Wedge or trim labiaplasty? (Photo)
Doctor Answers 17
Thank you for your question and sharing your photographs. Labiaplasty is a cosmetic procedure that may improve one's confidence and resolve physical issues that one may have with enlarged labia minora. Clitoral hood reduction may also be indicated depending on the findings on physical examination. Labiaplasty with and without clitoral hood reduction is a personal decision after being well educated on the benefits and risks. There are several techniques, which should be discussed with you by the surgeon. In my practice, I discuss this with my patients in order to educate them on their cosmetic issue, the surgical options and possible outcomes so that they can make an educated decision. I would recommend finding an experienced genital surgeon, which include Cosmetic Urologists, even if it involves traveling.
Best of luck.
Jeffrey S. Palmer, MD, FACS, FAAP (Cosmetic Urologist -- Cleveland, Ohio)
I would highly recommend the trim method for multiple reasons. One being that there are less complications with this method. Another being that you have a lot of skin throughout the entire labiaminora and clitoral hood. The wedge wouldn't get rid of that uniformly. The trim method would take care of all of that skin from the top and the bottom labia minora. Please be sure to seek out the opinion of a board certified plastic surgeon who specializes in Labiaplasty procedures.
Wedge vs Trim
Hi and thanks for your photos
You own photo looks similar to the starting point that i see with many of my own patients. The most important thing is to have a detailed examination with an experienced surgeon and to discuss the risks and benefits of each technique with your surgeon. In my practice, I would offer a women with this anatomy an extended wedge technique, where triangles of tissue are removed from the labia minora, bringing normal edge together to normal edge. This preserves normal anatomy, looks very natural, and avoids a stitch line along the edge of the labia. You could also consider anterior extensions to contour some of the heavy skin of the clitoral hood. In experienced hands, this is a predictable and safe technique that results in a very natural appearance. Separation happens occasionally, but in experienced hands this is not common and shouldnt be your reason to avoid the wedge.
Hope that helps-
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Wedge or trim labiaplasty?
Because every patient's anatomy is different it is important to have proper expectations post operatively. The second photo you've posted appears that a labiaplasty was performed without clitoral hood reduction. In your situation, you would be best suited with labiaplasty and clitoral hood reduction to produce a more natural appearance overall. Surgeons will often utilize both the wedge and trim methods to perform labiaplasty so it would be important to discuss with your surgeon before hand the exact outcome you are looking for, which may in turn influence the style of labiaplasty performed. The most important step you can take is finding a board certified surgeon who specialize in labiaplasty and has performed many procedures. Having an experienced surgeon should minimize your risk of negative outcomes.
Should I get a wedge resection or linear resection?
Based upon the photos you show - what you look like now and what you want to look like and what you don't want to look like - a combination of wedge and linear resection will likely be employed. One photo is not enough to determine exactly what will be done. Usually women have extra folds of skin that should be addressed at the same time as wedge resection or linear contouring. A detailed exam in critical. The big issue is making certain your doctor does not removed too much of your labial tissue. In the middle picture that looks "amputated" this issue here is that too much labia tissue was removed and the clitoral hood area was not properly reduced.
I reviewed your photos. I see that your ideal is one of my post-op patients and your failure is a pre-op from another surgeon that I eventually reconstructed. Your labia minora are enlarged but not massively enlarged. I performed your ideal with a central edge. One of the two most common techniques is the central wedge technique, which I invented in 1995 and published in the plastic surgery textbooks. It is also known as the "V" or wedge technique. Gynecologists and most plastic surgeons perform a labioplasty very differently. They essentially trim the labia minora (inner vaginal lips) and leave a long suture line instead of the normal labial edge. Their technique is the same whether a scalpel or a laser is used. In contrast, the central wedge removes triangles of tissue and bring the normal edges together. Thus, the normal labial edges, normal color, and normal anatomy are preserved, but the darkest labial tissue is usually removed. If you have extra tissue on your clitoral hood, it can be reduced it at the same time. No matter the technique, an inexperienced or unskilled surgeon can lead to a high rate of complications, chronic scar discomfort, labial deformities, and further surgery.
Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY
You should get a good result with either technique
based on your concerns, i would suggest a wedge technique with clitoral hood reduction. it is very rare for a wedge excision to separate. see a board certified PS.
david berman md
Wedge or trim labiaplasty?
