Aesth Plast Surg (2009) 33:366–376 Fig.11 Plication of the muscle aponeurosis diastases, ﬁxing the umbilicus stack, and preserving the lateral neurovascular bundles Fig. 12 With the patient in a semi-Fowler position (458) we identify the umbilicus stack and bring it upward 2 cm to release the suprapubic stretching Fig. 13 A criss-cross incision is done and the umbilicus stack is exteriorized and ﬁxed with four stitches deep into the aponeurotic level 371 and a waist improvement (Fig. 11). of approximately 8 cm Exteriorization of the Umbilicus Stack The patient is put in a semi-Fowler position (45 ) and the ﬂap is extended to the pubis area. A 2-0 nylon stitch is placed to support the ﬂap, and, using Allis forceps, the umbilicus stack is grasped and projected to the abdomen wall. We identify it with blue methylene, marking 1.5- 2 cm above its new position (Fig. 12). This procedure is very important to avoid stretching or vascular damage to the suprapubic area. With a No. 11 blade, we make a cross- shaped incision approximately 2 cm long and 1 cm wide. We trim the surrounding fat and four repairing stitches are placed to ﬁx the umbilicus stack deep into the muscle aponeurotic plane (Fig. 13). 123