A labiaplasty must be performed by a surgeon with experience. 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. This can lead to scallops and irregularities. 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. . 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. About 40% of the female genital cases I perform are revisions of labiaplasties and clitoral hoods botched by other doctors. Additionally, you have clitoral hood enlargement and appear to have clitoris enlargement. Does your clitoris enlarge with arousal? A clitoral hood reduction will not resolve your issue, but will make you worse if a clitoris reduction is not also done. A clitoropexy will not work, because your enlarged clitoris will pull out the sutures. Have you ever taken male hormones or had a hormone issue. You may want to see an endocrinologist to evaluate your hormone levels, but they are usually normal. Very few surgeons perform a clitoris reduction, since it is technically challenging and is rarely taught. It is an intricate procedure, since the sensory nerves have to be carefully preserved. I have done over 60 reductions without any loss of sensation or orgasmic ability. The clitoral reduction reduces the glans or head and also removes the erectile tissue in the shaft. After surgery, the clitoris will not stick out much or increase with arousal. The surgery is not very uncomfortable. It takes up to 3 1/2 hours and includes clitoral hood reduction. A labia minora reduction and/or labia majora reduction or enlargement can be done at the same time. Gary J. Alter, M.D. Beverly Hills, CA - Manhattan, NY- Dubai, UAE