Minimal Scarring Research Articles

Anterograde ultrasound guided lacertus fibrosus release at the elbow under WALANT - technical note.

Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release. The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT. We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine. The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division. The patient returns to full activity within days to a week after surgery. Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.

Enzyme-crosslinked hyaluronic acid hydrogel scaffolds for BMSCs microenvironment and wound healing.

Tissue engineering utilizing hydrogel scaffolds in combination with exogenous stem cells holds significant potential for promoting wound regeneration. However, the microenvironment provided by existing skin tissue engineering scaffold materials is often inadequate. Herein, we demonstrate an enzyme-crosslinked hyaluronic acid hydrogel to provide a growth microenvironment for exogenous bone marrow mesenchymal stem cells and promote acute wound healing. This material is developed by grafting dopamine onto hyaluronic acid, followed by enzyme crosslinking using horseradish peroxidase and hydrogen peroxide, which creates a loose, porous structure. The hydrogel possesses adhesive and self-healing properties, offering a microenvironment with excellent cell compatibility for exogenous BMSCs. In vivo studies showed that this hydrogel significantly accelerated the healing of acute full-thickness skin wounds, resulting in the formation of appendages such as hair follicles and minimal scarring. This study not only presents a novel skin tissue engineering scaffold but also offers a promising clinical strategy for achieving scar-minimized wound healing.

MANAGEMENT OF GUDA VIDRADI LEADING TO PARISRAVI BHAGANDARA (FISTULA-IN-ANO) BY BHEDANA KARMA FOLLOWED BY KSHARA SUTRA: A CASE STUDY

Guda vidradhi (Anal abscess) is described by Acharya Sushruta under Antar vidradhi. Vidradhi remains as a localized painful condition, with all the features of Vrana shotha (inflammation) with severe pain, tendency of early suppuration. Guda vidradhi is co-related with anal abscess on the basis of symptom. A perianal abscess is an infection in a mucous- secreting gland in the anal canal around anus. Fistula-in-Ano is an epithelial-lined tract connecting the anal canal to perianal skin. Parisravi Bhagandara is a type of bhagandara told by Acharya Sushruta caused by predominance of kapha dosa. Parisravi Bhagandara is treated by Chitraka based kshara sutra, which is cost effective and requires less hospitalization. Ayurveda as well as modern science described same line of treatment in the presence of pus. Acharya Sushruta mentioned that Bhedana Karma at the most prominent part for evacuation of dosha. Kshara sutra procedure was carried out on 40 years old female patient suffering from Guda Vidradi leading to Parisravi Bhagandara. After the complete cut through of fistulous track and wound healing, there were no complaints of pus discharge or pain. Bhedana Karma followed by Chitraka based Kshara Sutra in management of Guda Vidradi leading to Parisravi Bhagandara has significant results when compared with contemporary sciences. Kshara sutra can be carried out in OPD’s, with less complications, minimal scar after healing and cost effective when compared with contemporary sciences.

Three Years Follow-Up of Single-Stage Correction with Modified Chula Technique for Frontoethmoidal Encephalomeningocele: The Advantage of The Teamwork Approach (A Case Report)

Backgrounds: The main objective of Frontoethmoidal encephalomeningocele (FE) treatment are neural morbidities defect correction and aesthetically pleasing looks. Staged procedures are used to be performed in Indonesia. This article aimed to reveal the result of FE correction through the single-stage modified Chula technique (ST-MCT) procedure in collaboration with the neurosurgery team. Case Reports: A rare case of 5 years old girl diagnosed with FE was reported in this study. The FE was slowly increased in size, causing apparent facial deformity and the appearance of telecanthus. An ST-MCT procedure in collaboration with the neurosurgery team was conducted to correct the defects. The IOD values, IPD values, postoperative complications, and anesthetic improvements were evaluated in this study. Result: The patient was well after the surgery, with no complications and short length of stay. There were noted improvement of ICD, IOD and IPD postoperative follow up. At three years after the surgery ICD= 29mm; IOD= 26mm; IPD= 52 mm (normal range). Summary: ST-MCT procedure conducted in collaboration with neurosurgery team had shown excellent correction of ICD, IOD, and IPD values, no complication, shorter length of stay, and minimal scars. It considers as the most proper technique to reach a good result of correction and aesthetically pleasing looks in FE cases.