Thank you for sharing your question and photographs of expectations and current appearance. Though both wedge and trim labiaplasty techniques can have excellent results, based only on your pictures I would favor a wedge labiaplasty and clitoral hood reduction. Your incisions will be well hidden and allow you to maintain the natural color and edge of your labia. Hope this helps.
Wedge vs trim labiaplasty
Your story and concerns are in good company with almost ever other patient that undergoes labiaplasty and/or clitoral hood reduction (aka hoodectomy). Based upon your photos, your anatomy is very typical of someone who seriously considers having these procedures and experiences a major boost in (sexual) self-confidence and pleasure thereafter. In a multi-center peer reviewed study I was involved in back in 2009, 98% of labiaplasty patients were satisfied with their results and had an improved sexual experience post-operatively.
Labiaplasty, which most commonly involves surgical reduction of the labia minora (inner/thinner lips) but not infrequently trimming or tucking of the labia majora (outer/thicker lips), has become a relatively common procedure over the last ten and even more so last five years. Most commonly it is done under light sedation (aka twighlight sleep) with local anesthesia, in which case the patient should feel no pain during the operation. Whether the surgery is done using a laser, scalpel, or scissors does not really matter but what does matter is "symmetry". Symmetry is the most important aspect to the final aesthetic result. Most women, just like yourself, prefer to have as much of the darker pigmented edges removed as possible. Also, it's not how much tissue is removed but how much is left remaining because a certain amount is necessary to maintain proper form and function - typically ~10 mm or so of the dry part of the labia. To achieve these three most important elements, I have found that the "Trim Method" satisfies best. It is extremely important to consult with a board certified plastic surgeon that specializes in this operation (does at least 1 - 2 per week). It may cost you a bit more but it is this type of result you will want to live with for the rest of your life. Typical (all inclusive) fee at my office/surgery center is $4500.
Although there is no guarantee, women frequently do seek clitoral hood reduction (Hoodectomy) to improve exposure of the clitoris and hence better stimulation during sexual activity. By removing some of the excess &/or redundant skin concealing the clitoris, it becomes more readily exposed to sexual stimulation and hence a heightened sexual experience/orgasm is possible. Sometimes I recommend adding hoodectomy to labiaplasty to better harmonize the aesthetic outcome. Again, the key is seek consultation with a board certified plastic surgeon or gynecologist who performs this procedure regularly (>2-3 x/month) so that just the right amount of tissue is removed and just the right amount remains such that the clitoris is not constantly exposed and rubbing on clothing, etc... Typical fee for a hoodectomy is ~$3000 but reduced to about half that price if done along with a labiaplasty.
Now for recovery, because the labia tissue is so robust with blood supply it has an amazing ability to heal relatively quickly. Most patients are sore for 4-5 days before things start to get a lot better from there. Some patients can resume work before this time depending upon their occupation. No exercise for two weeks, no baths/jacuzzi or swimming for 3 weeks, and no sexual activity for typically 4 weeks. My patients are given an oral pain medication such as Vicodin or Percocet but icing the area for the first 48 hours and applying some custom made take-home topical local anesthetic cream seems to work the best. Glad to help.
Which is better for me: "Trim" or V-Wedge modification
While I cannot make a definitive judgement based only on 1 photo, based on what I see a "Y" modification of V-wedge LP, with the leg of the "Y" going up each side lateral to your hood, "gathering" and removing the wrinkling by taking it up laterally on either side would come close to the "look" you seek. "Reasonable expectations" are important; no surgeon can guarantee exact results, which are dependent on a combination of your anatomy, the skill of the surgeon, and your unknown healing process.
I would counsel you to take your time in research, choose a surgeon who can prove to you (s)he is well experienced, and is facile in both "Trim" and V-wedge. If a wedge is performed properly (see Dr. Adam Oppenheimer's technique video- I personally use ~ the same technique) and you are careful in your recovery, there is no reason for a Wedge to separate. Same for Linear/Trim. If your surgeon is careful, and follows the "rules" for Linear (well outside of Harts Line' at least 1/2-1 cm from inter-labial fold at the bottom laterally) and Wedge (leaving sub-Q tissue; using a good "foundational" 3-layer closure eliminating all "dead space,"), you should do well. Don't be afraid to travel to find the best surgeon & the best "deal." Most cost-effective is a procedure done in-office, "local" anesthesia. For price, make sure you ask for the "Total" out-the-door" price!
The video and weblink below may be of help. Also look at the labiaplasty pages for lots of "before & afters..."
Michael P Goodman, MD
Davis, CA, USA
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.