Concerned about possible nerve damage after wedge technique labiaplasty. Can possible loss of sensation avoided? (photos)

Question

Hello doctors, I am thinking about having labiaplsty, wedge technique (maybe also hood reduction). My main concern is nerves damage ). I feel that a lot of the sensation I have in the labias are on the upper line (markes in red). Is there a way to keep these parts and not damaging the nerves? Thanks a lot

Gary J. Alter, MD · Answer

A labiaplasty with a clitoral hood reduction can reduce your size. However, it must be performed by a surgeon with experience. One of the two most common labiaplasty 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. The area you mark in red will almost certainly be almost totally removed with a trim. Their technique is the same whether a scalpel or a laser is used. This often causes asymmetry, scallops, and a wide suture line. 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. Most of the area (frenula) that you mark in red will be saved as the suture line will be at the mid-point of each frenulum. I have done several thousand labiaplasties, many of them like yours, and have not had loss of sensitivity. If you have extra tissue on your clitoral hood, it can be reduced at the same time. Your clitoral hood is thick, wide, and protuberant. It can be decreased somewhat by reducing the sides. I pioneered a clitoropexy with clitoral hood reduction in which the clitoris is pushed closer to the pubic bone and the width, thickness, length, and protuberance of the clitoral hood can be drastically decreased. I have done it over 300 times with excellent results. I have not published this technique, so no one does it like me. 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. Make sure the surgeon shows you exactly where he will excise and make the suture line. He should be able to show you very accurately. About 40% of my labia cases are reconstructions of other surgeons' labiaplasties.

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY

Amir Sadr, MD, MSc (Plast), FEBOPRAS · Answer

Dear Ninny11
Thanks for your question and sharing your photographs. There are many techniques of doing labioplasty including wedge resection and edge trim. In experienced hands, risk of nerve damage is extremely low. If you compare wedge resection with edge trim, risk of complications with wedge resection would be more. Looking at your photos, I think you could have a labioplasty and clitoral hood reduction with curved linear excision ( edge trim) technique with minimal risk of nerve injury. Of course you need to have a face to face consult with surgeon to finalise that plan.

Michelle Jones Singer, MD · Answer

Remember that the clitoral nerves  are deeper inside and will not be disturbed by a labiaplasty. It is important that you discuss your concerns in detail with an experienced cosmetic surgeon or urologist. Also review what structures will be involved in the wedge resection.

Mark N. Scheinberg, MD · Answer

Thank you for your questionYour photos show the bulk of excess tissue is prepuce. There are two pair of inner labia. A lower pair that inserts into the clitoris and an upper pair called prepuce which forms the hood(the skin directly over the clitoris) and which can attach into and often overwhelm the lower pair. In your photo you can see the inner curve of tissue attaching to the clitoris and a large bulk of tissue above which is the prepuce and optimally should be removed leaving a "bridge of the nose" appearance above. That removal is needed prior to treatment of the lower pair. If you are looking to avoid nerve damage I would not avoid a central wedge as that creates a central scar which has higher risk of problems. The trim or natural edge , in my opinion, would be more effective. In any case, your surgery is not simple if it is done correctly. You need a surgeon with advanced skills to do it correctly and avoid complications. Do your homework. Investigate reviews, before and after photos and compare surgeons.The video below should be helpful.

Christine Rodgers, MD · Answer

HI ninny11,

I think that if you have an experienced labiaplasty surgeon, sensory nerve loss can be avoided.
You have a good amount of tissue around the clitoral area and if your surgeon understands the anatomy, the nerves to the clitoris and the frenulae should be preserved.

As with all surgeries and medical care in general, you need to search for an experienced surgeon, read the reviews and visit with a few so that you can make an informed decision.

Hope this helps a bit.

Good Luck!

Best,

Dr. Christine Rodgers

Adam J. Oppenheimer, MD, FACS · Answer

The labia and clitoris have an abundance of nerve endings. The most in the entire human body among either sex. Some tissue is definitely removed in labiaplasty, but I have not ever seen a patient have numbness or even reported changes in sensation after a labiaplasty. And definitely never had any reported pain with intercourse or trouble with orgasm. That all may seem strange based on the high sensitivity, but the body is sometimes mysterious. Even to doctors.

That said, I would avoid a wedge. You should aim for results and not a specific technique. The wedge is not a good approach. It separates often. It notches often. It doesn’t leave the edges smooth. Edge labiaplasty and hood reduction is the right approach and I’ve had success hundreds and hundreds of times with this technique. Best to find a doctor who has results reviews photos videos and just can show you the results that you deserve. The link attached is a before and after gallery of my work. If you can’t see a similar gallery by your surgeon, keep looking.

Marco A. Pelosi III, MD, FACOG, FACS · Answer

The area that you marked in red is called the frenulum. In your case, the frenulum is enlarged and is part of the most prominent area of your labia minora and it needs to be reduced. If you don't have the frenulum reduced, your result will look unbalanced and deformed. In brief, it wouldn't make sense to do anything at all. Just leave it alone rather than create a poor aesthetic result that would need to be revised at a second operation. You also have significant loose skin along the sides of the clitoral hood which also needs to be reduced to achieve a smooth aesthetic result.

Burcak Tok, MD · Answer

hello , if the places you marked are not removed when labiaplasty is done , it will not make any sense . Loss of sensation may occur in the wedge technique, too. Therefore, in my opinion, very sensitive areas for you with labiaplasty are a problem.

George Marosan, MD · Answer

Thank you for your question and photos. A wedge resection technique will not affect the areas you circled. A trim method, will cut right through it. If your surgeon uses the trim method and wants to avoid this area, you will end up with excess skin hanging down. Your clitoral hood needs to be addressed as well to get an anatomically pleasing result.
See a board certified plastic surgeon or gynecologist experienced in female cosmetic genital surgery for an in person consultation/evaluation. Remember, not all are experienced in these surgeries. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. You could orient the wedge to be away from this area of your labia but I would favor a trim approach to address the tissues of your clitoral hood and labia minora.  Seek out in-person consultations with specialists in your area to get the best advice.

Concerned about possible nerve damage after wedge technique labiaplasty. Can possible loss of sensation avoided? (photos)

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