedures in abdominoplasty with additional emphasis on what features are important to the aesthetic appearance of the umbilicus. The surgical procedures and aesthetic preferences are summarized in this article. Results: Eight surgical procedures are illustrated here. The best surgical techniques allow a procedure to be performed in a timely fashion as well as to produce the best short-term and long-term results. Three of the procedures illustrated are unusual, complex, and time consuming, and are recommended only for cases when the umbilicus must be completely reconstructed because the original umbilicus is too malformed to be of use in reconstruction. Discussion: Suggestions taken from the various surgical techniques are emphasized, including striving for proper umbilical depth; defatting the new periumbilical region of the abdominal fat; tacking the stalk to the abdominal aponeurosis or attaching the superficial abdominal fascia to the edges of the abdominal flap incision; recognizing the importance of shape, size, and positioning of the final result; and avoiding large incisions. Conclusion: There are many acceptable methods for resetting the umbilicus available to cosmetic surgeons, and each surgeon must determine his or her favorite procedure. The best technique for a particular case may include ideas from several of the surgical approaches. The final result should strive for a moderately small, vertically shaped umbilicus with superior hooding. The new umbilicus should not have any protrusion or distortion.