Umbilicosculpture: a concept revisited

Treatment and Prevention of Umbilical Sagging with Laser-assisted Liposuction: The New Happy Protocol

Sagging of the periumbilical skin, also known as the "sad umbilicus," is one of the most common postoperative complications in liposuction. It is characterized by an increase in the width and decrease in the height of the umbilicus. Technological advances in power-assisted liposuction resulting in skin tightening have been central to improvements in the treatment of sagging skin. Laser-assisted liposuction is a procedure in which a laser fiber induces lipolysis and skin tightening. Laser treatment delivered using a 980-nm diode laser may result in up to 30% skin surface area contraction. The aim of this study was to describe a new technique called the "happy protocol" for the treatment and prevention of the sad umbilicus. The periumbilical region is treated using a 980-nm diode laser set to an output power of 20 W, with a total delivered energy of 5000 J. The developed technique may be applied to correct shape distortions or to create a natural-looking and aesthetically pleasant umbilicus during liposuction. A decrease in the width of the umbilicus followed by an increase in height are observed in the first postoperative days. Patients who were followed up for 7 months postoperatively showed positive aesthetic results. The final outcome was an oval-shaped umbilicus, with increased height and reduced sagging in the periumbilical region.

Identifying the most attractive umbilical position - an eye tracking- and survey-based investigation

Abdominoplasty is a popular procedure in plastic surgery providing aesthetic, functional and psychological relief for patients suffering from excess abdominal tissue. Correct umbilical positioning is crucial for a successful aesthetic surgical outcome. This study aims to assess the most attractive position of the umbilicus by means of subjective and objective outcome measures. 58 Caucasian study participants with a mean age of 36.87 (15.6) years rated eight different umbilical positions. The various positions were determined based on the ratio of the distance between the xiphoid process and the umbilicus and the distance between the umbilicus and the infra-umbilical crease: 1:1, 1.25:1, 1.5:1, 1.75:1, 2:1, 2.5:1, 3:1 and 5.5:1. Semi-quantitative scoring of attractiveness based on a 5-point Likert scale and eye tracking analyses were utilized. The results revealed that the volunteers perceived as most attractive the ratio of 2:1 with 4.32 (out of possible 5.0). The ratio of 5.5:1 received the lowest rating with 1.8. The results of the objective eye tracking analyses confirmed the subjective rating as the 2:1 ratio was fixated last amongst all other displayed ratios with 1.85 s whereas the 5.5:1 ratio had the shortest interval between image display and first stable eye fixation with 0.94 s. The study confirms the concept of 'internal representation of beauty'. Abdominoplasty procedures could rely on this easy to perform ratio by dividing the distance into thirds and using the boundary between the inferior and middle third as a clinically reliable landmark.

Prevention of Umbilical Sagging After Medium Definition Liposuction

BACKGROUND

The loss of the umbilical vertical axis, causing a horizontal shape deformity after liposuction, is a current aesthetic issue. The use of energy devices, such as LASER and VASER, has been advocated as an option for improving skin retraction, but no data are available on the prevention of umbilical sagging.

OBJECTIVES

The authors sought to describe a technique for preventing umbilical deformities after medium definition liposuction employing suction-assisted liposuction.

METHODS

Over a period of 31 months, 62 patients underwent medium definition liposuction with direct needle fixation of the umbilical stalk to prevent horizontal umbilical deformities. All patients underwent surgery performed by a single surgeon (G.B.). All patients underwent objective measurements of the umbilical shape before and after the procedure utilizing digital image measurements by Mirror Image software, version 6.0 (Fairfield, NJ). Statistical analysis was performed with IBM SPSS Statistics V26. The mean age of the patients was 28.8 years. The follow-up evaluation was performed 2 weeks and 9 months postoperatively.

RESULTS

Over a period of 31 months, 60 patients (96.7%) who underwent abdominal etching liposuction showed maintenance of (n = 9, 14.5%) or improvements in the umbilical shape 9 months postoperatively (n = 51, 82.2%, P < 0.05). Two patients (3.2%) experienced worsening of the umbilical shape after surgery despite suture fixation.

CONCLUSIONS

Horizontal shape deformities of the umbilicus after liposuction can be improved by utilizing direct needle fixation of the umbilical stalk. The approach has been shown to be effective, safe, and reproducible for the prevention of umbilical sagging in selected patients.

