It seems like a small thing, but many of my prospective tummy tuck patients mention how they like our photos, especially the nice looking belly buttons.
During a full abdominoplasty, we re-use the original umbilicus, but we have to make a new cut-out in the skin for it, once the upper abdominal skin has been shifted downwards and pulled snug. It’s much like making a new button-hole for a button on a shirt.
Here are some of my “surgical secrets” for making pretty belly-buttons:
1) the right size: when you trim the original umbilicus, and when you make the new cut-out, the sizes must match. Don’t make the new cut out either too large nor too small…
2) the right location: the umbilicus needs to be in the midline, at the correct height, which is on a line at the top of the so-called “iliac crest” – that bony bit on the top of the hip you can feel on your side. Try it for yourself, and see. By putting the skin incision at the correct location, you avoid tension on the closure, which could lead to a distorted shape later.
3) the right shape: don’t make the new umbilical cut-out perfectly round – or else it will tend to shrink / scar down later. There are multiple techniques for this; I prefer the “tulip” or “pac-man” methods, in which the pre-existing umbilicus is converted to a “tulip” or “pac-man” shape. A small V-shaped flap of tummy skin is designed to fit neatly into the top of the “tulip” portion of the umbilicus, re-creating the hooded configuration of the upper part of the belly button. This method looks nice, and reduces the risk of a scarring problem known as umbilical stenosis.
4) tailor the underlying fat: After all, you don’t want to have any puffy fat around the umbilicus…
5) Perform a tidy layered closure.
And now you know most of how it’s done. It’s really not magic, after all. Just like schoolwork, points are awarded for neatness!