The umbilicus as described in the literature is a 1.5- to 2-cm–diameter depressed scar, surrounded by a natural skin fold, anatomically situated at the level of the superior iliac crests. Many surgical procedures for reconstructing the umbilicus during dermolipectomy have been described. Some authors have proposed using a different array of skin incisions to improve the shape of the umbilicus and disguise the periumbilical scar. Others defend the use of a conchal cartilage composite graft as the donor area to re-create the shape of the umbilicus.

Most of existing procedures propose a circular skin incision of the umbilical cone to free it from its original position. The biological development of a circular scar eventually leads to retraction of the circular incision and therefore to stenosis of the neoumbilicus.

We propose a simple procedure that permits restoration of the umbilical anatomy and concealment of the scar, which is buried around the umbilicus, leaving only its inferior margin visible.

Surgical technique

The first half of umbilicus restoration comprised a skin incision to free the umbilicus from its original position. After marking the incision area, we positioned an index finger in the umbilical cavity and cut around the mark, freeing the umbilicus cone in a circle of tissue (Figure 1) measuring 1.5 cm in diameter.

A circle was drawn and an incision made around an index finger positioned in the umbilicus cavity to free the circular cone.

After removing the excess abdominal skin, we repositioned the neoumbilicus. Two fixation points 5 mm under the umbilicus margin, one at the 6 o’clock and one at the 12 o’clock position, were employed to attach the umbilicus to the aponeurosis of the linea alba and the xiphoumbilical line, respectively, with nylon 3–0 sutures (Figure 2).

Fixation was performed 5 mm under the umbilicus margin with nylon 3–0 sutures at the 6-and 12-o’clock positions.

After guide sutures were placed to approximate the abdominal flap and the pubic area, the position of the umbilicus on the abdominal skin was determined. An index finger was inserted through the lower abdominal incision, after which the location of the umbilicus was palpated and its position marked directly above on the abdominal skin, 0.5 cm under the projected position of the neoumbilicus, so that when we removed the skin, it opened vertically a little more than 1 cm. This technique released tension on the pubic incision, making it easier to reapproximate.

A rectangle was drawn on the abdominal skin at the neoumbilical position (Figure 3, A and B). The A-B line should not exceed 2 cm, and the A-A line should not exceed 0.5 cm. Subcutaneous fat was removed with a pair of scissors after the skin incision around the neoumbilical position was made.