LEVEL OF EVIDENCE: 4

[Shape and aesthetic outcome evaluation of transposed umbilicus according to four surgical procedures]

INTRODUCTION

In abdominal plastic surgery, umbilicus is frequently transposed, generating scars and shapes variating with the techniques used. Various umbilical transposition techniques have been described, all of them attempt to reproduce the "ideal" umbilicus. This study aimed to define the shape and the aesthetic results obtained with four different surgical procedures, in order to choose an "ideal" umbilical transposition technique.

PATIENTS AND METHODS

This retrospective study analyzed the characteristics of transposed umbilicus, in 50 patients who had undergone abdominal dermolipectomy for aesthetic reason, after a loss of weight or in breast reconstruction by Deep-Inferior-Epigastric-Perforator. Four surgical procedures were chosen, which differed by their counter-incision shape in the abdominal flap (Y, inverted Y, de-epidermized round with horizontal incision or U), and the deep points position of umbilical docking (along a horizontal or vertical axis). Shape and depth were evaluated by a panel of experts. The global assessment was based on a double evaluation, by the surgical jury and the patients themselves.

RESULTS

The counter-incision type determined the umbilicus shape: triangular for the Y (60%) or inverted-Y (41%), round for the U (52%) and vertical oval (67%) or round (32%) for the de-epidermized circle. The deep points position influenced the umbilicus axis. Regarding the appreciation, the de-epidermized circle had the best results for surgeons in a significant way, and for patients (respectively 72% and 100% satisfied), followed by the inverted-Y (57% and 92%) and Y techniques (55% and 89%) and at last the U (50 and 75%).

CONCLUSION

Horizontal counter incision in a de-epidermized round, with two anchoring points on a vertical axis, generates vertical oval or round shaped umbilicus, considered attractive in the literature, and giving the highest aesthetic satisfaction for both surgeons and patients.

Neoumbilicus after Selective Excision in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

The umbilicus offers no functional importance to the adult human but remains a key aesthetic landmark of the anterior abdominal wall, and its absence can be a cause for concern in aesthetic and reconstructive patients. Umbilical reconstruction or transposition for abdominoplasty and abdominally based flap operations is frequently complicated by umbilical death, infections, development of wounds needing prolonged wound care, and generally poor aesthetic outcomes. A multitude of techniques have been described to create the "ideal" neoumbilicus, but none has proven to be superior to the technique that comes before it. Our data demonstrate that, in a select set of patients, it may be beneficial to electively remove the umbilicus. Thus, umbilical reconstruction can be performed as an adjunct procedure to the primary operation with a superior aesthetic result and minimal risk for complications. This article describes the authors' approach to delayed neoumbilical reconstruction in patients undergoing elective umbilical resection.

Umbilical reconstruction: different techniques, a single aim

The umbilicus is a unique physiologic scar of human life resulting from the healing process of the cut umbilical cord at birth. Its absence leads to an unnatural abdominal appearance, and an abnormally shaped or misplaced umbilicus may draw undue attention to the central abdomen. Loss of the umbilicus can be an embarrassing deformity; this occurs when older techniques of umbilical hernia or incisional hernia repair are employed and after abdominoplasty, urachal cyst repair, omphalocele repair, gastroschisis repair, some tumor excisions, and mobilization of bipedicled or bilateral TRAM/DIEP flaps for breast reconstruction. Umbilicoplasty, in which the umbilicus remains anchored to the deep abdominal fascia but is transposed through a newly-formed aperture in the upper abdominal skin flap, is performed in abdominoplasty either for abdominal flap harvest or purely for aesthetics. On the other hand, umbiliconeoplasty describes the de novo creation of an umbilicus that is absent for either congenital or acquired reasons. The optimal umbilical reconstruction should be reliable, reproducible, aesthetically appropriate, and associated with low morbidity. Ideally, it is also single-staged, except in the case of an infected wound, in which case a delayed primary approach may be prudent. (www.actabiomedica.it)

Spare parts neoumbilicoplasty

Umbilical preservation can be challenging, particularly in complex cases involving simultaneous ventral hernia repair and abdominoplasty. Although the umbilicus serves no functional purpose, removal of the umbilicus can draw unwanted attention to the abdominal area and can cause emotional distress to patients. There are several well documented options for umbilical reconstruction. We present a new umbilical reconstruction technique relevant for such cases. This neoumbilicoplasty allows for preservation of the original umbilicus with relocation and reconstruction using local flaps. The technique is relatively simple and the time needed is minimal. The result is a natural, well positioned umbilicus using the principles of spare part surgery.

