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 (44)

Labiaplasty: wedge versus trim

+7

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 48 reviews

Labiaplasty technique

+2
Thank you for your question. In general, there are techniques to performing this surgery, and you've correctly identified them both. The trim method involves taking away excess labial skin in a longitudinal fashion along the length of the labia. This obviously takes less time for the surgeon to perform and is technically an easier method. It also, unfortunately, takes away the natural edge of the labia, forcing the surgeon to place a scar where previously there was an anatomical landmark, namely the edge. The wedge method is a longer, more difficult operation. It does, however, preserve the natural border of the labia, and more closely mimics that natural state of "normal" or aesthetically pleasing labia. In the hands of an experienced Board-certified plastic surgeon, the wedge method is the way to go. Good luck and fare well. 

Daniel Kaufman, MD
New York Plastic Surgeon
5.0 out of 5 stars 5 reviews

Labiaplasty Method of Wedge Vs. Trim...

+2
You ask a great question. Obviously your answer will be biased depending on which surgeon you ask and which procedure he prefers. It may help you to simply look at many photos of each procedure. Which do You like the looks / results of best ?  I know when i look at pictures of both, i see a definitive difference in the appearance. Generally, in my opinion, one looks normal to me, and one looks operated. But that's my opinion. I generally prefer the nerve sparing wedge technique that preserves the normal natural edge of the labia. When excising a wedge, it allows the two natural edges and the nerves that supply them, to be brought back together, leaving a perpendicular scar to the natural intact edge that heals in an imperceptable fashion. Excising a wedge which may be centered more anteriorly, from the middle or more posterior, depending on the anatomy reduces the entire labia. When excising a wedge, the labial tissue from the front and the posterior aspects come together, reducing the size of the entire labia minora. As mentioned, modifications can be made to extend the wedge to reduce redundant tissue in areas, for further shaping and sculpting including reduction of excessive clitoral hood tissue. The trim procedure, in my opinion, leaves an unnatural scarred edge of the entire labia devoid of its natural color. Mother nature creates a more natural edge than surgery and healing does. Yes, the wedge procedure may be more technically difficult compared to a trim procedure, however, it is overall a relatively simple procedure for an experienced surgeon which take about an hour.

Sam Gershenbaum, DO
Miami Plastic Surgeon
4.5 out of 5 stars 27 reviews

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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 229 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

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 46 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 20 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 24 reviews

Which to Choose: V-Wedge Labiaplasty or Trim Labiaplasty?

+1
Consult with a board-certified plastic surgeon or gynecologist who does labiaplasty surgery. After performing a physical examination, he/she can discuss your options.

The trim method is typically associated with an easier recovery with less swelling and lower risk of wound separation, but some women like to avoid the suture line at the edges of the labia. The V-Wedge approach is an ideal option for patients who prefer no suture lines along their labia.

It takes two weeks to recover, during which activities need to be limited, though most women can return to desk-type work at one week. In my pracitice, we recommend no intercourse or tampons for 6 weeks.

Click on the link below to see a trim (or linear) labiaplasty case.

Heather J. Furnas, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 9 reviews

Wedge vs trim for labiaplasty

+1
Whenever multiple methods exist for a procedure, there may be no one right way for every patient.  The choice of procedure depends upon the patient's anatomy and the surgeon's skill set.  The trim method is quicker, but leaves scar tissue at the point of contact for intercourse.  Most of my patients wish to avoid this.  The wedge method has the advantage of allowing modification of the labia and clitoral hood at the same time, which is often needed.  The best way to learn what is right for you is with a consultation with a surgeon who is certified by the America Board of Plastic Surgery who performs labia surgery.  This will provide you with all your options and answers to your questions. 

Mark P. Solomon, MD
Philadelphia Plastic Surgeon
4.5 out of 5 stars 7 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.