Wedge Method Vs Trim Method for Labiaplasty?

I am 19 years old and have been dealing with the discomfort of having large labia since puberty. I am uncomfortable when I am exercising, and sometimes just sitting or walking around. I find it difficult to keep clean and am worried that it will pose a sexual problem in the near future when I get married and become intimate with my husband.

What are the pros and cons of having a labiaplasty using the "wedge method" vs "the trim method"? I am in the process of having consultations and was interested in hearing more pros and cons of the different methods. Also, I am a college student so I am in classes, should 6-7 days be enough recovery? I am looking into having this done over spring break. Thank you.

Doctor Answers 64

Labiaplasty: wedge versus trim

There is no absolute guide to what is the correct method.

Sometimes it comes down to the surgeon's comfort level and experience with one technique over the other.

The primary advantage to the wedge is that its proponents like the shorter scar located across the labia rather than along its edge. It is claimed that it leaves more of the natural edge intact.

In my practice, it is the edge that bothers many of my patients; they do not like the thick, dark, rough surface and desire to have it removed. Furthermore, the vast majority of my patients undergo a combined clitoral hood reduction.

With the "trim method" (I call it the leading edge resection), this creates once incision that is continuous. If this is performed with the wedge resection, it will require use of a separate incision and therefore defeats the purpose of less scarring.

Wedge resections, in my opinion are best for prominence of the central 1/3 of the labia minora which will be resected with this. Lastly, I feel that occasionally the wedge resection results in tension at the edge of the repair.

In my hands, it really comes down to your anatomy.

In summary:

WEDGE TRIM Positive Negative Positive Negative Transverse scar Only mid labia treated Entire labia treated Linear scar Central 1/3 2 incisions clit hood 1 incision clit hood Extends deeper portion Less vascular portion Edge may see tension


Chicago Plastic Surgeon
4.9 out of 5 stars 72 reviews

Labiaplasty techniques - wedge vs. trimming the edge

As you can see from the answers here, some surgeons prefer each technique, and it is certainly true that either technique can produce a good result and a satisfied patient.  However, there are some important differences, and you are wise to look into the options.

I certainly agree that a surgeon's experience with each procedure is important.  The "trimming" procedure is technically simpler, and less likely to cause complications and problems during surgery, as long as we stay away from the clitoris, which is anatomically at the front of the labia where they come together.  However, trimming alone will not reduce the fullness in the clitoral hood, so if that is important to you, be sure that the surgeon plans to address it.

I do not agree that the wedge procedure only improves the central portion of the labia.  By taking out a wedge, the tissue in front is pulled backward and the tissue in back is pulled forward, and that does reduce the excess tissue in those areas as well.

Also, with the  wedge procedure, we can extend the outer limb of the wedge toward the front, on either side of the clitoral head, and get some good tightening of the excess tissue over the clitoris without making an incision directly over the clitoris (which might endanger that very delicate anatomy)

Because the wedge tightens the entire length of the labia, it can improve the area around the clitoris as well.  With the trim method, the surgeon has to stay about 1 cm from the clitoris, which means that you may be left with a boxy "tab" adjacent to the clitoris where the labia could not be treated.

With the inner limb of the wedge (that goes toward the opening of the vagina), the surgeon should be certain to stay away from the opening of the urethra (where your urine comes out).  I often put a catheter into the urethra at the beginning of surgery to make it easier to keep track of the urethra and ensure that the opening is not damaged during the surgery.  The catheter is removed at the end of the procedure.

I have not seen significant healing problems with either technique (and I have done both, although currently I mostly do the wedge resection).  As with any surgery, minor problems might require a revision.

I would agree that, for very long and large labia, trimming might allow us to remove more tissue, but in my experience, a very significant amount of reduction can be done with the wedge procedure.

So, I would compare the techniques like this:

WEDGE:

  • Does not disrupt or remove the delicate free margin of the labia minora
  • Tightens the entire length of the labia minora, including the portion next to the clitoris
  • Can be carried forward on either side of the clitoris, tightening the clitoral hood
  • More complex procedure, requiring more skill, to reduce the chance of too much tightening of the opening of the vagina or injury to the urethral opening.

