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

[BACKGROUND] 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.

[METHODS] 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.

[RESULTS] 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).

[CONCLUSIONS] 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.

[EVIDENCE RATING SCALE FOR THERAPEUTIC STUDIES] Level of Evidence - III.