Innovative Modifications in Diamond Umbilicoplasty: Simplified Techniques for Improved Cosmetic Results.

Umbilicoplasty is one of the main steps in abdominoplasty procedures. Various techniques of umbilicoplasty are performed by surgeons from diverse backgrounds, all aiming for a naturally appearing umbilicus with minimal scarring. In this report, we present two umbilicoplasty methods practiced at our center. The key steps involved in both techniques include securing the umbilicus in its new position, creating a natural umbilical depth, and preventing visible scarring. These two methods are easily reproducible, time-effective, and consistently yield aesthetically pleasing results. We also discuss alternative umbilicoplasty methods performed in other facilities.

Dynamics of Human Palatal Wound Healing and the Associated Microbiome

Wound healing in the oral mucosa is superior to that in the skin, with faster wound closure accompanied by reduced inflammation, less angiogenesis, and minimal scar formation. A well-characterized oral wound model is critical to investigating the mechanisms of oral wound closure and the efficacy of various clinical interventions. Currently, there are a few human oral wound models, although none of them are well characterized. In the present study, we describe and characterize a human hard palate wound healing model. A 3.5-mm circular and two 1 × 5-mm rectangular full-thickness wounds were made in the first and second molar region, 5 mm from the gingival margin, on the hard palate of human subjects. The circular wound was used to monitor wound closure and collect swabs for a microbiome analysis via 16s rRNA sequencing. The rectangular wounds were biopsied and the tissue was used to evaluate the gene expression of wound healing-related mediators by real-time polymerase chain reaction. Saliva was also collected to examine the protein levels of similar molecules by enzyme-linked immunosorbent assays. Circular wounds were nearly closed on day 7 after wounding. Significant changes in the gene expression of inflammatory cytokines, growth factors, antimicrobial peptides, and extracellular matrix-related molecules were identified in day 1 and day 3 wound tissue and compared with unwounded tissue on day 0. Changes in the protein levels of various mediators were limited in the saliva. In addition, alpha diversity, beta diversity, and differential microbiome analysis demonstrated significant changes in bacterial colonization of the wound surface over time compared with unwounded mucosa. In summary, we comprehensively characterize a human hard palate wound-healing model that details the dynamic changes of wound closure, levels of wound healing-related mediators in the wound and saliva, and the oral wound microbiome.

A Novel Technique for Top Surgery in Small-Breasted Individuals Who Experience Gender Dysphoria – Concentric Periareolar Mastectomy, Interlocking Suture and Waterjet-Assisted-Liposuction

Background: In small-breasted individuals, who experience gender dysphoria, the concentric periareolar approach is typically the preferred method for mastectomy. However, this method carries a notable risk of hypertrophic scars and changes in the areolar dimensions. This study introduces the periareolar interlocking suture (PIS) as a new scar-minimizing procedure, with a low complication rate and high patient satisfaction. Patients and Methods: We performed a concentric periareolar mastectomy (CPM) combined with PIS and waterjet-assisted liposuction (WAL) in patients with small breasts (A to B-Cup) and good skin quality/elasticity. Outcome measures included complication rates, patient satisfaction (assessed via the BODY-Q Chest and Nipples Scale and scar appearance), nipple sensitivity, and the rate of surgical corrections. Results: Between April 2017 and December 2023, we conducted 2312 mastectomies in 1156 people who experience gender dysphoria, with 410 breasts treated using CPM combined with PIS and WAL. The mean patient age was 23 years, mean hospital stay was 4 days, and mean operation time was 96.1 minutes. The overall complication rate was 7.8%, with acute hematomas occurring in 4.6% of the cases. Secondary revisions were necessary in only 2.2% of cases. Patient satisfaction, measured using the BODY-Q scale, was statistically significant and very high. Conclusion: Individuals with gender dysphoria are well-informed and increasingly demand aesthetic outcomes. Whenever feasible, procedures with minimal scarring are preferred. The technique presented here resulted in very high patient satisfaction, preserved nipple sensitivity, and a low rate of complications and secondary aesthetic corrections in a carefully selected cohort of patients with small breasts.

