The "Hourglass" umbilicoplasty: An original four-flap design for aesthetic umbilical reconstruction

The aesthetic outcome of abdominoplasty is largely defined by the appearance of the umbilicus. Existing neoumbilicoplasty techniques may result in suboptimal contour, asymmetry, or visible scarring. This study presents a novel four-flap "Hourglass" technique designed to replicate natural umbilical anatomy with high aesthetic precision.

A retrospective comparative analysis was performed in 49 female patients who underwent abdominoplasty with neoumbilicoplasty between 2020 and 2025. Patients were allocated into three groups according to the surgical technique: Hourglass (n = 19), vertical oval incision (n = 15), and inverted-U incision (n = 15). Aesthetic outcomes were independently assessed by two plastic surgeons using a five-parameter Likert scale (shape, size, depth, natural appearance, and scar quality; maximum score = 25). Postoperative complications were recorded.

The Hourglass technique achieved the highest mean aesthetic scores across all parameters, with statistically significant superiority in shape (p = 0.0009), natural appearance (p < 0.0001), and scar quality (p = 0.00002). No statistically significant differences were observed for size (p = 0.068), depth (p = 0.347), or overall complication rate (p = 0.27).

The Hourglass neoumbilicoplasty offers a simple, reproducible, and anatomically accurate method for reconstructing a natural-appearing umbilicus. It provides symmetrical, stable, and aesthetically superior results without increasing complication rates, supporting its routine application in abdominoplasty.

Level of Evidence - III.