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Wedge Method Vs Trim Method for Labiaplasty?

I am 19 years old and have been dealing with the discomfort of having large labia since puberty. I am uncomfortable when I am exercising, and sometimes just sitting or walking around. I find it difficult to keep clean and am worried that it will pose a sexual problem in the near future when I get married and become intimate with my husband.

What are the pros and cons of having a labiaplasty using the "wedge method" vs "the trim method"? I am in the process of having consultations and was interested in hearing more pros and cons of the different methods. Also, I am a college student so I am in classes, should 6-7 days be enough recovery? I am looking into having this done over spring break. Thank you.

Doctor Answers (34)

Labiaplasty: wedge versus trim

+5

There is no absolute guide to what is the correct method.

Sometimes it comes down to the surgeon's comfort level and experience with one technique over the other.

The primary advantage to the wedge is that its proponents like the shorter scar located across the labia rather than along its edge. It is claimed that it leaves more of the natural edge intact.

In my practice, it is the edge that bothers many of my patients; they do not like the thick, dark, rough surface and desire to have it removed. Furthermore, the vast majority of my patients undergo a combined clitoral hood reduction.

With the "trim method" (I call it the leading edge resection), this creates once incision that is continuous. If this is performed with the wedge resection, it will require use of a separate incision and therefore defeats the purpose of less scarring.

Wedge resections, in my opinion are best for prominence of the central 1/3 of the labia minora which will be resected with this. Lastly, I feel that occasionally the wedge resection results in tension at the edge of the repair.

In my hands, it really comes down to your anatomy.

In summary:

WEDGE TRIM
Positive Negative Positive Negative
Transverse scar Only mid labia treated Entire labia treated Linear scar
Central 1/3 2 incisions clit hood 1 incision clit hood
Extends deeper portion Less vascular portion
Edge may see tension

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Labiaplasty techniques - wedge vs. trimming the edge

+2

As you can see from the answers here, some surgeons prefer each technique, and it is certainly true that either technique can produce a good result and a satisfied patient.  However, there are some important differences, and you are wise to look into the options.

I certainly agree that a surgeon's experience with each procedure is important.  The "trimming" procedure is technically simpler, and less likely to cause complications and problems during surgery, as long as we stay away from the clitoris, which is anatomically at the front of the labia where they come together.  However, trimming alone will not reduce the fullness in the clitoral hood, so if that is important to you, be sure that the surgeon plans to address it.

I do not agree that the wedge procedure only improves the central portion of the labia.  By taking out a wedge, the tissue in front is pulled backward and the tissue in back is pulled forward, and that does reduce the excess tissue in those areas as well.

Also, with the  wedge procedure, we can extend the outer limb of the wedge toward the front, on either side of the clitoral head, and get some good tightening of the excess tissue over the clitoris without making an incision directly over the clitoris (which might endanger that very delicate anatomy)

Because the wedge tightens the entire length of the labia, it can improve the area around the clitoris as well.  With the trim method, the surgeon has to stay about 1 cm from the clitoris, which means that you may be left with a boxy "tab" adjacent to the clitoris where the labia could not be treated.

With the inner limb of the wedge (that goes toward the opening of the vagina), the surgeon should be certain to stay away from the opening of the urethra (where your urine comes out).  I often put a catheter into the urethra at the beginning of surgery to make it easier to keep track of the urethra and ensure that the opening is not damaged during the surgery.  The catheter is removed at the end of the procedure.

I have not seen significant healing problems with either technique (and I have done both, although currently I mostly do the wedge resection).  As with any surgery, minor problems might require a revision.

I would agree that, for very long and large labia, trimming might allow us to remove more tissue, but in my experience, a very significant amount of reduction can be done with the wedge procedure.

So, I would compare the techniques like this:

WEDGE:

  • Does not disrupt or remove the delicate free margin of the labia minora
  • Tightens the entire length of the labia minora, including the portion next to the clitoris
  • Can be carried forward on either side of the clitoris, tightening the clitoral hood
  • More complex procedure, requiring more skill, to reduce the chance of too much tightening of the opening of the vagina or injury to the urethral opening.

TRIM:

  • DOES remove the delicate free margin of the labia minora, which might be an advantage for a patient who does not like that pigmented tissue and wants it removed
  • Removes tissue along the entire length of the labia minora, except for the area immediately next to the clitoris, which may produce an extra "tab" of tissue there
  • Does not improve or tighten the clitoral hood.  If this is important, the trim can be combined with another procedure to reduce the clitoral hood, with an incision that may or may not be directly over the clitoris
  • May be more effective for very long and enlarged labia
  • Simpler and less technically demanding procedure

The only absolute rule I would suggest is that you NOT try to talk a surgeon into doing a procedure with which he or she is not completely comfortable.

However, the good news is that labiaplasty is a great procedure for improving both the appearance and discomfort from enlarged labia.

Scottsdale Plastic Surgeon
5.0 out of 5 stars 8 reviews

Wedge vs. trim for labioplasty

+2

You've done your homework!  I usually do a "hockey stick" wedge excision that allows me to remove a lot of the excess bulk but preserve the edge of the labia which is usually more pigmented and wrinkled than the center part of the labia.  With a trim procedure, the natural edge is removed.  Some ladies really want a smooth and less pigmented edge that a trim procedure leaves, but most of my patients want it to look as natural as possible. 

