Choosing the cosmetically superior laparoscopic access to the abdomen: the importance of the umbilicus (original) (raw)
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Aesthetic Plastic Surgery, 2022
Background The umbilicus is crucial to the aesthetic appearance of the abdomen. With abdominoplasty and umbilicoplasty, placement of the umbilicus is essential and often left at the surgeon’s discretion. This study aims to investigate the ideal male umbilical shape and location by examining photographs of top male models in 2019. Methods In this observational study, we examined 81 photographs of top male models to assess different ratios based on anatomical landmarks and umbilical appearance. Results The ratio of the distance from the xiphoid to the center of umbilicus (XU) and corresponding distance from center of umbilicus to abdominal crease (UC) had the most reliability (ratio XU/UC, with average measurement: 1.68 ± 0.38), which placed the male navel at a similar position but marginally below the average female umbilicus. Our findings revealed that an oval horizontal is the ideal umbilical shape in males, which differs from what is most aesthetically pleasing in females (oval ve...
The Average Size and Position of the Umbilicus in Young Men and Women
Springer eBooks, 2017
Introduction: Abdominoplasty was the third most common cosmetic surgical procedure in 2012. The umbilicus is transposed within the abdominal skin flap during this procedure. Few studies address the size and location of the umbilicus with precise measurements as well as those that do report on a heterogeneous population. The goal of our study was to determine the average size and position of the ideal umbilicus by limiting the study to young men and women of normal body habitus. Methods: Subjects were recruited in a University of Virginia Institutional Review Board-approved study. Demographics of the subjects were recorded. Each subject's umbilicus was assessed for height, width, and position relative to existing landmarks. Results: Eighty subjects met the inclusion criteria: 43 women and 37 men. Most of the subjects were white (72.5%). The mean ± SD BMI was 22.4 ± 2.5 kg/m 2. The mean ± SD height and width of the umbilicus was 2.1 ± 0.6 cm and 2.3 ± 0.7 cm, respectively. The umbilicus was located at a mean ± SD of −0.7 ± 1.3 cm in relation to the iliac crest (crest at zero). There were differences seen in the position between men and women. There were no statistical differences in measurements between the races. Conclusion: Our study serves as a guide for umbilical positioning with mean measurements for men and women, and categorized by sex and race.
Anatomical position of umbilicus in Latin-American patients
European Journal of Plastic Surgery, 2019
Background The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5-3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key-its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological wellbeing. Methods The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization. Results In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1. Conclusions Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values. Level of Evidence: Level III, risk / prognostic study.
Women’s aesthetic perceptions of the genitalia and their association with anatomical measurements
Archives of Gynecology and Obstetrics, 2023
Background: The purpose of this study to determined women's perceptions of the vulva with the criteria de ned in the literature for the ideal vulva and determine their relationship with anatomical measurements in order to determine the extent to which women's perceptions of normal align with our aesthetic standards of normality. Methods: First of all, a questionnaire was applied to all participants. The items of the data collection form were included personal information, obstetric and gynecological information, their perceptions of their external genitalia and any physical, sexual, psychological, and hygiene problems they experience. Then examination and measurements of the external genitalia were performed. Results: The majority of participants considered their genitalia normal (n=101, 89.4%), while 12 participants (10.6%) considered them abnormal. Statistical analyses showed that women's perception of their genitalia as normal in appearance and size was associated with labia minora asymmetry (p=0.023 and p=0.006, respectively) and hyperpigmentation (p=0.010 and p=0.047, respectively) but not with labia minora measurements or protrusion (p>0.05) Conclusions : Although there is a tendency in the eld of aesthetic surgery to de ne ideals and aesthetic standards for all parts of the body, our de nitions of normality do not always coincide with those of the individual. The appearance of the genitalia is as personal as the face, and an individual's self-perception is more important than our ideal. Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Among 132 surveys distributed, 113 women completed the survey and were examined for this study (85.6%). The distribution of ages, education levels, BMI and gynecological backgrounds of the participants are given in the Table 1. Table 1 Distribution of Demographic Features and Gynecological Backgrounds of the Participants Age (year) Min-Max (Median) Mean ± Sd 19-57 (37) 36.8 ± 10.0 BMI Min-Max (Median)) Mean ± Sd 17.2-41.0(25.3) 26.2 ± 4.8 The duration of menstruation(day) Min-Max (Median) Mean ± Sd 3-15(5) 5 ± 3 The age at rst menstruation Min-Max (Median) Mean ± Sd 9-16(13) 12.9 ± 1.5 The sexual life %(n) Sexually active 77(87) Sexually inactive 23(26) No previous sexual experience 16,8(19) (37) The age at rst sexual intercourse* Min-Max (Median) Mean ± Sd 15-37 (23) 23.2 ± 4.8 Pregnant history %(n) None 35,3(40) At least once 64,6(73) Menstrual patterns**%(n) Regular cycle 90.3(93) Irregular cycle 9.8(9) Menopausal 9.7(11) Education %(n) Middle school or lower 31 (35) High school 10.6 (12) Undergraduate 42.5(48) Postgraduate (master/doctorate) 15.9(18) *The mean age at rst sexual intercourse in the 94 participants.** Ninety-two patients reported their menstrual patterns, while the other 11 (9.7%) stated they were menopausal. The majority of participants considered their genitalia normal (n = 101, 89.4%), while 12 participants (10.6%) considered them abnormal. In the normal group, only 2 participants reported that their genitalia were larger than normal, whereas all 12 of the participants in the abnormal group stated that they considered their genitalia to be large or very large. Ninety-three participants (82.3%) said the size of their genitalia was unchanged (congenital) and 20 participants (17.7%) reported that their genitalia had changed over time. Of the 14 participants who considered their genitalia large or very large, 6 (42.9%) said it was acquired and 8 (57.1%) said it was congenital. Eighty-two participants (72.6%) said they were satis ed with the appearance of their genitalia, while 31 (27.4%) were not. Five (35.7%) of the 14 participants who considered their genitalia larger than normal said they were satis ed with their appearance. In contrast, 22 (22.2%) of the participants who considered their genitalia normal were not satis ed with their appearance. Problems reported by the participants in relation to their external genitalia included physical discomfort (n = 6, 5.3%), di culty initiating sexual intercourse (n = 2, 1.8%), impact on clothing selection (n = 10, 8.9%), discomfort when wearing tight-tting clothing (n = 23, 20.4%), negative feedback from their male partner (n = 4, 3.5%), adverse effect on self-con dence (n = 20, 17.6%), adverse effect on quality of life (n = 2, 1.8%), adverse effect on sex life (n = 3, 2.7%), and adverse psychological impact (n = 4, 3.5%). In addition, 15 participants (13.3%) stated that they wanted to undergo genital aesthetic surgery. On physical examination, labia minora protrusion was detected in 45.1% (n = 51) and asymmetry in 42.5% (n = 48) of the participants. Examination ndings are shown in Table 2.
Preferences in the Aesthetic Appearance of the Female External Genitalia
Anaplastology, 2016
Objective: In recent years, women have become more dissatisfied with the appearance of their labia minora, in particular their width, shape, and symmetry, prompting increased requests for labiaplasty. This has been attributed to the popular depiction of female genitalia in media outlets as homogenously hairless, symmetrical, and without protruding labia minora. Over-reduction of labia minora, although requested by patients, should not be performed due to their physiologic importance. Methods: We designed a survey to better understand preferences for the aesthetic appearance of female external genitalia. Survey Monkey was used to distribute an online questionnaire to a convenience sample of authors' contacts. Respondents were asked to refer to three images of female external genitalia-varying in labia minora width but all still physiologically normal-and select the image that they felt to be most normal and most attractive, respectively. Pearson's chi square test with significance level of 5% was used for statistical analysis. Results: Overall 95.8% (767/800) selected non-visible or slightly visible labia as the most "normal" variants, and 96.6% (773/800) selected either A or B for the most "attractive" variants of labia minora. Respondents selected images most consistent with popular culture depictions of genitalia, which seem to be driving genital plastic surgery requests. Conclusion: Given these findings, we recommend a discussion with patients about preferences and a belief regarding what is truly normal and encourages more widespread media visibility and education about normal physiologic variability in female external genitalia.