Neoumbilicoplasty With a Pedicled Deep Inferior Epigastric Perforator Island Flap

Management of the umbilicus is a common dilemma at the time of abdominoplasty and abdominal wall reconstruction. It is not uncommon for underlying pathologies, such as hernias and surgical scars, to result in a disfigured or obliterated native umbilicus or make the blood supply to the umbilical stalk unreliable. In these scenarios, the umbilicus is often sacrificed. Staged neoumbilical reconstruction may be offered and typically utilizes a small skin flap and full-thickness skin graft (Ann Plast Surg 2009;63:358-360). Our technique, in contrast, permits reconstruction of the neoumbilicus in the immediate setting utilizing normally discarded skin with a robust blood supply from a deep inferior epigastric artery perforator. In this series of 13 consecutive neoumbilicoplasties, the pedicled deep inferior epigastric artery perforator island flap provided reliable results and favorable aesthetic outcomes.

Morphometric Analysis of the Umbilicus According to Age

BACKGROUND

Morphometric and anatomical analyses of the shape and position of the umbilicus have been conducted in adults, but umbilicoplasty in children remains challenging because growth is still occurring.

OBJECTIVES

The main objective of this study was to evaluate the difference in the position and shape of the umbilicus between childhood and adulthood. The secondary objective was to improve the surgical management of umbilicoplasty in children.

METHODS

This prospective single-center study focused on the morphometric analysis of the umbilicus in 200 adults and children. All data, including standardized measures and pictures, were determined by one single operator.

RESULTS

Despite a variation of approximately 2% in the xiphoid-pubis distance, the location of the umbilicus remains stable during the entire growth period. In a supine individual, the location is at one half to two thirds of the xiphoid-pubis distance (slightly lower in children), with a mean ratio of 0.57 for the xiphoid-umbilicus distance to the xiphoid-pubis distance. In the general population, the most common shapes are round and vertical oval. T-shaped umbilici were only observed in adults. Round and protruding shapes were twice as frequent in children under 18 as in adults. The horizontal oval shape was twice as frequent in adults.

CONCLUSIONS

Abdominal growth and changes in the repartition of subcutaneous adipose tissues with age are responsible for the vertical orientation and deepening of the umbilicus as well as its horizontal orientation. To promote final cosmetic outcomes, secondary umbilicoplasty must place the umbilicus between one half and two thirds of the xiphoid-pubis distance.

LEVEL OF EVIDENCE 4

The Importance of Umbilical Blood Supply and Umbilical Delay in Secondary Abdominoplasty: A Case Report

LEVEL OF EVIDENCE 5

Anatomical Prediction for Surgical Positioning of the Umbilicus in a Croatian Population

AIM

The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings.

METHODS

In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body mass (BM), body height (BH), BMI, WC and HC, and waist-hip ratios (WHR). All collected data were subjected to standard statistical analyses.

RESULTS

This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM × 0.5799 + BH × -0.5051 + BMI × -1.8230 + WHR × -10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age × 0.2033 + BM × 0.6445 + BH × -0.5692 + BMI × -2.2802 + WC × -0.0911 + 101.9408.

METHODS

We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected.

The dome procedure: a new technique for the reconstruction of the umbilicus

PURPOSE

The absence of the umbilicus is, in essence, an aesthetic deformity of the abdominal wall. The goal of reconstructing the umbilicus is to obtain a natural, three-dimensional appearance. In this study, we present a new technique called the "dome procedure" for the reconstruction of the umbilicus.

METHODS

This procedure can be applied under local anaesthesia on an outpatient basis and the drawing of the design is simple. The technique was applied to six patients who presented with an absence of the umbilicus following repair of a large incisional and umbilical hernia.

RESULTS

No major or minor complications were encountered. Patient satisfaction was high after surgical intervention.

