From Vertical to Transverse Plication: The TULUA Successful Move Towards a Safer, Globally Accepted Abdominoplasty

Objective: To discuss the TULUA (transverse Plication, no undermining, unrestricted liposuction, Umbilical Amputation with neo-umbilicoplasty, Abdominoplasty) impact, widespread adoption, and surgeon’s acceptance in improving safety and aesthetic outcomes, while contrasting it with established methods. Background: Traditional abdominoplasty, practiced for over a century, often involves extensive flap dissection, vertical plication, umbilical transposition and restricted liposuction, leading to complications such as necrosis, poor scarring and aesthetic dissatisfaction. TULUA introduces an innovative, vascular-preserving approach that reduces complications and enhances results. Methods: This study examines the surgical technique of TULUA, encompassing patient selection, preoperative markings, operative steps and postoperative care. The rationale behind the surgical modifications is explored, highlighting the technique’s application in aesthetic and reconstructive procedures, including TULUA-DIEP for donor site closure in breast reconstruction. Results: Clinical evidence reveals TULUA’s significant advantages: reduced necrosis, minimised wound closure tension and superior aesthetic outcomes. These include improved contouring, optimal umbilical shape and positioning and lower scar placement. Its proven safety has driven widespread adoption in aesthetic and reconstructive surgery. Discussion: TULUA shifts from vertical plication to a transverse technique, prioritising blood supply preservation and enabling safe, unrestricted liposuction. This method achieves enhanced outcomes, aligns with modern surgical reasoning and establishes TULUA as a reference for safety and efficacy in abdominoplasty. Conclusion: TULUA reduces complications and improves results, with future developments in laparoscopic techniques and new technologies promising to expand its applications further.