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Out with the outties and in with the innies

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Before (left) and after umbilicoplasty surgery. (Courtesy of Dr. Michael Bermant, M.D.)

Crystal Johnson was 5 years old when she realized she was different.

All the other kids had “innie” belly buttons and Johnson had an “outtie,” a difference that made her uncomfortable, even at a young age.

“It was kind of weird,” said Johnson, 24, of Eden Prairie, Minn. “It just doesn’t look normal. Outties are not something you see on TV and in magazines.”

To remedy her unease, Johnson underwent an umbilicoplasty, a surgical procedure in which an outtie belly button is transformed into an innie.

Johnson’s experience highlights a clear fashion fact: Innies are in. And outties? Well, they’re out.

The tiny area right above the waist, known to kids as the belly button, to adults as the navel and to doctors as the umbilicus, is actually just a scar that heals after the umbilical cord detaches from the body after birth.

And how that scar forms, doctors say, is arbitrary.

But unlike the scars that result from stitches or scrapes, the belly button scar can be totally reversed. And people all over the country, mostly women, are having the surgery that does precisely that. And in the months leading up to spring break, when girls try to shed winter pounds and give their skin a pre-beach caramel glow, umbilicoplasty is one of the services desired by women who want to feel desired.

“I don’t feel self-conscious around swimsuit season,” Johnson said. “I probably would have if I had an outtie because it’s not the norm.” Johnson said her parents pushed her to have the procedure at a young age because of similar feelings.

“Cosmetically, it looks better,” said Johnson’s mother, Claudia, 52, who needed the procedure done as a child to correct a hernia. “Other kids make fun of you for having [an outtie].”

Dr. Michael Bermant, a board-certified plastic surgeon who operates a clinic outside of Richmond, Va., has been reconstructing navels for more than 30 years and knows everything there is to know about the infamous lint-collectors.

How one gets an innie or an outtie to begin with, he said, just depends on how the scar heals.

“There is no such thing as a family-style belly button; it’s not something you inherit,” Bermant said.

Innie scars “curve into the deepest component of that area” and outtie scars heal with “an extra bubble of tissue.”

Although some umbilicoplasties are done for medical reasons, like a hernia or another defect in the abdominal wall, most of the umbilicoplasties Bermant performs are done simply as a matter of cosmetic preference. Most patients just say they “can’t stand the way their belly buttons look,” Bermant said.

Women often approach Bermant after they’ve recently lost a large amount of weight, which can exacerbate the appearance of loose skin hanging over the belly button, and after pregnancies, which often cause an outtie to appear, even in women who previously had innies.

But Bermant is most busy in the months leading up to summer, because of the swimsuit factor.

“Most requests come as the season comes closer to having the belly exposed,” he said. Bermant’s clients hail from all over the world, so summer never falls at the same time at his clinic.

Umbilicoplasties are often done as part of an abdominoplasty (also known as tummy-tuck surgery) and are uncommon enough that the American Society of Plastic Surgeons doesn’t even track how frequently they’re performed.

“It’s not a common surgery for me,” said Dr. Mordecai Blau, another board-certified plastic surgeon, but the patients who have had it done have done so “mostly for cosmetic reasons.”

Like any surgery, umbilicoplasty is not to be taken lightly. Bermant always educates his patients on the anatomy of the abdomen and the risks of the procedure, which include typical surgical risks like possible injury to tissue, bleeding and infection.

During a routine umbilicoplasty, which can take anywhere from 90 minutes to three hours, Bermant said, patients are usually given a local anesthetic.

The procedure, without an accompanying tummy-tuck, rings up at around $4,000.

The cost was worth it for Claudia Johnson. “It definitely makes me feel better about myself,” she said.

But some say an umbilicoplasty, as with many other forms of plastic surgery, is only a temporary solution for serious underlying body-image issues.

“When a woman chooses a procedure like this, who does she imagine will appreciate the change?” asked Daniel Shaw, a psychoanalyst specializing in intimacy issues. “Is it for herself? Is she thinking about how women will see her? Or how men will see her on the beach?”

Shaw doesn’t discount the benefit of cosmetic surgery. In fact, “for a lot of people,” he said, “it makes a tremendous difference in their self-esteem. Surgery sometimes allows people some freedom from [long-term self-consciousness issues].”

But the belly button, in particular, he said, has a particularly erotic quality to it that may create a desire in people to change it for reasons linked to sex appeal, which may not be a good thing.

“When you think of a belly button, you’re not showing it at a job interview, you’re not showing it on the first date, necessarily,” Shaw said. “There are healthy and unhealthy reasons for changing your appearance.”

But Crystal Johnson is pretty happy that she no longer has an outtie.

“It’s different,” she said of the protruding navel, “and it’s not a pretty different. It’s a weird different.”

E-mail abe2109@columbia.edu