One of the more challenging cosmetic surgery goals is to obtain depth of the umbilicus in the thin multiparious woman when performing abdominoplasty. The technique described allows for a predictable and natural appearing umbilicus in the patient population that has a stretched out belly button and very little subcutaneous fat.
After elevation of the abdominal flap, two percutaneous horizontal mattress sutures of 3-0 vicryl tack the center of the umbilicus superiorly and inferiorly to the fascia. This fixes the base of the umbilicus and preserves the lateral blood supply. Next, a midline plication is performed with interrupted figure-of-eight 2-0 or 0 ethibond suture. This forms a trough that restores depth to the umbilicus. The umbilicus is incorporated into the superior and the inferior figure-of-eight suture. The remainder of the abdominoplasty is performed in the usual fashion.
Even though a few mm of the Vicryl suture are exposed, this has never been a problem. In fact, I have never seen the suture in a post-op patient.
I routinely use this technique in those patients who have an elongated umbilicus. The blood supply is preserved and the umbilicus is shortened and fixed to the underlying fascia.