The TRICK-TIP Rhinoplasty: Tip of the Nose Preservation Using the Combined Synergy of Open and Closed Approaches.

BACKGROUND: This study introduces and assesses the outcomes of a novel rhinoplasty technique, TRICK-TIP (Transcolumellar and Inter Cartilaginous Keystoning with Tip preservation), employing a combined open and closed approach with tip anatomy conservation and structured tip support. METHODS: The procedure involves a low stairstep columellar sectioning, followed by transmembranous and intercartilaginous incisions without skin dissection in the columella or tip. Elevating the entire mobile nose as a three-layered flap provides extensive access to the entire nasal pyramid and septum. Tip modifications, including retrograde cephalic cartilage resection and supratip skin thinning, are performed based on individual cases. A key columellar strut is frequently used, initially sutured in the interdomal space and then turned down for height adjustment and final fixation. Interdomal sutures, supratip sutures, and alar resection are implemented as needed. RESULTS: One hundred twenty patients participated, with high satisfaction and a low frequency of adverse effects reported using four FACE-Q™ questionnaires. One hundred and two independent raters evaluated pre and postoperative photographs, scoring "overall nose result" as 3.6 out of 5, with minimal or absent nostril deformities (1.84), soft triangle deformities (1.73), and columellar external scar deformity/visibility (1.35) where 1 is the absence of the deformity and 5 is disfigurement. Complications were absent, and revisions were infrequent. CONCLUSIONS: The combined benefits of the wide-open approach, shortened surgery duration, and nasal tip preservation contribute to outcome optimization. TRICK-TIP rhinoplasty is characterized by simplicity, enabling targeted modifications, preventing soft triangle and rim complications, and facilitating essential tip support while maintaining favorable results. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Siguiendo la trayectoria de la abdominoplastia TULUA ­ Revelación de su evolución e impacto global / Tracing the Trajectory of TULUA Abdominoplasty ­ Unveiling its Evolution and Global Impact

La técnica de abdominoplastia TULUA, fue concebida por el Dr. Francisco Villegas en Colombia, su acrónimo en inglés refleja sus principios fundamentales: plicatura Transversal, Sin despegamiento, Liposucción sin restricción que incluye la línea media y flancos, Neo umbilicoplastia, ubicación baja de cicatriz y libre posición del ombligo. A lo largo de los últimos 12 años, la técnica TULUA ha ganado espacio en América Latina, Norteamérica, la zona árabe e India. Destacando su relevancia, se ha propuesto la publicación de un libro monográfico, programado para 2024, que abarcará desde los principios fundamentales hasta las experiencias internacionales con la técnica. Las indicaciones de la abdominoplastia TULUA han evolucionado, incluyendo casos estéticos, secundarios, hernias, cicatrices previas, pérdida masiva de peso, alta definición, aumento muscular y combinaciones con otras plicaturas. Ha sido aplicada con éxito en cierre del abdomen donante de reconstrucción mamaria. A través de investigaciones especializadas y revisiones de pares, la TULUA ha sido reconocida por su aplicabilidad y beneficios, especialmente en la realización segura de liposucción en abdominoplastias. Se sugieren estudios adicionales para evaluar los resultados y posibles complicaciones, abriendo oportunidades para una mayor comprensión y refinamiento. El futuro de la abdominoplastia TULUA parece prometedor, anticipando trabajos prospectivos, indicaciones adicionales y un enfoque gradual para cirujanos en formación. En última instancia, la técnica se presenta como una adición al repertorio de procedimientos estéticos abdominales, contribuyendo al avance de la cirugía abdominal estética.

