Which technique, "V-wedge"& modifications, or "Linear/Trim" is best for YOU??

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The debate rages on among cosmetic gynecologic and plastic surgeons: which technique, linear/trim or V-wedge modification, is the “best” for performing a labiaplasty for excessive-sized, redundant labia minora, with or without redundancy of the clitoral hood. One has only to read popular often-accessed websites like RealSelf to realize that strong opinions abound. There are two major camps: acolytes of the V-Wedge and proponents of the linear/trim method.

Unfortunately, those surgeons who perform only one method or another may not truly understand that a labiaplasty is an artistic undertaking, and one that should be personalized for each individual. “If all you have is a hammer, everything looks like a nail.” Most practitioners stick with one method or the other either because that is the only one they have learned or are comfortable with, or that they have had a couple bad outcomes with a particular method, so studiously now prefer the other…

The reality is that no one method holds the sacred key. The “Holy Grail” of labiaplasty for a given woman should be, in my opinion, “…The Right Procedure for the Right Woman for the Right Reason.” Given this philosophy, and the fact that each woman’s labia are different, an ideal surgeon is one who can perform different techniques so as to choose the proper approach for a given patient. I have never seen two women who look exactly the same (or, for that matter, 2 sides on the same woman that look the same.) I favor individualizing technique dependent on a woman’s individual anatomy, and her choice of post-surgical appearance. While I certainly can perform a linear (and its “sisters,” “trim” and “curvilinear”) or V-Wedge (and its “sisters,” V-Y wedge, Z-plasty, and superior/inferior flap rotation) on any patient, not rarely, either because of anatomy, individual patient choice, and different recovery realities for different patients, one procedure choice stands out as “best.” In an ideal world, your genital plastic/cosmetic surgeon should be an artist, and your individual labia his or her palette. This calls ideally for your surgeon to be facile with more than one technique, and when counselling patients as to their choice of surgeon, one requirement should be that the surgeon is comfortable performing both linear and wedge and their modifications, so as to choose his or her technique based on your desires and your anatomy, not solely on the only technique he or she knows how to perform.

An extremely important issue here involves the clitoral hood. While there are serviceable techniques for encompassing enlarged & redundant hoods in either linear or wedge modifications, it is exquisitely important that your surgeon be both experienced and comfortable with reducing an aesthetically or functionally robust hood. Avoid any surgeon who cannot prove to you by his/her knowledge, backed by many photos, that he/she is savvy and experienced with hood reduction.

I have reproduced below several “before and after” photos of labiaplasty/hood reduction procedures performed by both linear and wedge techniques, with explanations about each one. You can begin to get an idea why it is important for your surgeon to be both an architect and an artist, to be savvy in alternative techniques, and be able to design the procedure to specifically fit your anatomy. 

Article by
Davis OB/GYN