Toronto A new procedure is designed to optimize the umbilicus in combination with other procedures. Presenting research here at the annual meeting of the Canadian Society for Aesthetic (Cosmetic) Plastic Surgery, Kimit Rai, M.D., a cosmetic, plastic, and reconstructive surgeon based in New Westminster, British Columbia, Canada, describes how a desirable navel can be achieved in combination with other procedures such as abdominoplasty, body contouring, ultrasound liposuction and breast lift. "The stitching is done on the inside, so there is less scarring," says Dr. Rai in an interview with Cosmetic Surgery Times . "Stitches don't have to be taken out, and the outcome is a lot more natural and nicer." ABDOMINOPLASTY DISCONTENT Dr. Rai, a member of the Canadian Society of Plastic Surgeons and American Society of Plastic Surgeons, says that patients often undergo abdominoplasty and are not satisfied with the appearance of their navel following the procedure."The navel often doesn't look natural after a tummy tuck is performed," he says. "There are a number of requests to follow up abdominoplasty with a procedure to change the appearance of the belly button because there is a lot of loose skin that surrounds it. It doesn't need to be performed as a stand-alone procedure. The 'inverted u' umbilicoplasty better mimics the natural belly button." Candidates for the surgery are typically young, both female and male, and have experienced significant weight loss and desire a tummy tuck and better looking navel, or are women who are out of their child-bearing years and desire a tighter looking abdominal area and improved navel as well. Candidates must be nonsmokers or quit smoking for at least a month prior to surgery. THE 'INVERTED U' To date, Dr. Rai has performed 100 umbilicoplasty procedures. He maintains a 10 cm to 12 cm position from the suprapubic area to the umbilicus. At that point, he makes an inverted u-shaped incision. The original umbilicus is tacked to the abdominal fascia to shorten the pedicle. The abdominoplasty flap is attached to the suprapubic incision to stabilize the skin, explains Dr. Rai. An inverted u-flap is created as the surgeon conducts defattening of the umbilicus and the u-shaped flap. The original navel is then sutured onto the u-flap, which has been defattened with the sutures being buried, and the umbilicus being secured. The suturing is done within the new umbilical site with the sutures half-buried in the umbilicus. The u-flap acts as a tongue that is sutured to the inferior component of the original navel to give a natural hood. Steri-strips and compressive dressings are applied to the area. If other procedures are being conducted, such as body contouring, they are then completed. COMBINATIONS AND CAVEATS Full recovery following a combined umbilicoplasty and abdominoplasty is roughly six weeks, Dr. Rai says. If procedures were to be performed separately, such as ultrasound liposuction first and abdominoplasty later, it would prolong recovery time to several months, he adds. However, in combining procedures, surgeons have to take care to avoid too much loss of blood. "Patients could become hypovolemic if there is too much blood loss," explains Dr. Rai. "Fluid replacement and iron supplementation may be needed. Sometimes Eprex (erythropoietin) is used to stimulate the kidneys to produce more blood hemoglobin. It is preferable if there is not a huge amount of fat that is extracted if procedures are combined. The maximum is probably two liters of fat." SEQUELAE MINIMAL Following the procedure, it is recommended that patients keep the navel area dry for about a week. It is suggested that patients massage the area and apply vitamin E to reduce the appearance of any scars, Dr. Rai explains. Other topical agents that can be applied include hydrocortisone cream or Polysporin, Dr. Rai adds. Patients with darker skin and/or those of Mediterranean origin are more susceptible to developing hypertrophic scars and keloids, though, to date, such scars have occurred in fewer than 1 percent of cases, he notes. Those cases were treated by Kenalog (triamcinolone acetonide) injection. Other complications of the procedure have been minimal, notes Dr. Rai, with two cases of inferior separations, both of which were closed by secondary closures. No infections have been reported to date, and no revisional procedures have been performed.
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