Understanding Labiaplasty: Wedge, Trim, Clitoral Hood Reduction
Labiaplasty is the surgical procedure performed to alter the shape of labia majora or labia minora. Labia majora is the outer folding and labia minora is the inner folding of the vulva that has a wide range of thicknesses, sizes, and colors and varies in each individual. Labiaplasty is typically performed for labia minora. There are many indications that are significantly impacting one’s life, other than the aesthetic reasons, that a woman may seek to alter the size or shape of her labia.
For instance, an athlete with extensive labial tissue may have discomfort performing and may undergo this procedure. In other cases, women with elongated labia may find it psychologically distressing especially during sexual intercourse, and even avoid several items of clothing like tight pants or swimsuits that make them feel vulnerable.
Furthermore, some cases of enlarged labia are congenital however, women do claim an increase in size after hormonal therapy, or childbirth. Other conditions that are addressed by labiaplasty include abnormalities like vaginal atresia, intersex conditions, Mullerian agenesis, or cases of accidents, trauma, or childbirth that may have caused the tearing and damage of the labial tissue. This surgical technique is also employed in cases of male-to-female reassignment vaginoplasty where labia is created.
The aim of these techniques is to trim out the excess tissue so that the labia minora stays fixed neatly inside the labia majora. Moreover, the size of labia minora is long enough that it does not protrude past labia majora especially when standing, and does not interfere with hygiene or sexual intercourse.
Due to the growing popularity of these cosmetic procedures, advances have been made in the techniques that can be employed in different cases to get the desired outcomes according to the patient’s needs. Labiaplasty is usually performed along with vaginoplasty where the asymmetry of the vagina, as well as the vulva, are corrected.
The patient shall be examined in standing as well as in lithotomy position where she shall indicate her concerns and her aesthetic goals. Under the abovementioned common aim, different techniques have been developed that cater to the individual’s case based on their anatomy, degree of hypertrophy from type I (less than 2cm) to type VI (larger than 6cm), their complaints, preferences, and expectations.
Labiaplasty is usually performed as an outpatient procedure where the surgery continues for almost an hour. Depending upon the treatment plan, labiaplasty can be performed under general anesthesia as well as local anesthesia with sedation.
As the name suggests, a wedge-shaped section of the labia minora is marked in the thickest part of the labia before the surgery and it is resected. In this technique, only the skin and the mucosal part of the thickness is removed and the submucosal tissue remains intact resulting in only partial resection. This approach of partial resection also prevents the risk of excising pertinent labial nerves which results in post-operative numbness and painful neuromas. This technique results in preserving the wrinkled edges and gives the vulval area a natural look postoperatively.
Moreover, an additional 90-degree Z-plasty technique incorporated in wedge resection can result in a more refined surgical scar. Another advantage of this technique of labiaplasty is the freedom of moving upwards towards the clitoral hood to remove the prominent tissue without having to give a separate incision, therefore avoiding the need to give direct incisions near the extremely sensitive clitoris.
The downside of the wedge technique is the demanding nature of this surgery. The success of this procedure depends greatly on the judgment of the surgeon performing the surgery. Undercorrection leads to persistent redundant labial tissue and overcorrection which causes excessive tension at the wound site and results in easier tearing in case one has a vaginal birth in the future needs to be avoided by a meticulous judgment of the surgeon.
This technique, also called edge resection, was the original technique employed in labiaplasty. Most plastic surgeons today still prefer this technique as the procedure is still the easiest to perform. After the blood supply to the tissue to be resected is stopped by placing clamps across the tissue the excess tissue is removed from the free edge of the labia minora and the trimmed edges of then sutured back using absorbable suture. In essence, the excess part of labia minora, marked prior to the surgery, is resected and sutured to attain the desired symmetry of the labia minora with the labia majora.
Although this technique of labiaplasty is simple and easiest to perform, it restricts the surgeon from performing clitoral hood reduction procedures which makes him unable to address the excess tissue on the prepuce if present. This leads to an additional corrective surgery since the hood becomes more prominent against the resected labia minora. The advantage of this technique is that the hyperpigmented and irregular edges of the labial tissue are replaced with a linear scar. A downside to this procedure is the loss of natural wrinkles or rogues of the labia minora that results in an unnatural look of the vulva. Moreover, there is a greater risk of damaging the nerve endings when performing this procedure.
Clitoral Hood Reduction
Labiaplasty with clitoral hood reduction or clitoral unhooding technique is employed where the woman finds excessive tissue of the clitoral hood displeasing and complains of it interfering with her sexual response. As the name suggests, it involves resection of the excess tissue in the clitoral hood that may be visible hanging out of the labia while standing.
This procedure is performed to create asymmetry between the clitoral hood and the resected labia minora that not only gives the vulva a pleasing image but also prevents the clitoral hood from sagging and fully covering the clitoris in the long run.
Other procedures of labiaplasty for labia minora include laser labiaplasty and the deepithelialization technique for labiaplasty. For labia majora, the procedures are performed both ways: cutting out tissue or performing liposuction for labia that is fuller or longer than desired and injecting fillers or fat to plump labia that are as full as desired.
Since labiaplasty is usually performed as an outpatient procedure, the patient is usually able to go home the same day. However, care must be taken for preventing infection of surgical wound sites. Regular follow-ups are advised as a part of any technique used and patients must be educated on immediate medical attention in case of development of hematoma, in case of fever or purulent discharge from the surgical site. Patients are also advised to avoid strenuous physical work for three to four days after the surgery and sexual intercourse for almost four weeks after the surgery.
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Frequently Asked Questions
How many years have you been a practicing plastic surgeon?
My first year out of residency was in 2005
Describe your philosophy and approach to cosmetic enhancement and treatment of patients
Philosophy: Superior advice predicated upon evidence-based medicine, innovative insight, and efficient execution.
Treatment goals: Create a natural-appearing, balanced aesthetic enhancement that complements the patient’s unique features.
What’s most important to you when treating patients?
Comfort and security: We strive to achieve the ultimate customer experience. In surgery, much like professional sports, talent typically prevails. Championships however, are won by the teams who subscribe to organizational excellence. Accordingly, with good surgical planning and sound judgment, the majority of routine surgeries follow fairly predictable outcomes. Hence, customer service makes the experience complete. That’s what ultimately differentiates you as a surgeon from the masses. And that is our goal: to exceed our clients expectations.
What does a consultation with you entail?
Initially, patient information is gathered including photographs, salient medical history, and aesthetic goals. Next, I perform a comprehensive consultation utilizing videos and interactive patient education software. Following the consultation, the patient reviews the surgical procedure, peri-operative plans, and financials with the surgical consultant.
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