A Soft Tissue-Borne Patient-Specific Guide for Foreign Body Removal in the Facial Region.

Foreign body removal in the facial region poses significant challenges due to the complex anatomy and the proximity to critical structures. This study introduces a soft tissue-borne patient-specific guide (PSG) designed to enhance precision and minimize invasiveness in foreign body removal. Four patients underwent foreign body removal using PSGs, with CT and cone-beam computed tomography (CBCT) imaging employed for segmentation and detailed analysis of both hard and soft tissues. This approach enabled the planning and design of stable and personalized guides. Ultrasound tracing was used for intraoperative verification. All procedures were successful, with minimal scarring, no complications, and reduced operative time. The use of PSGs improved surgical accuracy and efficiency, highlighting their potential for foreign body removal in other regions of the body and for broader clinical applications in maxillofacial surgeries.

Progress in gasless endoscopic thyroidectomy.

Gasless endoscopic thyroidectomy obviates the necessity for carbon dioxide insufflation to establish a surgical workspace, thus mitigating the potential complications associated with this practice. This technique presents several benefits, such as the maintenance of neck functionality, minimal scarring, and enhanced visibility of the surgical field, which contribute to its extensive adoption in clinical settings. The objective of this study is to synthesize the current methodologies of gasless endoscopic thyroidectomy and to evaluate the advantages and disadvantages inherent to each technique. It aims to offer theoretical insights to assist surgeons in determining the most suitable approach for gasless endoscopic thyroidectomy in their clinical practice.

Neuromuscular Regeneration of Volumetric Muscle Loss Injury in Response to Agrin-Functionalized Tissue Engineered Muscle Grafts and Rehabilitative Exercise.

Neuromuscular deficits compound the loss of contractile tissue in volumetric muscle loss (VML). Two avenues for promoting recovery are neuromuscular junction (NMJ)-promoting substrates (e.g., agrin) and endurance exercise. Although mechanical stimulation enhances agrin-induced NMJ formation, the two modalities have yet to be evaluated combinatorially. It is hypothesized that the implantation of human myogenic progenitor-seeded tissue-engineered muscle grafts (hTEMGs) in combination with agrin treatment and/or exercise will enhance neuromuscular recovery after VML. The hTEMGs alone transplant into VML defects promote significant regeneration with minimal scarring. A sex-appropriate, low-intensity continuous running exercise paradigm increases acetylcholine receptor (AChR) cluster density in male mice twofold relative to hTEMG alone after 7weeks of treadmill training (p<0.05). To further promote neuromuscular recovery, agrin is incorporated into the scaffolds via covalent tethering. In vitro, agrin increases the proliferation of hMPs, and trends toward greater myogenic maturity and AChR clustering. Upon transplantation, both hTEMGs+agrin and hTEMGs+exercise induce near 100% recovery of muscle mass and increase twitch and tetanic force output (p>0.05). However, agrin treatment in combination with exercise produces no additional benefit. These data highlight the unprecedented regenerative potential of using hTEMGs together with either agrin or exercise supplementation to treat VML injuries.

Correction of Severe Pterygium Colli with a Staged, Double, Posterior and Lateral Approach: A Case Report

AbstractPterygium colli is a rare congenital disorder characterized by excessive skin in the lateral and posterior neck, often associated with genetic syndromes such as Turner's syndrome or Klippel–Feil syndrome. Severe presentations present special challenges for surgeons since its diagnosis is not always evident and its treatment often results in important scaring. Surgical correction of the typical cases mostly involves a lateral approach, but in this “special” case, we used a double, posterior and lateral approach. A 15-month-old girl with prenatal diagnosis of a cystic lesion in the posterior neck presented with massive neck webbing at birth. Genetic studies ruled out chromosomal disorders and RASA 1 mutations. Surgical correction involved a modified posterior approach combined with a lateral approach 1 year later. The cervical tissue redundancy was successfully reduced achieving a good aesthetic outcome with very acceptable scars. At 1 year of follow-up, the patient continues with good neck appearance and mobility. The goal of surgical treatment of pterygium colli is achieving a harmonious neck contour with good function and minimal scarring while minimizing complications and sequelae. No consensus exists on the optimal approach for its correction, emphasizing the need for individualized treatment considering patient-specific characteristics, particularly in the severe cases.