The TULUA abdominoplasty technique, conceived by Dr. Francisco Villegas in Colombia, its acronym in English reflects its fundamental principles: Transverse plication, no Undermined flap above the umbilicus, Liposuction without restrictions including midline and flanks, Neo umbilicoplasty, low scar placement, and free umbilical positioning. Over the past 12 years, the TULUA technique has gained acceptance in Latin America, North America, the Arab region, and India. Highlighting its relevance, the publication of a monographic book has been proposed, its launch is scheduled for 2024, covering from fundamental principles to international experiences with the technique. Indications for TULUA abdominoplasty have evolved, including aesthetic cases, secondary cases, hernias, previous scars, massive weight loss, high definition, muscle augmentation, and combinations with other plications. It has been successfully applied in closing the donor abdomen for breast reconstruction. Through specialized research and peer reviews, TULUA has been recognized for its applicability and benefits, especially in safely performing liposuction during abdominoplasties. Additional studies are suggested to evaluate results and potential complications, opening opportunities for greater understanding and refinement. The future of TULUA abdominoplasty appears promising, anticipating prospective works, additional indications, and a gradual approach for surgeons in training. Ultimately, the technique presents itself as an addition to the repertoire of abdominal aesthetic procedures, contributing to the advancement of aesthetic abdominal surgery.

TULUA: Effects of Flap Undermining and Type of Wall Plicature in a Rat Model Abdominoplasty.

BACKGROUND: TULUA, a transverse plication lipoabdominoplasty, which excludes elevation of the supraumbilical flap and includes a skin graft neoumbilicoplasty, claims greater safety and better results. An animal study was designed to compare it, with two current techniques. MATERIALS AND METHODS: Three matched groups of 12 rats had combined liposuction and abdominoplasty. Liposuction was extensive and unrestricted. Groups 1 and 2 had vertical plication and transposition umbilicoplasty, and group 3 had transverse plication and neoumbilicoplasty. Flap elevation in the epigastrium was wide to costal margins in group 1, limited to a tunnel in group 2, and no dissection in group 3. The animals were observed for 21 days and then euthanized. Intraoperative, postoperative, and postmortem variables and findings were measured and analyzed to find differences between groups. RESULTS: Transverse lipoabdominoplasty demonstrated a wider wall plication area, as well as a decrease in tension to close the wound, causing the horizontal scar to remain in a low position. In vertical plication lipoabdominoplasty groups, flap necrosis and seromas were more frequent, and the umbilical position descended due to secondary healing and scar contraction. The scar's scores were better in the transverse group and were confirmed when evaluated by external observers.In postmortem examination, horizontal plication presented less widening; perforator vessels were preserved when surgical undermining of the upper abdomen was not performed, and there were fewer seromas. CONCLUSION: In a rat model, TULUA demonstrates superior results and a decrease in complications when compared to lipoabdominoplasties with vertical plication and wide or tunneled dissection in the upper abdomen. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

BACKGROUND: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience. METHODS: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics. RESULTS: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded. CONCLUSION: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Embarazo posterior a lipoabdominoplastia de plicatura transversa, sin disección supraumbilical, liposucción irrestricta, neoumbilicoplastia y colocación baja de la cicatriz (TULUA): reporte de caso y revisión de la literatura / Pregnancy after transverse plication lipoabdominoplasty, undermining halted at umbilicus, liposuction without restrictions, umbilicoplasty with a skin graft, and low transverse scar localization (TULUA). Literature review and case report

