What procedures would help me? Do I need clitoral hood reduction and labiaplasty? (Photo)

It appears that you have significant excess of the labia minora as well as hooding over the clitoris.

There are various techniques for performing labiaplasty, and which one is best largely depends on your anatomy. In this case my perference would be to perform a labiaplasty using a posterior wedge technique to maintain the natural edge of the labia minora, along with a clitoral hood reduction and reduction of the prepuce superiorly. You have too much fullness of the labia minora superiorly for an edge trim to provide a natural result.

Your labia majora also appears to be deflated. Fat grafting to this area can help restore fullness and further hide the labia minora.

Your labia minora and clitoral hood are very enlarged. 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. 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. 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 350 times with excellent results. I have not published this technique, so no one does it like me.

However, you definitely have clitoral enlargement. 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.

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 40 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.

No matter the techniques, an inexperienced or unskilled surgeon can lead to a high rate of complications, chronic scar discomfort, labial deformities, and further surgery. About 40% of my labia cases are reconstructions of other surgeons' labiaplasties.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY