Q: Dr. Eppley, I was wondering if you could take a look at the attached photos and see if I am a good candidate for umbilicoplasty to achieve a typical “innie”. I have been told by my general practitioner and another cosmetic surgeon I do not have a hernia (they made me cough and felt around my abdomen) but I can insert more than half my finger into the tunnel of my bellybutton which made me question this? It just feels like it is a VERY long stalk and with excess skin. I do have a little fat around my midriff but when I was younger and very skinny my belly button protruded a lot. I am working on losing the weight but do not want it to protrude again. Please have a look and tell me what you think.
A: When it comes umbilicoplasty surgery, it is important to consider what makes the outie belly button look the way it does. Outie belly buttons can occur by two anatomic mechanisms. The most recognized one is an actual umbilical hernia (Type 1) that causes the entire stalk of the belly button to protrude outward either staying within the umbilical stalk or even protruding beyond the outer skin ring. This type of outie belly button feels very soft and can be pushed all the way beyond the abdominal wall fascia. A ring defect through the fascia can be felt by deep palpation. The other type of outie belly button is not associated with a true hernia (Type 2) and is either due to a long umbilical stalk (probably due to where it was cut at birth) relative to the thickness of the abdominal wall or from a weak or absent attachment of the stalk to the fascia. This type of outie belly button will feel more firm, less distensible and can not be pushed inward beyond the underlying abdominal wall fascia.
Either way the outie belly button can be converted to an innie through an umbilicoplasty procedure. The Type 2 outie belly button is somewhat easier and more reliable to fix since there is not a concomitant fascial defect/hernia to deal with at the same time and thus has a more stable base onto which to attach the inwardly reshaped umbilicus.
Dr. Barry Eplpey
Q: Dr. Eppley, I am interested in belly button reshaping and it seems like you have done this surgery. Since most doctors said they can not do anything I am not sure if it is the stitching that is the problem or under the stitching. I removed my gallbladder last year, since then it has not been the same. I had a beautiful innie and now I am somewhat outie and it has been emotionally upsetting for me. I do not want to have any noticeable scars after doing the procedure or to make matter worse. I just want to make sure it will look the same as before. Please let me know how is it done and where is the scar hidden. Thank you so much for your understanding and your time.
A: Most cases of belly button reshaping is done to change outies to innies. Outie belly buttons may occur naturally or as a result of a surgical procedure as in your case. Your gall bladder was most likely removed by a laparoscopic technique of which one port was done through the belly button. Given that an innie belly button is nothing more than skin tethered down to the abdominal wall fascia, the insertion of the laparoscope disrupted this funnel-shaped attachment and now the belly button skin is just floating so to speak. Thus your innie became a partial outie now. Your belly button can be repaired by reattaching it back down to the abdominal fascia through an incision inside the belly button. This rsults in no scar on the outside. This can be done under local or light IV sedation anesthesia. I have performed this procedure numerous times for exactly the problem you now have.
Dr. Barry Eppley
Q: Dr. Eppley, I am a woman who is interested in umbilicoplasty. I have attached one photo which is similar to how my bellybutton looks. I am not certain if it is a hernia as I have had this my entire life. I am wondering how if an umbilicoplasty procedure could successfully change my outie bellybutton into an innie bellybutton, even if it is not a hernia.
A: The umbilicoplasty procedure involves a variety of small procedure to reshape the belly button or umbilicus. It can be done t change an outie to an innie as you desire or to remake an umbilicus lost from prior surgeries. An outie belly button may or may not represent an actual hernia. If you stick your finger and push the outie in…and feel an inner ring or hole and the outie pushes into an innie…then it is a hernia. If you push on it and the outie simply gets flattened but does not push in, then it is not a hernia, it is just a ‘button of skin’ so to speak. It is not possible to answer that question by just looking at your picture but I suspect, given your young age and perhaps not having children (??) that your outie is not a true hernia. Eitehr way, an umbilicoplasty can convert an outie into an innie whether it is a hernia or not, just some slightly different techniques are used to do it. An umbilicoplasty can be done under just local and, at the most, some IV sedation as a simple outpatient procedure. There is no real recovery from it.
Dr. Barry Eppley