RESUMEN Objetivo: Reportar el caso de una gestante con antecedente de abdominoplastia con plicatura transversa (transverse plication lipoabdominoplasty, undermining halted at umbilicus, liposuction without restrictions, umbilicoplasty with a skin graft, and low transverse scar localization - TULUA) y revisar la literatura disponible en torno al efecto queproduce la abdominoplastia sobre el embarazo y el impacto de la gestación sobre el resultado estético en una paciente con esta intervención. Materiales y métodos: Se reporta el caso de una mujer de 23 años, en estado de gestación, con antecedente de abdominoplastia ocho meses antes de su embarazo. Se realizó una búsqueda de la literatura en Medline vía PubMed, Cochrane library, SciELO, LILACS, BVS y Google Scholar, sin restricción por tipo de idioma o fecha de publicación. Se incluyeron estudios de cualquier diseño, incluyendo reporte de casos. Se excluyeron capítulos de libro y guías de práctica clínica. Resultados: La búsqueda identificó 1.158 estudios, de los cuales 13 cumplieron los criterios de inclusióny de exclusión, estos fueron series o reportes de caso, para un total de 111 pacientes. No se encontraron reportes de TULUA antes de embarazo. El rango de edad al momento del parto fue de 19 a 37 años y todos los neonatos fueron a término con peso adecuado para la edad gestacional. Once estudios describieron la vía de parto, siete por cesárea y cuatro por vía vaginal; dos estudios reportaron el desarrollo de prolapso cervical uterino, uno de ellos a las 15 semanas de gestación y otro al momento del trabajo de parto; tres pacientes experimentaron deficiente bloqueo nervioso en la pared abdominal durante la cesárea. En lo que respecta a los resultados estéticos después del parto, la literatura es limitada a la hora de describir una posible recidiva de laxitud cutánea o diástasis. No obstante, dos reportes de caso señalaron un resultado estético satisfactorio. Conclusión: la literatura sobre embarazo posterior a una abdominoplastia es escasa y se limita a reportes de caso. La abdominoplastia podría incrementar la frecuencia de prolapso cervical y de cesárea, sin que se conozca con precisión el impacto de la intervención sobre los resultados perinatales. La reparación de la pared abdominal aparentemente se mantiene. Se requieren más estudios que aborden el resultado perinatal en mujeres con abdominoplastia y el impacto de la gestación sobre los resultados de la intervención.

ABSTRACT Objective: To report the case of a pregnant woman with a history of transverse plication abdominoplasty (TULUA) and to conduct a review of the available literature on the impact of this intervention on the course of gestation and vice versa. Materials and methods: Case report of a 23-year-old pregnant woman with a history of TULUA abdominoplasty performed eight months before pregnancy. A literature search was conducted in Medline, Cochrane Library, SciELO, LILACS, BVS and Google Scholar, with no restriction by language or date of publication. Studies of any design were included, including case reports. Book chapters and clinical practice guidelines were excluded. Results: Overall, 1,158 studies were identified, of which 13 case reports or case series met the inclusion and exclusion criteria, for a total of 111 patients. No reports of TULUA before pregnancy were found. Age at the time of delivery ranged between 19 and 37 years and all births were at term, with newborns of adequate birth weight. Eleven studies described the route of delivery, including 7 cases of cesarean section and 4 vaginal deliveries. Two studies described the development of cervical prolapse, one at 15 weeks of gestation and the second at the time of labor. Three patients experienced impaired abdominal wall nerve block during the cesarean section. Regarding cosmetic results after delivery, there is a paucity of data about potential relapse in the form of skin laxity or diastasis. However, satisfactory cosmetic results were reported in two cases. Conclusion: There is a paucity of literature on the topic of pregnancy following abdominoplasty, and it is limited to case reports. The literature suggests that abdominoplasty could increase the frequency of cervical prolapse and cesarean section, although the impact on perinatal outcome is not clear. It appears that abdominal wall repair is maintained. Additional studies focusing on perinatal outcomes in women with abdominoplasty and the impact of gestation on the results of the intervention are required.

TULUA: lipoabdominoplastia de plicatura transversa sin despegamiento supraumbilical. Serie de 176 pacientes / TULUA: transverse plication lipoabdominoplasty without supra-umbilical flap detachment. A series of 176 patients

