What are these folds and how should they be operated? (Photos)

Question

Hello doctors I consider having labiaplasty + hood reduction, and I want to have deeper understanding of it . 1) How are those two folds on the sides of the clitoris (red) define anatomically? Parts of the labia, clitoris hood or a different classification? 2) Does it have higher risk on operate these folds (since their proximity to the clit or another risk cause)? 3) What are the surgical approaches for that? Thanks a lot

Mark N. Scheinberg, MD · Answer

Thank you for your questionThere are actually two pair of inner labia: lower pair that inserts into the clitoris and an upper pair, called prepuce, which forms the hood (the skin over the clitoris) and can insert and even overwhelm the lower pair. The side folds you have is prepuce which can and should be removed prior to attention to the lower pair, optimally giving a "bridge of the nose" appearance, freeing the lower pair to be reduced by any of a number of procedures. The "reduction of prepuce" can be safely performed by surgeons WELL TRAINED in this technique. The lower pair can be reduced by several methods. The natural edge preservation techniques give the most natural appearance but it is up to you as to the final appearance you prefer. You need to do your homework. Look at reviews and before and after photos to get it right the first time. See the photos and video below to learn more about your options.

Michael A. Reed, MD · Answer

Labia are formed from three variable folds.  The first contribution is the frenular fold.  This fold begins as an attachment to the underside of the clitoris and terminates by contributing to the formation of your labia. The next fold is the lateral clitoral hood fold. It begins just next to the clitoral hood and terminates midlabum.  Lastly,  the preputial folds which are represented by two red circles in the picture you provided.  These vulvar structures are similar to the foreskin of the penis in male anatomy.  In the hands of a well trained cosmetic gynecologist, it is very unlikely to damage the nerve of the clitoris.  The dorsal nerve of the clitoris runs directly in the midline along the top of the entire length of the clitoris.  Those preputial folds are skin and skin only, there are no major blood vessels or nerves in or near these structures.  The only risk I see is not addressing the clitoral hood folds and looking top heavy by only reducing your labia minora. Either surgical approach linear trim or wedge labiaplasty can accomplish your results.  Best of Luck! Dr Michael A Reed aka @thecosmeticgyn

Adam J. Oppenheimer, MD, FACS · Answer

You’re an anatomist! I think it’s great to have a solid understanding of our own bodies. The detail of the vulva is different in every patient and it requires a different approach while still using the same overall pattern. Seek out the best surgeons in the world to help with your specific goals and let them worry on your behalf.

Mehmet Bekir Sen, MD · Answer

Hi,
Labiaplasty and clithoral Aesthetic is exactly what you need. Since this area you show is located in the clithoral region, we consider it within the scope of clitoris aesthetics. There is no demonstrated drawback to excising these extra skin folds. I recommend that the surgery be performed by a surgeon who is very experienced in genital aesthetics procedures. 
Remember that Beauty always comes from within you.
Thank you
Dr. Mehmet Bekir SENGenital Aesthetic Expert

John Michael Thomassen, MD · Answer

The area marked encompasses the clitoral hood.  This is excised when reducing the hood, taking care to avoid the midline to avoid the clitoral nerve.

Gary J. Alter, MD · Answer

The folds on the sides of the clitoral hood are just an anatomical variation, which I have actually treated hundreds of times. Yours are just more exaggerated than most. They can be easily and safely removed without any fear of injuring your clitoris or sensation. I assume you also probably desire a labiaplasty. Your labia minora are enlarged but not massively enlarged. In that case, a labiaplasty is a good idea, but it 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. The extra tissue on the side of your clitoral hood can easily be reduced it at the same time by extending the side excisions of the labia. 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.

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

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

Michelle Jones Singer, MD · Answer

Technically speaking, the folds of skin that are not attached to the clitoris in your photograph are not the clitoral hood. The skin that encircles the clitoris in the middle is known as the clitoral hood. The procedure is known as clitoral hood contouring or reduction and it includes removing the projecting skin by incisions on each side when patients want to have them made smaller. Because neither the clitoris nor the clitoral nerves are involved in the procedure, there is no risk to the clitoris.

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

The lateral folds of skin in your photo are not connected to the clitoris are not technically the clitoral hood. The clitoral hood is the skin that wraps around the clitoris in the midline. However, when patients seek to have them made smaller, the operation is called clitoral hood contouring or reduction and it involves removing the protruding skin through linear incisions on each side. The operation presents no risk to the clitoris because it doesn't involve the clitoris or the clitoral nerves. This assumes that the surgeon is an expert. Any operation is dangerous in non-expert hands. It can be combined with either linear or wedge labiaplasty procedures.

Irena Karanetz, MD · Answer

Hello and thank you for your question.

Based on the pictures that you provided, you appear to have enlarged and elongated inner lips (labia minora).  I would recommend a Labiaplasty procedure in order to reduce the length and the width of your labia minora which will help achieve the look you desire.  The appearance of the folds would also improve after labiaplasty procedure.

During clitoral hood reduction, excess folds of the clitoral hood can be removed to create a more balanced appearance of female genitalia. However, not everyone is a candidate for this procedure.

I suggest that you seek an in person consultation with a Board-Certified plastic surgeon specializing in Labiaplasty to further discuss  your options, specific techniques, concerns and expectations.

I hope this helps.
Best regards, Dr. Karanetz

Dr. Irena Karanetz
Fellowship-Trained
Board Certified Plastic Surgeon

Burcak Tok, MD · Answer

hello, we remove the excess tissues on the two sides of the clitoris where you marked with red .These tissues are the part of the klitoral hood. When we do it with the right technique, the risk is almost non-existent. I personally prefer the surgical method for labiaplasty and clitoral hoodoplasty. I see better wound healing.