CONCLUSIONS

The dome procedure, which enables the umbilicus to have a natural appearance with sufficient depression and normal-appearing wrinkles, is simple, easy to perform, and safe.

Concepts in Navel Aesthetic: A Comprehensive Surface Anatomy Analysis

INTRODUCTION

The navel contributes to abdominal surface identity and beauty. In Western societies, the display of the navel in women's fashion has grown and, nowadays, women are much more concerned about its shape and position. Despite this, few studies are available on navel surface anatomy and there is no standardization regarding its proper placement in cosmetic abdominoplasty.

MATERIALS AND METHODS

In this observational study, we analyzed navel shape and position on 81 high quality pictures, having been chosen as top 2013 bikini models by editors of mass media. An on-line survey on navel shape and position has been made via facebook.com, involving 1,682 people.

RESULTS

The analysis revealed that navel position is quite variable based on the proportions analyzed with an acceptable narrow data spread of the xiphoid-umbilicus:umbilicus-abdominal mean crease ratio of 1.62 ± 0.16. The data dispersion for the other three ratios was wider, making them less reliable as references. The most appreciated navel shape was the vertical oval with superior hooding (82 %), and the less appreciated ones were the horizontal oval (29 %) and the protruding shape (47 %). When comparing navel position on the same body, the majority of participants choose the one with the navel relocated according to the golden ratio (i.e., 1.618) CONCLUSION: The most attractive navel position is located at the xiphoid-umbilicus:umbilicus-abdominal crease golden ratio. Bony landmarks seem to be not reliable as references for proper navel positioning. The use of the Fibonacci (golden mean) caliper intraoperatively might aid in proper positioning of the navel in abdominoplasty.

A new technique involving a spherical stainless steel device to optimize positioning of the umbilicus

BACKGROUND

Creating an aesthetically pleasing umbilicus may be challenging due to various factors that involve the patient limitations and suboptimal techniques available to the surgeon. Although many techniques aim to locate the umbilicus after abdominoplasty, none are ideal. The authors use a new technique involving a stainless steel spherical device for definite location of the new neo-umbilicus site.

METHODS

Abdominoplasty with full muscle plication and umbilicoplasty was performed to test the effectiveness of this new technique that involves a stainless steel marble called the Umbilicator. It has a diameter of 1.5 cm and three 2-mm holes drilled 120° apart in an equilateral triangle. The Umbilicator is secured to the inferior and superior dermis of the umbilical stalk to help identify the future location of the umbilicus on the abdominal skin. Once the marble is secured, the superior abdominal flap is redraped and trimmed, the suture is repaired, and the location of the umbilicus is determined by feeling for the smooth spherical surface bump with gentle downward pressure on the overlying abdominal skin located within the proximity of the umbilicus.

RESULTS

The result of this technique produced a definitive means of identifying and delivering the umbilical stalk during abdominoplasty. This technique has been performed in 23 consecutive abdominoplasty procedures with no difficulties locating the umbilical stalk and no infections resulting from the procedure.

CONCLUSIONS

Accurate identification of the umbilicus provides the ability to create an aesthetically pleasing neo-umbilicus, thus optimizing abdominoplasty results.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article.

Intraoperative assessment of the umbilicopubic distance: a reliable anatomic landmark for transposition of the umbilicus

BACKGROUND

A clear understanding of the anatomic location and the aesthetic traits of the umbilicus is essential for the plastic surgeon repositioning the umbilicus during an abdominoplasty. Currently no consensus exists regarding the ideal location for this unique aesthetic unit of the abdomen. To their interest, the authors noted that the intraoperative distance from the pubic symphysis to midumbilical stalk measured 15 cm for several consecutive patients. They believe the umbilicopubic distance is another clinically useful and reliable anatomic landmark for the plastic surgeon relocating the umbilicus during an abdominoplasty.

METHODS

A retrospective chart review analysis was performed for 40 consecutive patients who underwent abdominoplasty or panniculectomy between July 2009 and May 2010 at the authors' institution. The intraoperative measurement of the umbilicopubic distance (pubic symphysis to midumbilical stalk) was available for 32 of these patients. The average umbilicopubic distance was calculated. Two separate graphs were generated to evaluate the relationship of the umbilicopubic distance to the patients' height and body mass index (BMI). The data were saved and analyzed using Microsoft Office Excel.