INTRODUCCIÓN Y OBJETIVO: Desde 2005 el autor ha realizado una lipoabdominoplastia fundamentalmente diferente para evitar complicaciones como necrosis, dehiscencia, redundancia epigástrica, cicatriz alta, mala posición del ombligo y seromas. Las modificaciones son: 1- liposucción sin restricción, 2- no despegamiento del colgajo epigástrico, 3- amputación umbilical, 4- plicatura transversal inferior de la pared abdominal, 5- neoumbilicoplastia con injerto de piel en la posición ideal y 6- ubicación baja de la cicatriz transversal (TULUA). El objetivo del presente trabajo es recoger una serie de casuística, resaltando algunos detalles técnicos y valorando resultados. MATERIAL Y MÉTODO: Presentación de una serie de 176 pacientes con detalles de técnica y estadísticas descriptivas, cuantificando resultados con énfasis en la posición de cicatriz y ombligo y su proporción, lo mismo que el resultado de la cintura y epigastrio. Comparamos estadísticamente los cambios de la cintura y la disminución de la tensión necesaria para el cierre de la herida quirúrgica atribuidos a la plicatura transversa. RESULTADOS: Los resultados estéticos fueron cuantificados en 9.4 según escala (0-10). Globalmente el porcentaje de complicaciones fue de 18.7%, la mayoría debidas a problemas con la integración del injerto del ombligo. Resaltar que solo una paciente presentó necrosis distal del colgajo y otra dehiscencia parcial de la herida. Encontramos diferencias estadísticas en la disminución de la tensión para el cierre de herida quirúrgica y cambios en la circunferencia de la cintura (p = 0.001). CONCLUSIONES: Los resultados estéticos cuantificados fueron altos con ventajas adicionales en términos de seguridad vascular, disminución de tensión de la herida, buena posición y calidad del ombligo, ubicación baja de la cicatriz transversal, disminución del perímetro de la cintura y corrección del epigastrio. Se trata de una técnica simple y segura que incrementa las indicaciones de abdominoplastia a un grupo más amplio de pacientes

BACKGROUND AND OBJECTIVE: Since 2005 the author has performed a fundamentally different lipoabdominoplasty to avoid complications such as necrosis, dehiscence, epigastric redundancy, high scar, bad position of the umbilicus and seromas. The modifications are: 1- unrestricted liposuction, 2- no detachment of the epigastric flap, 3- umbilical amputation, 4- lower transverse plication of the abdominal wall, 5- neoumbilicoplasty with skin graft in the ideal position and 6- low location of the transverse scar. In this paper, we collect a large clinical serie, marking some technical aspects and evaluating the results. METHODS: A series of 176 patients with technical details and descriptive statistics is presented, measuring results with emphasis on scar and umbilicus positioning and their proportion, as well as the result of changes in waistline and epigastrium. Changes in the waist perimeter and reduction of the tension necessary for closure of the surgical wound, attributed to the transverse plication, were statistically compared. RESULTS: The aesthetic results were quantified in 9.4 according to a scale (0-10). Overall, the complications were 18.7%, most of them due to incomplete graft take or delayed healing of the neoumbilicus. It was remarkably that only 1 patient presented with distal necrosis of the flap and another with partial dehiscence of the wound. Statistical differences were found in the decrease in tension for surgical wound closure and changes in waist circumference (p = 0.001). CONCLUSIONS: Quantified aesthetic results were high with additional advantages in terms of vascular safety, decreased wound tension, good position and quality of the umbilicus, low transverse scar location, decreased waistline and epigastric bulge correction. This technique can be simpler and safer, increasing abdominoplasty indications to a larger group of patient

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Pregnancy after transverse plication lipoabdominoplasty, undermining halted at umbilicus, liposuction without restrictions, umbilicoplasty with a skin graft, and low transverse scar localization (TULUA). Literature review and case report.