Negative pressure assisted rubbing suction technique for the treatment of axillary osmidrosis based on minimally invasive principle

BackgroundAxillary Osmidrosis is highly prevalent and occurr in adolescents, bilateral onset, its pathogenesis is related to abnormal secretion function of apocrine glands, with a significant genetic predisposition, the patient's bilateral armpit area can smell a spicy pungent odor, although it does not affect the health, but it is inconvenient to life, socialize. Patients are often accompanied by low self-esteem and urgently require treatment, and most of them have the requirement of minimally invasive treatment and minimal scarring. MethodIn this study, we aimed to evaluate the efficacy of minimally invasive treatment of axillary osmidrosis with refined negative pressure-assisted rubbing suction technique. From August 2022 to August 2023, 50 patients (28 females and 22 males) with axillary osmidrosis were treated with refined negative pressure-assisted rubbing suction technique. HE staining of the tissue rubbed out of six of these patients showed a large amount of apocrine gland. ResultsIn the subjective evaluation of 50 (100 sides) patients, 66 sides (66 %) were very satisfied with the results of the treatment, 30 sides (30 %) were satisfied, and 4 sides (4 %) were dissatisfied. Clinical efficacy evaluation showed that 74 sides (74 %) of patients rated the results as cured, 18 sides (18 %) as significantly effective, 4 sides (4 %) as effective, and 4 sides (4 %) as ineffective. No serious surgical complications occurred except for the occurrence of Subcutaneous hydrops and hematoma on 6 sides. ConclusionsRefined negative pressure-assisted rubbing suction technique is an easy and effective method for minimally invasive treatment of axillary hyperhidrosis and deserves clinical promotion.

Barbaloin loaded chitosan-gum kondagogu polyelectrolyte complex based biocomposites film for enhanced antibacterial, antioxidant and wound healing activity

This study developed an advanced biocomposites film by combining chitosan (CS) with gum kondagogu (GKG) to form a polyelectrolyte complex (PEC) and incorporating zinc oxide nanoparticles (ZnO NP) and barbaloin (BB) to boost wound healing. In brief, the PEC formed between CS and GKG was confirmed through FTIR analysis. The integration of BB into the PEC polymeric matrix resulted in a uniform distribution of BB and loss of crystallinity. As well, the optimized CS/GKG/BB-3 biocomposite film displayed good mechanical strength (8.9 ± 0.30 MPa), high water absorption (451.1 ± 6.02 %), and good water retention potential. The optimized biocomposite film exhibited notable antioxidant properties and effective antimicrobial activity against Staphylococcus aureus and Escherichia coli. Moreover, in vivo studies demonstrated that this biocomposite film facilitated rapid and complete re-epithelialization, enhancing tissue regeneration with minimal scarring, outperforming other biocomposite film formulations. Here, the controlled degradation profile and excellent moisture retention of the CS/GKG/BB-3 biocomposite film created an ideal environment for wound healing. In conclusion, the prepared CS/GKG/BB-3 biocomposite film offers the potential as a superior alternative to traditional wound dressings, emphasizing the synergistic benefits of CS, GKG, ZnO NP, and BB in developing advanced biomaterials for effective wound care and tissue repair.

Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy.

This study aims to assess the safety, efficacy, and esthetic outcomes of an innovative 4 cm right infra-axillary incision approach for concomitant ascending aorta and aortic valve replacement (AAR and AVR), with a specific focus on achieving optimal surgical outcomes while ensuring minimal visible scarring. We retrospectively examined all elective cases of concomitant AAR and AVR surgery performed at our institution from July 2021 to June 2023. Exclusions encompassed emergency surgery, acute type A aortic dissection, active aortic valve endocarditis, redo cardiac surgery, the necessity for concurrent mitral valve replacement, or left ventricular assist device implantation. We collected and analyzed perioperative data for the patients. The study comprised 24 consecutive patients. Cardiopulmonary bypass time and aortic cross-clamp time averaged 215.0 (interquartile range [IQR], 38.0) and 158.0 (IQR, 37.0) min, respectively. No instances of reoperation due to postoperative bleeding or need for permanent pacemaker implantation were recorded. Initial 24-h postoperative drainage volume averaged 186.9 ± 76.9 mL. Average follow-up duration was 21.7 ± 6.2 months (range, 5 to 30 months). Throughout short-term follow-up, no occurrences of valve dysfunction, paravalvular leak, cardiovascular events necessitating readmission, or mortality were observed. The right infra-axillary incision approach effectively yields secure, successful, and cosmetically pleasing outcomes for concomitant AAR and AVR. Further research and comparisons are warranted to validate these findings.