RESULTS

In the study population, the average intraoperative umbilicopubic distance was found to be 15.05 cm. The results validate the mean umbilicopubic distance of 15.04 cm reported by Dubou and colleagues in 1978. For patients whose stature fell between 145 and 178 cm, the umbilicopubic distance was consistently 15 cm. A tendency toward a higher umbilicus was noted as the patients became taller. The BMI did not seem to influence the location of the umbilicus as measured intraoperatively.

CONCLUSION

Translocation of the umbilicus to 15 cm from the pubic symphysis in patients with a stature of 145-178 cm is another clinically useful, safe, and expeditious method for relocation of the umbilicus during an abdominoplasty.

The inverted-v chevron umbilicoplasty for breast reconstruction and abdominoplasty

The umbilicoplasty is a key component of abdominoplasty and closure of autologous abdominal wall donor sites in breast reconstruction (TRAM/DIEP). The aesthetically-pleasing umbilicus tends to be small and vertically-oriented in nature, with superior hooding and shadow, inferior retraction and slope, and positioning at the topmost level of the iliac crest. In this Featured Operative Technique, the authors describe their technique for performing an inverted-V chevron umbilicoplasty, which is their method of choice for restoring the umbilicus to an aesthetic and youthful appearance with minimal scarring.

Reconstructing a natural looking umbilicus: a new technique

An attractive umbilicus is an essential component of the abdominal wall. It defines the midline abdominal sulcus and adds to a shapely abdominal curvature. Certain procedures place the umbilicus at risk thus providing a need for a neoumbilicus. Three-hundred and twenty cases of abdominoplasties, panniculetomies, and TRAM flaps for breast reconstruction were reviewed. Five patients underwent an umbilical reconstruction after loss of the native umbilicus. A crescent-shaped incision was used to create an inferiorly based skin flap. The flap was inset to the abdominal fascia. A small full-thickness skin graft was used to form the superior hood. All patients attained an esthetically pleasing umbilicus with minimal scarring. No contracture, flap necrosis, or graft loss were noted. We present a novel, simple, and reliable technique of umbilical restoration. It circumvents the need for external scars and allows for achieving a naturally appearing umbilicus.

Neoumbilicoplasty Is a Useful Adjuvant Procedure in Abdominoplasty

Background

Neoumbilicoplasties are indicated in congenital conditions associated with umbilical agenesis, umbilical loss due to inflammatory destruction, excision of skin cancer involving the umbilical stump and in surgical procedures for herniorrhaphy, as well as in the rare condition of umbilical endometriosis.

Objective

Neoumbilicoplasty is an adjuvant procedure that may be necessary during abdominoplasty with wide myofascial plication, or repair of concomitant hernias of the abdominal wall. The present article justifies sacrificing the umbilicus followed by neoumbilicoplasty in patients with significant wide myofascial plication or concomitant hernias of the abdominal wall.

Methods

Seventeen patients underwent a combination of abdominoplasty and wide (greater than 10 cm) vertical plication of the myofascial complex and required neoumbilicoplasty. The male to female ratio was 1:16; mean age was 44 years, mean weight 94.1 kg and mean height 160.2 cm. Characteristic body morphology included gross trunk obesity with a prominent anterior abdominal wall. The female patients were multiparous. Sacrificing the umbilici followed by neoumbilicoplasty was required in patients with umbilical hernias and patients who had divarication of the rectus abdominis muscles with short umbilical stumps.

Results

Nine patients had concomitant ventral hernias (52.94%) and eight patients had divarication of the rectus abdominis muscles with short umbilical stumps (47.05%). The mean perioperative myofascial plication distance was 15.41 cm and the gap closure required three to five rows of sutures.

Conclusion

Neoumbilicoplasty is a useful adjuvant procedure during abdominoplasty with wide myofascial plication or repair of concomitant hernias of the abdominal wall.