OBJECTIVE: To report the case of a pregnant woman with a history of transverse plication abdominoplasty (TULUA) and to conduct a review of the available literature on the impact of this intervention on the course of gestation and vice versa. METHODS: Case report of a 23-year-old pregnant woman with a history of TULUA abdominoplasty performed eight months before pregnancy. A literature search was conducted in Medline, Cochrane Library, SciELO, LILACS, BVS and Google Scholar, with no restriction by language or date of publication. Studies of any design were included, including case reports. Book chapters and clinical practice guidelines were excluded. RESULTS: Overall, 1,158 studies were identified, of which 13 case reports or case series met the inclusion and exclusion criteria, for a total of 111 patients. No reports of TULUA before pregnancy were found. Age at the time of delivery ranged between 19 and 37 years and all births were at term, with newborns of adequate birth weight. Eleven studies described the route of delivery, including 7 cases of cesarean section and 4 vaginal deliveries. Two studies described the development of cervical prolapse, one at 15 weeks of gestation and the second at the time of labor. Three patients experienced impaired abdominal wall nerve block during the cesarean section. Regarding cosmetic results after delivery, there is a paucity of data about potential relapse in the form of skin laxity or diastasis. However, satisfactory cosmetic results were reported in two cases. CONCLUSIONS: There is a paucity of literature on the topic of pregnancy following abdominoplasty, and it is limited to case reports. The literature suggests that abdominoplasty could increase the frequency of cervical prolapse and cesarean section, although the impact on perinatal outcome is not clear. It appears that abdominal wall repair is maintained. Additional studies focusing on perinatal outcomes in women with abdominoplasty and the impact of gestation on the results of the intervention are required.

TITULO: EMBARAZO DE PLICATURA TRANSVERSA, SIN DISECCIÓN SUPRAUMBILICAL, LIPOSUCCIÓN IRRESTRICTA, NEOUMBILICOPLASTIA Y COLOCACIPON BAJA DE CICATRIZ (TULUA): REPORTE DE CASO Y REVISIÓN DE LA LITERATURA. OBJETIVO: Reportar el caso de una gestante con antecedente de abdominoplastia con plicatura transversa (transverse plication lipoabdominoplasty, undermining halted at umbilicus, liposuction without restrictions, umbilicoplasty with a skin graft, and low transverse scar localization - TULUA) y revisar la literatura disponible en torno al efecto queproduce la abdominoplastia sobre el embarazo y el impacto de la gestación sobre el resultado estético en una paciente con esta intervención. METODOS: Se reporta el caso de una mujer de 23 años, en estado de gestación, con antecedente de abdominoplastia ocho meses antes de su embarazo. Se realizó una búsqueda de la literatura en Medline vía PubMed, Cochrane library, SciELO, LILACS, BVS y Google Scholar, sin restricción por tipo de idioma o fecha de publicación. Se incluyeron estudios de cualquier diseño, incluyendo reporte de casos. Se excluyeron capítulos de libro y guías de práctica clínica. RESULTADOS: La búsqueda identificó 1.158 estudios, de los cuales 13 cumplieron los criterios de inclusióny de exclusión, estos fueron series o reportes de caso, para un total de 111 pacientes. No se encontraron reportes de TULUA antes de embarazo. El rango de edad al momento del parto fue de 19 a 37 años y todos los neonatos fueron a término con peso adecuado para la edad gestacional. Once estudios describieron la vía de parto, siete por cesárea y cuatro por vía vaginal; dos estudios reportaron el desarrollo de prolapso cervical uterino, uno de ellos a las 15 semanas de gestación y otro al momento del trabajo de parto; tres pacientes experimentaron deficiente bloqueo nervioso en la pared abdominal durante la cesárea. En lo que respecta a los resultados estéticos después del parto, la literatura es limitada a la hora de describir una posible recidiva de laxitud cutánea o diástasis. No obstante, dos reportes de caso señalaron un resultado estético satisfactorio. CONCLUSIONES: la literatura sobre embarazo posterior a una abdominoplastia es escasa y se limita a reportes de caso. La abdominoplastia podría incrementar la frecuencia de prolapso cervical y de cesárea, sin que se conozca con precisión el impacto de la intervención sobre los resultados perinatales. La reparación de la pared abdominal aparentemente se mantiene. Se requieren más estudios que aborden el resultado perinatal en mujeres con abdominoplastia y el impacto de la gestación sobre los resultados de la intervención.