Scarless Abdominoplasty in the Umbilical Region: Indications and Contraindications

Introduction: Standard abdominoplasty inevitably causes scarring in the umbilical region. Given the aesthetic significance of the navel, as the central anatomical landmark of the anterior abdominal wall, techniques that preserve the natural anatomy are warranted. The criteria for patient selection for such operations remain poorly defined, limiting their clinical application. Objective: The aim of this study was to define the indications and contraindications for scarless abdominoplasty in the umbilical region through a comparative analysis of clinical and subjective outcomes. Materials and Methods: A comparative study was conducted involving 115 patients operated on between 2021 and 2026. The experimental group consisted of 32 patients who underwent abdominoplasty without scarring in the umbilical region, while the control group comprised 83 patients who underwent standard abdominoplasty with umbilical transposition. The technique of scarless abdominoplasty in the umbilical region entailed limited mobilization of the cutaneous–subcutaneous flap, energy-based ultrasound-assisted liposuction in the supraumbilical region, suturing of rectus abdominis diastasis when clinically indicated, and fixation of the umbilicus in its physiological position without a skin incision around it. Energy-based ultrasound-assisted liposuction permits skin contraction in the supraumbilical area through a controlled internal thermal effect. The incidence of complications and BODY-Q questionnaire outcomes were evaluated at 3 months, 6 months, and one year. No significant differences in baseline clinical characteristics were observed between the groups. Results: The overall rate of postoperative complications in the experimental group was 18.8% (n = 6), compared to 24.1% (n = 20) in the control group; the difference was not statistically significant (p > 0.05). According to the BODY-Q questionnaire, patients in the experimental group reported significantly higher satisfaction with scar appearance (91.0 ± 3.5 vs. 83.0 ± 5.7; p < 0.001) and the umbilical region. The umbilicus retained its anatomically natural shape and depth. The use of energy-based ultrasound-assisted liposuction in the supraumbilical area contributed to the contraction of the upper cutaneous–subcutaneous flap, which made it possible to prevent extensive mobilization and the formation of a significant scar around the umbilicus in these patients. Conclusions: Scarless abdominoplasty in the umbilical region is a safe and effective technique in appropriately selected patients. Energy-based ultrasound-assisted liposuction produces an internal thermal effect that enhances the contraction of the cutaneous flap. Indications for this method comprise a moderate amount of excess skin tissue in the supraumbilical region, preserved skin elasticity, a normal or high umbilical position, and rectus abdominis diastasis grade I–II. Contraindications include pronounced excess skin tissue in the supraumbilical region, a low umbilical position, and general somatic contraindications to surgery.