A tummy tuck, technically called an abdominoplasty, is a body contouring procedure that removes loose skin and excess fat while tightening the underlying abdominal muscles. The final aesthetic success of this surgery often rests on the appearance of the umbilicus, or belly button, which becomes a central focal point on the newly flattened abdomen. When patients observe a result they describe as “weird” or unnatural, they are usually referring to a poorly reconstructed navel, known as a neoumbilicus. This specific concern arises because the belly button must undergo a complex process of reshaping and repositioning, which is a specialized step called umbilicoplasty.
Why the Navel Must Be Recreated
The anatomical structure of the navel dictates why it cannot simply move with the skin flap during a tummy tuck. The belly button is connected to the deeper abdominal muscles by a fibrous cord known as the umbilical stalk. This stalk remains anchored to the fixed abdominal wall, even as the surgeon lifts the entire sheet of skin and fat, called the abdominal flap, off the muscles below.
As the skin flap is pulled downward and tightened, the original opening for the navel is carried along with it, creating a skin bridge over the fixed umbilical stalk. A new opening must be precisely cut into the now-tightened skin flap, allowing the original navel to emerge and be sutured to the surrounding skin. This process of creating a new opening and attachment introduces the potential for an unnatural look.
Common Reasons for Unnatural Appearance
The perception of an unnatural result stems from specific aesthetic flaws in the reconstructed navel. One common issue is keyholing or stenosis, where the opening appears too small or pinched, often due to excessive scar contracture or a tight closure. Conversely, the navel may look too wide, circular, or unnaturally large, which is a telltale sign of a surgically altered umbilicus that lacks the desired vertical or T-shape.
Another frequent complaint is visible scarring around the perimeter or a lack of natural depression. When scarring is excessive or hypertrophic, it can create a raised, ring-like appearance that draws unwelcome attention. The phenomenon of tenting occurs when the skin flap is pulled too tautly over the umbilical stalk, causing the navel to appear flat, shallow, or even slightly protruding instead of recessed. Furthermore, a reconstructed navel can look “off” if its placement is incorrect, such as being positioned too high or too low on the abdomen relative to natural landmarks like the superior iliac crests.
Surgical Techniques That Influence Shape
The final shape of the neoumbilicus is strongly influenced by the surgeon’s choice of incision and suturing technique during the umbilicoplasty. A simple circular incision made in the abdominal flap is often associated with a higher risk of scar contracture, leading to a small, pinched, or stenotic appearance. To counteract this, many surgeons utilize specialized incision shapes, such as an inverted V, an inverted U, or a Mercedes/star-shaped cut, to hide the scar within the navel’s folds and promote a more natural vertical orientation.
The way the surrounding skin is secured to the umbilical stalk influences natural contour. If the skin is sutured under excessive tension, it results in the flat or tented look, as the natural concavity is lost. Achieving a natural shadow and depth, often referred to as an “innie” appearance, requires the surgeon to meticulously sculpt the subcutaneous fat around the new opening. By thinning the periumbilical fat and securing the navel to the deeper fascia, the surgeon creates a slight depression, preventing a flat, featureless result.
Options for Correcting Aesthetic Concerns
Fortunately, many aesthetic concerns with a neoumbilicus can be addressed with a secondary procedure once the initial healing is complete. If the navel is too small or misshapen, an umbilical revision surgery can be performed, often under local anesthesia. This procedure allows the surgeon to excise excess scar tissue, reshape the perimeter, or deepen the depression by further sculpting the surrounding tissue.
For raised or thick scarring, non-surgical treatments like steroid injections can be used to flatten and soften hypertrophic scars around the navel’s edge. Silicone sheeting or gels are also routinely recommended for scar management post-surgery. Patients should wait between six to twelve months after the initial tummy tuck before undergoing any revision. This waiting period allows swelling to subside and scar tissue to fully mature, ensuring a more stable and predictable result from the corrective procedure.