An injectable hydrogel of porcine cholecyst extracellular matrix for accelerated wound healing.

Hydrogel formulations of xenogeneic extracellular matrices have been widely used for topical wound care because of their exceptional tunability over other formulations like lyophilized sheets, powders, non-injectable gels, pastes, and ointments. This is important in the treatment of wounds with irregular shapes and depth. This study identified an injectable hydrogel formulation of porcine cholecyst extracellular matrix (60%) in medical-grade carboxymethyl cellulose (40%) as vehicle and evaluated its biomaterial properties. Further, an in-depth evaluation of in vivo wound healing efficacy was conducted in a rat full-thickness skin excision wound healing model, which revealed that the hydrogel formulation accelerated wound healing process compared to wounds treated with a commercial formulation and untreated wounds. The hydrogel appeared to have promoted a desirable pro-regenerative tissue reaction predominated by Th2 helper lymphocytes and M2 macrophages as well as an effective collagen remodeling indicative of diminished scarring. In conclusion, the porcine cholecyst extracellular matrix injectable hydrogel formulation appeared to be a promising candidate formulation as an advanced wound care biomaterial for faster healing of skin wounds with minimal scarring.

Advancement of Nanofibers in Wound Healing: A Review

The field of wound healing is currently experiencing a ground-breaking transformation with the introduction of nanofiber technology. This groundbreaking discovery has the potential to revolutionize regenerative medicine and tissue engineering worldwide, effectively meeting the growing need for innovative and affordable healthcare solutions. This comprehensive review explores the evolution and utilization of nanofibers to enhance wound healing. Nanofibers, known for their ability to mimic the extracellular matrix of human tissue, play a crucial role in facilitating cell growth and wound repair. The review explores sophisticated techniques like electrospinning and the integration of bioactive agents such as antibiotics and growth factors with nanofibers. It emphasizes on the precision with which these nanofibers are customized to address specific therapeutic requirements. Additionally, the review sheds light on the use of both natural and synthetic polymers in crafting biocompatible nanofibers, which significantly reduces healing time while ensuring optimal aesthetic recovery, meeting the expectations of patients with minimal scarring. It emphasizes the synergy of expertise from materials science, biology,and clinical practices in propelling nanofiber-based therapies from the laboratory to the forefront of clinical care. Through this succinct overview, we aim to underscore the immense potential of nanofibers in transforming wound care. We are offering a glimpse into a future where effective and efficient healing is within reach, marking a remarkable leap forward in the global quest for advanced healthcare solutions.

Role of Laparoscopy in Reproductive Age Group Women with Gynecological Problems in a Tertiary Medical College

Background Laparoscopy has been a revolution in gynecological surgery as it is safe and minimally invasive. It can be used as a diagnostic as well as treatment modality for different gynecological problems like Chronic pelvic pain, adnexal cyst, ectopic pregnancy, Pelvic inflammatory disease and infertility.MethodsThis study was carried out at College of Medical Sciences-Teaching Hospital from April 2022 to March 2023 in 105 women. All the women undergoing laparoscopic surgeries were analyzed for indications, intraoperative findings and interventions.ResultsThe mean±SD of age of women was 30.34±7.73 years, most were in age group 26-35 years. The most common indications for Laparoscopy were for Adnexal cyst (74.28%), Chronic Pelvic Pain (14.28%) and Infertility (11.42%). The most common findings according to site were Ovarian pathology (48.60 %) followed by peritoneal pathology (22.9 %), Tubal pathology (17.14%) and normal findings (10.50%). In ovarian - Dermoid cyst (31.37 %), in tubal - ectopic pregnancy (55.56%), in peritoneal-Adhesions (45.83%) were the most common finding. In laparoscopic interventions, 26.70% had cystectomy, 14.3 % had salpingectomy and 13.3 % had Sterilization. Conclusions Laparoscopy as a modality for diagnosis and treatment of gynecological problems has been well established in recent times. It’s been a choice of surgery because of its reduce postoperative pain, shorter hospital stay, faster recovery and minimal scar. However, adequate advanced training and equipment are needed to perform skillful laparoscopic surgeries.