Anatomical Prediction for Surgical Positioning of the Umbilicus in a White Population
Annals of Plastic Surgery, 2015
Aim: The umbilicus is an essential esthetic landmark on the abdominal wall in women and men. There are only few models published for predicting exact localization of the umbilicus. The aim of our study was to develop a mathematical model for predicting correct umbilical positioning in a sample of young women and men and in a sample of middle-aged women. In addition, we wanted to develop a predictive model applicable to both sexes. We applied our models with distinct anthropometric characteristics such as body mass index (BMI) and waist circumference (WC)/hip circumference (HC) to further expand our findings. Methods: In this study, 98 Croatian women and men randomly selected from the University of Zagreb and 46 female patients awaiting abdominoplasty procedure at our institution were included. Anthropometric data and measurements between the umbilicus and fixed bony points around the anterior abdomen were collected. The data collected were body mass (BM), body height (BH), BMI, WC and HC, and waist-hip ratios (WHR). All collected data were subjected to standard statistical analyses. Results: This study developed 2 different regressive equations for the most accurate prediction of exact umbilical localization. In women, the best prediction of the position of the umbilicus was based on the distance from the interanterior hypochondrium line to the umbilicus using the following regressive equation: u-i-hy = BM  0.5799 + BH  j0.5051 + BMI  j1.8230 + WHR  j10.6364 + 89.6411. In men, the best prediction of the position of the umbilicus was based on the distance from the umbilicus to the interspinous line using the following regressive equation: u-i-is = age  0.2033 + BM  0.6445 + BH  j0.5692 + BMI  j2.2802 + WC  j0.0911 + 101.9408. Methods: We found that age and anthropometric dimensions have a significant influence on the position of the umbilicus on the anterior abdominal wall. The naturally occurring anthropometric variations between women and men made the results of a unique predictive model for umbilical position inaccurate. We found that using 2 distinct predictive models, 1 for both subgroups of women and 1 for men, generated the most accurate predictive results. This quantitative tool should be applied to both women and men for the correct positioning of the umbilicus in reconstructive and esthetic procedures in which the original umbilical location is affected.
Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina
Clinical anatomy (New York, N.Y.), 2015
Patient perceptions of genital esthetics are motivating requests for plastic surgeries that could change sexual sensitivity. There is little information about the sensitivities of labial and introital sites. The aim of this study is to assess the relationship between sexual sensitivity and self-reported sizes of labial and introital sites. Sixty-two healthy, sexually active, adult women (mean age 37.9, range 21-60) with no history of genital or vaginal surgery gave written consent to participate in this study. A modified version of Self-Assessment of Genital Anatomy and Sexual Function (L-SAGASF-F) was used to assess labial and introital size. Site-specific sensation was rated on Likert scales of 1-5. Anatomical locations were compared for ratings. Of 62 responders, 84% (52) described their labia as "average-sized," 11% (7) described their labia minora and 13% (8) their labia majora as "large", and 3% (2) and 5% (3) as "small". Sexual pleasure ratings w...
Natural-Looking Umbilicus as an Important Part of Abdominoplasty
Aesthetic Plastic Surgery, 2003
The umbilicus is an important and essential aesthetic component of the abdomen. Many surgeons use different methods to relocate umbilicus during abdominoplasties. We prefer to use a simple combination of different well-known principles to form the neo-umbilicus. The main steps of the procedure are to make an elliptical vertical incision, to do vertical abdominal fascial plication, to embed the umbilical stalk in this plication by suturing the umbilical skin and the rectus fascia together to maintain the umbilical dimple, to place it at the vertical incision made in the abdominal skin at a predetermined point. Silk sutures are used for the abdominal fascial plication and neo-umbilical fixation. Liposuction from the neo-umbilicus to xiphoid along the midline of the upper abdomen creates a minimal superior sulcus. In each patient, a three-dimensional umbilicus with sufficient depression was obtained. All patients, including one case with complications, were pleased by the final aesthetic results.
Journal of …, 2013
Background: Existing outcome studies on women seeking labiaplasty have not used a validated scale that is specific for satisfaction with genital appearance. They have also not screened for the presence of body dysmorphic disorder (BDD). There are therefore two primary aims of this study (1) to validate the Genital Appearance Satisfaction (GAS) scale in women seeking labiaplasty and (2) to modify and validate a version of the Cosmetic Procedures Screening questionnaire (COPS-L), which has previously been used to screen for BDD. Method: Two groups of women were recruited: a group desiring labiaplasty and a control group. All participants completed the GAS, the COPS-L and other general measures of mood, disgust sensitivity, sexual satisfaction and body image quality of life. Results: Both the GAS and COPS-L demonstrated good internal consistency, concurrent and convergent validity with measures of related constructs, and discriminated between women seeking labiaplasty and controls. Three factors were identified in the GAS but were not robust enough to recommend their use clinically as subscales. The COPS-L discriminated between women seeking labiaplasty with and without BDD. Discussion: We recommend that both the GAS and the COPS-L be routinely used for audit and outcome monitoring of interventions for women distressed by the appearance or function of their genitalia. The GAS has an advantage in assessing additional functional symptoms in such women. The COPS-L may be helpful in identifying women with BDD. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13 For personal use only. 48 D. Veale et al. J Psychosom Obstet Gynaecol, 2013; 34(1): 46-52 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13 For personal use only. Items in bold refer to the factors extracted which are 40.4. 50 D. Veale et al. Validation of genital appearance satisfaction scale and the cosmetic procedure 51 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Ms Sarah Fay on 02/26/13