‘Incognito’ dermal ring umbilicoplasty

Abstract

Background. After using the standard umbilicoplasty techniques described for the white population, many of our dark-skinned patients developed prominent scars at the umbilical inset site. This prompted us to modify the technique to improve the aesthetic appeal of the translocated umbilicus. 

Objective. To describe a new umbilicoplasty technique aimed at reducing visible scarring, especially in keloid-prone patients. 

Methods. Between 2014 and 2019, 16 patients underwent abdominoplasty using this new technique. All patients were female, aged 30 - 45 years and with a body mass index of between 35 and 40. Thirteen patients were of Fitzpatrick skin type 6, and the remainder of type 4, 3 and 1, respectively. Umbilical detachment was done by keeping a de-epithelialised dermal ring outside the intact umbilical centre. The outer ring of dermis was attached to defatted area of the neo-umbilicus site of the abdominoplasty flap, followed by suturing of the borders of the T-shaped neo-umbilicus opening to the inner circle of the original umbilicus. The aim is to hide the umbilical suture line in the concavity of the umbilical pit, while maintaining the pit diameter with the dermal attachments. At the same time, extra support is given by the dermal ring sutures to prevent scar-widening. 

Results. All patients operated on using the new technique had less-visible scars, and no patient developed either scar hypertrophy or scar-widening, which was common in patients treated with the older technique. Keeping the epidermal section small allows partial effacement of the umbilicus, which allows easier cleaning. Ten patients were lost to long-term follow-up. 

Conclusion. Adding a peripheral de-epithelialised dermal ring, and keeping a small diameter of epithelialised umbilical stump, led to the suture line being under less tension, and resulted in a less-visible scar in the small cohort of the study. In addition, the smaller diameter allowed the umbilical walls to stretch open more to allow easier cleaning in patients with thick abdominal walls.