Aesthetic Approaches to Zygomatic Fracture Management: Achieving Optimal Outcomes With Minimal Scarring.

The zygomaticomaxillary complex is integral to facial aesthetics and is frequently involved in facial fractures. These injuries often necessitate surgical intervention, with open reduction and internal fixation being the standard treatment. This article presents a novel philosophy for managing zygomatic fractures, emphasizing the "Scarless Surgery" technique. The authors' approach prioritizes minimal osteosynthesis material and fixation points while utilizing the least visible surgical access. For isolated zygomatic arch fractures, an intraoral technique is preferred, whereas the frontozygomatic suture is approached through an upper eyelid crease for optimal aesthetic outcomes. The zygomaticomaxillary buttress is accessed through a vestibular mucosal incision and the infraorbital rim benefits from a transconjunctival approach. The findings suggest that fewer fixation points can still yield satisfactory stability and cosmetic results, aligning with literature supporting the efficacy of 1 and 2-point fixations. This modern technique not only minimizes visible scarring but also conforms to the contemporary push for minimally invasive surgical methods. The authors' experience and the existing literature support the efficacy of this approach, reinforcing its viability as a standard practice in the surgical management of facial trauma.

Neo-Omphaloplasty within a Vertical Scar: The Double Trapezium Flap Technique

Background: Various techniques for neo-omphaloplasty (or umbilicoplasty/umbiliconeoplasty) have been established in recent decades. However, when the omphaloplasty must be integrated into a vertical scar, most of these techniques are unsuitable. Method: We established a technique comprising two “cross-border” trapezium flaps that come together in a key-lock fashion to be applicable for umbilical reconstruction in vertical scars. Between 2020 and 2023, we performed the double trapezium flap technique in 11 patients requiring abdominal wall correction due to previous operations resulting in the loss of the original navel and a vertical midline scar. The follow-up period was 12 months. Results: We encountered two minor wound healing disorders not involving the omphaloplasty. One patient experienced a more severe wound healing complication involving the vertical scar and the lower flap of the neo-umbilicus. No cases of umbilical flattening or detachment of the anchorage stitches were detected. Patients ranked the aesthetic outcomes as “excellent” (n = 9) or “good” (n = 2). Physicians ranked the results as “excellent” (n = 7), “good” (n = 4), and “average” (n = 1). Conclusions: For the selected patients, this technique appears to be a good and reliable option to create a natural looking neo-umbilicus, creating sufficient umbilical depth with minimal scarring. While a study population of 11 patients is hardly enough to endorse a new technique, appropriate cases are comparatively rare and very specific.

A Three-Step Approach (MUC) for Umbilicoplasty: Creating a Deep Umbilical Depression in Lipoabdominoplasty.

Various methods of umbilicoplasty have been proposed to create an aesthetically pleasing umbilicus. However, following conventional lipoabdominoplasty, some patients, particularly those with a thin layer of abdominal fat, may exhibit a shallow navel. A modified umbilicoplasty with a three-step approach was performed between Jan 2019 and Mar 2023. The three-step procedure included multiple plications, umbilical stalk fixation, umbilical insertion and central gathering (MUC). Patients were followed up for at least 6months. Umbilical depth and complications were recorded. A total of 36patients were performed with MUC umbilicoplasty, with a mean age of 36.1years. Patients were satisfied with umbilical appearance. The average depth of the navel after MUC procedure was 1.8±0.3cm. A patient developed a hypertrophic scar in the umbilicus, which was treated with an intralesional injection of triamcinolone acetonide. No other complications were observed. The MUC approach to umbilicoplasty provides a deep umbilical depression with minimal scars. This three-step procedure is particularly beneficial for patients with a thin layer of abdominal fat. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .