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 (37)

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 43 reviews

Labiaplasty Techniques

+2
Labiaplasty has become a very popular plastic surgery procedure over the past 5 years.  In my practice, it is considered one of the essential elements in a Mommy Makeover.  The trim technique has been around forever while the wedge technique has been popularized over the last decade.  I have used both techniques and find that both I and my patients are happiest with the wedge technique.  In this technique, one can both get rid of excess labia and also tighten the vaginal introitus (opening to the vagina).  With the wedge technique, the natural look of the vagina is maintained by having the normal edge of the labia remaining, while still removing that portion of the labia minora that sticks outside of the larger labia.  Clitoral hood reduction is also a popular part of this procedure and, if done correctly, increases sensitivity without any downside.  I recommend you see only Board Certified Plastic Surgeons with a great deal of experience in this area.

S. Larry Schlesinger, MD, FACS
Honolulu Plastic Surgeon
5.0 out of 5 stars 191 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.

James Nachbar, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 10 reviews

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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.

Lisa L. Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 40 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.

Usha Rajagopal, MD
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.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

Wedge Method Vs Trim Method for Labiaplasty

+1
Thank you for your question.

Both the wedge and trim method are acceptable procedures.  The procedure of choice will be determined by your surgeon based on your personal anatomy and what is to be addressed.  The trim technique is more common as it has a lower chance of having wound healing issues and generally tends to allow for a smoother transition.  The downside, is that with the trim technique, the incision line lies along the labial border.  This means that you may experience slightly more discomfort initially; however, this resolves within a few days.  Most people are able to return to desk work within 5 days, so i think you plan for time off is more than adequate.

good luck

Kunaal Jindal, MD
Toronto Plastic Surgeon

Postoperative recovery time for labiaplasty

+1
Most labiaplasty patients are surprised that the procedure is less painful and easier to recover from than they thought.  Most of our patients have minimal pain, minimal bleeding, and can return to work within a few days.  Returning to exercise can be a 3 or 4 week process depending on healing, but I would suggest that you ask those specific questions from the doctor you choose.  Look at a lot of the before and afters of labiaplasty done by the doctor you choose. This gives you a guide as to what to expect, and it also will raise good questions for discussion.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 11 reviews

Depends on consultation with your surgeon

+1
The most common form of labiaplasty, the Trim Technique, involves surgically removing the longitudinal section of excess labial tissue. The trimming procedure is the simplest form of labiaplasty, providing lessened complication risks and a straightforward recovery process. For these reasons, it's the preferred treatment course for most patients. 

The Wedge technique preserves the natural tissue border of the inner labia and was developed in order to minimize patient scarring. Only women with appropriately shaped labia, where the excess tissue to be removed is composed of a small portion of the inner labia, are candidates for the Wedge Technique, however.

The most suitable technique for you can be determined during a consultation with a board certified plastic surgeon. 6-7 days off of school should be sufficient time for your initial recovery.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 52 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!

Mark D. Epstein, MD
Stony Brook Plastic Surgeon
5.0 out of 5 stars 144 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.