Salvage reconstructive surgery in an adult patient with failed previous repair of an extrophy-epispadias complex. An operation with a functional and aesthetic purpose

Salvage surgical procedures after failed reconstruction for an extrophy-epispadias complex are extremely challenging. The goals are to restore continence and improve aesthetic appearance in order to provide quality of life and an improved body image to the patient. We describe the surgical steps in an adult patient who presented anal urinary incontinence and a poor body image due to the absence of an umbilicus and the presence of hypertrophic scars. He underwent a modified Mainz II reconstruction of the lower urinary tract at childhood for an extrophy-epispadias complex. Restoration of continence was achieved by the construction of a modified Mainz I pouch with a continent stoma in a neo-umbilicus. Body image improved dramatically by the construction of a neo-umbilicus, a surgical revision of the hypertrophic abdominal scars and an abdominoplasty. It is mandatory that such demanding surgery should only be attempted as a combined multidisciplinary effort with urologists and plastic/reconstructive surgeons.

The Two-Dermal-Flap Umbilical Transposition: A Natural and Aesthetic Umbilicus after Abdominoplasty

BACKGROUND

The aesthetic and natural appearance of the transposed umbilicus after abdominoplasty is a key factor to the overall result and satisfaction of patient and surgeon alike. In this article, the authors present a technique in umbilical transposition that creates a natural-appearing umbilicus.

METHODS

The skin in the neoumbilical position is deepithelialized and incised in the midline, thus creating two dermal flaps that are sutured down to the abdominal fascia, thereby creating a natural periumbilical concavity, inconspicuous scars, and a tension-free closure, resulting in a decreased chance for cicatricial umbilical scarring. Twenty patients underwent umbilical transposition during abdominoplasty with this technique between 2003 and 2005.

RESULTS

Both patient and surgeon satisfaction were very high, with three senior surgeons changing their surgical technique after being introduced to that described in this article. One complication culminated in partial skin dehiscence early in our experience when deep dermal sutures were not used for skin closure.

CONCLUSION

The technique described is simple, safe, and easily learned, and results in a very satisfying aesthetic and natural-appearing umbilicus in patients after abdominoplasty.

Anatomical localization of the umbilicus: an Indian study

BACKGROUND

The umbilicus is essential to the aesthetic appearance of the abdomen. However, very little has been written about the exact location of the aesthetically pleasing umbilicus as far as the Indian cosmopolitan population is concerned. Although a variety of reconstructive methods are available, no real standards define the location of the umbilicus.

METHODS

In this study, 75 cosmopolitan female volunteers were evaluated in supine position, and the distance of the umbilicus (from central stalk) to fixed bony points over the anterior abdominal wall was measured. These linear measurements were subjected to standard statistical methods.

RESULTS

In this study, the authors observed that the umbilicus is situated around the midline plane such that the ratio of the distance between the xiphisternum and the umbilicus and the distance between the pubic symphysis and the umbilicus is 1.6:1; also, the ratio of the distance between the umbilicus and anterior superior iliac spine and the inter-anterior superior iliac spine is approximately 0.6:1.

CONCLUSIONS

During umbilicoplasty, when each anterior superior iliac spine is taken as a center, and arcs are drawn with a radius 0.6 times that of the inter-anterior superior iliac spine distance, the point of intersection of these arcs is the approximate location of the umbilicus around the midline plane, which should match the ratio of 1.6:1 (i.e., the ratio of the distance from the umbilicus to the xiphisternum and the distance from umbilicus to the pubic symphysis). An effort is made to find and establish the body proportions and symmetry and to determine the critical ratios so as to help the reconstructive surgeon to plan an aesthetically pleasing umbilicus.

A simple new technique for neo-umbilicoplasty

This article describes a new technique for reconstruction of the umbilicus. The technique used simply originated from a few clinical cases in which we were confronted with an absent or destroyed umbilicus. Previously described techniques for neo-umbilicoplasty were unsatisfying or seemed too complex in our hands. We introduce this easy, safe and reproducible technique which in our experience resulted in a very acceptable newly formed umbilicus.

Refinements in abdominoplasty

When performing traditional abdominoplasty, three fundamental defects of the abdominal wall must always be addressed by the plastic surgeon. They include redundant skin, excess fat, and musculofascial laxity. Plastic surgeons have found that this procedure consists of dermolipectomy and rectus plication, extremely effective in restoring the abdomen to its youthful shape in the vast majority of patients. This article will review the recent advancements in body contouring surgery while focusing on the recent technical refinements in abdominoplasty.