It's sooooo important to remember that normal genitalia is really variable and the goal of this surgery is to rid you of the excess length and bulk of the labia, and not to do a "custom designer" job.

Most ladies are very pleased with their result regardless of the particular method used. 

Lisa Lynn Sowder, M.D.

Seattle Plastic Surgeon
5.0 out of 5 stars 39 reviews

Trim vs. Laser vs. Wedge: A comparison of labiaplasty techniques [with graphic video]

+2
[Graphic video below]
Depending on your anatomy and desired results, as well as the experience and preference of your surgeon, there are three different techniques that can be used.

The trim technique simply removes excess tissue by cutting away the edges of the labia minora. In general, this method is most useful when the goal of the procedure is to remove rough and/or discolored outer edges from the labia. This technique is also used when the labiaplasty is being performed in conjunction with a clitoral hood reduction because both procedures can be completed using a single incision. While this technique can successfully reshape and renew the labia minora, it can also lead to stiffness and discomfort along the incision, as well as a loss of sensation1-7 if not done by an experienced surgeon

Oftentimes lasers are used to trim the edge of the labia minora, a technique known as laser labiaplasty.8 Using the lasers instead of the traditional trim technique has some advantages: shortens the time needed to complete the procedure, reduces bleeding, but can lengthen recovery time. However, this method removes the normal labial edges and can result in an unnatural appearance. The heat generated by the laser can also damage tissue and nerve endings, leading to other complications.

In cases that do not involve issues along the labial edge, only an excess of tissue or asymmetry, the wedge method is often used. This method removes a wedge-shaped section of tissue from the middle third of the labia and then stitches the top and bottom sections back together.2 This technique preserves the normal appearance of the labial edge. The interior incision also means that less stress is placed on the stitches, reducing complications. However, occasionally this closure breaks down, causing a gap in the labia and requiring a second surgery to fix it.

As with all cosmetic procedures there are positives and negatives associated with undergoing any type of labiaplasty. However, by choosing an experience, certified plastic surgeon you can minimize the risks and finally achieve the results you desire.

San Francisco Plastic Surgeon
4.5 out of 5 stars 17 reviews

I do a "Modified Wedge" in most cases

+2

Hello,

I have been doing labiaplasty surgery for nearly ten years. I no longer do "trims" as patients have been more uncomfortable and seem more likely to end up with less attractive results. I stopped doing the trim about five years ago.

In most patients a Modified Wedge heals faster and looks more natural. My patients have been happy with the appearance and function the operation provides.

The answers for this of course depend upon your chosen surgeon's experience of course.

Orange Plastic Surgeon
5.0 out of 5 stars 22 reviews

Which technique - lateral trim or central wedge?

+1
I previously used the lateral trim technique, but now use the central wedge technique exclusively. It is a lot more complicated to perform, but once you understand how to perform this procedure, it is not hard to do at all. THe results are consistent and very controllable. In my opinion, there is really no indication to do a lateral trim procedure any more. I believe it is outdated by the central wedge technique.

I have to agree with everything Dr. Alter has stated in this discussion thread. As for the pigmentation differrence, this is a minor issue, and no patient has ever even brought it up to me. The surgical results are so natural and satisfaction rate is so high, that a little step in color along the side of the labia is a non-issue for my patients. I commend Dr. Alter on a wonderful contribution to plastic surgery!

Web reference: http://www.epsteinplasticsurgery.com/procedures/body-procedures/labiaplasty

Stony Brook Plastic Surgeon
5.0 out of 5 stars 128 reviews

Which procedure

+1
Since I do both techniques I think it depends on the result you want! If performed in a conservative fashion both leave almost no evidence of prior surgery. if done poorly then very hard to fix. Good Luck!

Web reference: http://richmondsurgicalarts.com

Richmond Plastic Surgeon
5.0 out of 5 stars 21 reviews

Labioplasty recovery

+1
These are all very good questions! 
Wegde vs Trim: I feel that the best method depends on each patients anatomy.  As you can see from the photos on the internet...There is a lot of variability in a woman's anatomy "down there!'  I usually talk to each patient about pros and cons of the two methods and why I think they may be a better candidate for one vs the other.  In my experience the trim method allows for a quicker recovery and less risk of wound healing problems (which are fortunately rare). The wedge method is particularly good if the redundant labia tissue is limited to the central part of the labia minora itself.
I think that a week long spring break would be enough time to recover from a standard labioplasty procedure. 
Good luck!
Nashville Plastic Surgeon
5.0 out of 5 stars 4 reviews

Labiaplasty: Wedge vs Trim

+1
That is a very good question and there are proponents of both methods.  They both have advantages and disadvantages.   

The trim method is thought to be technically easier to perform.  This method amputates the the distal edge giving the surgeon direct control over what tissue is removed.  The down side is that the scar is placed on the outer edge of the labia.

The wedge method allows shifting of the labia so that the excess tissue can be removed while maintaining the natural edge along the outer rim.  This method is technically more difficult but allows more shaping of the labia and avoids the scar being placed on the outer edge of the labia minora.  

Both methods can be done effectively in the correct hands.  Have the discussion with your plastic surgeon and ask him or her why they do a specific method. 

I hope this helps.  
Miami Plastic Surgeon

Labialplasty

+1

Both methods should give you the results you are looking for. I do these procedures with a local anesthetic. The scars do heal very well in most cases.

Newport Beach Plastic Surgeon
4.5 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.