TRIM:

  • DOES remove the delicate free margin of the labia minora, which might be an advantage for a patient who does not like that pigmented tissue and wants it removed
  • Removes tissue along the entire length of the labia minora, except for the area immediately next to the clitoris, which may produce an extra "tab" of tissue there
  • Does not improve or tighten the clitoral hood.  If this is important, the trim can be combined with another procedure to reduce the clitoral hood, with an incision that may or may not be directly over the clitoris
  • May be more effective for very long and enlarged labia
  • Simpler and less technically demanding procedure

The only absolute rule I would suggest is that you NOT try to talk a surgeon into doing a procedure with which he or she is not completely comfortable.

However, the good news is that labiaplasty is a great procedure for improving both the appearance and discomfort from enlarged labia.

James Nachbar, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 19 reviews

Wedge vs. trim for labioplasty

You've done your homework!  I usually do a "hockey stick" wedge excision that allows me to remove a lot of the excess bulk but preserve the edge of the labia which is usually more pigmented and wrinkled than the center part of the labia.  With a trim procedure, the natural edge is removed.  Some ladies really want a smooth and less pigmented edge that a trim procedure leaves, but most of my patients want it to look as natural as possible. 

It's sooooo important to remember that normal genitalia is really variable and the goal of this surgery is to rid you of the excess length and bulk of the labia, and not to do a "custom designer" job.

Most ladies are very pleased with their result regardless of the particular method used. 

Lisa Lynn Sowder, M.D.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 66 reviews

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Labiaplasty technique

Thank you for your question. In general, there are techniques to performing this surgery, and you've correctly identified them both. The trim method involves taking away excess labial skin in a longitudinal fashion along the length of the labia. This obviously takes less time for the surgeon to perform and is technically an easier method. It also, unfortunately, takes away the natural edge of the labia, forcing the surgeon to place a scar where previously there was an anatomical landmark, namely the edge. The wedge method is a longer, more difficult operation. It does, however, preserve the natural border of the labia, and more closely mimics that natural state of "normal" or aesthetically pleasing labia. In the hands of an experienced Board-certified plastic surgeon, the wedge method is the way to go. Good luck and fare well. 

The method of labioplasty most often depends on the women's anatomy.

There are many websites writing about the advantages and disadvantages of various techniques in the correction of labio minora.  Both techniques, if done correctly and for the correct anatomic indications heal extremely well.  I perform many labioplasties and use different techniques based on the needs of the patient.  Sometimes fat grafting of the labia majora is necessary to enhance the rejuvenation of the area.

Which technique - lateral trim or central wedge?

I previously used the lateral trim technique, but now use the central wedge technique exclusively. It is a lot more complicated to perform, but once you understand how to perform this procedure, it is not hard to do at all. THe results are consistent and very controllable. In my opinion, there is really no indication to do a lateral trim procedure any more. I believe it is outdated by the central wedge technique.

I have to agree with everything Dr. Alter has stated in this discussion thread. As for the pigmentation differrence, this is a minor issue, and no patient has ever even brought it up to me. The surgical results are so natural and satisfaction rate is so high, that a little step in color along the side of the labia is a non-issue for my patients. I commend Dr. Alter on a wonderful contribution to plastic surgery!

Mark D. Epstein, MD
Stony Brook Plastic Surgeon
4.9 out of 5 stars 220 reviews

Wedge Method Vs Trim Method for Labiaplasty?

Both the wedge and trim method can be effective depending on your aesthetic goals. The trim method is a less complex and time consuming method to remove excess skin along the length of the labia. This method also removes the natural edge of the labia. This can be a positive or a negative aspect of this method depending on the patient’s individual goals. The wedge method is more difficult and time consuming that leaves the natural edge of the labia. Both methods produce natural looking results. My advice is to schedule a consultation with a board-certified plastic surgeon to discuss your concerns and aesthetic goals.

Scott Chapin, MD, FACS
Philadelphia Plastic Surgeon
4.8 out of 5 stars 20 reviews

Wedge method vs trim method for labiaplasty

At the Manhattan Center for Vaginal Surgery I have been performing cosmetic genital procedures routinely for over ten years. Initially I performed the trim method. Although my patients did not complain I was not satisfied with the outcome. The healed edge did not look natural. I then switched to the wedge method with modifications so that the results look totally natural. I am absolutely convinced that this method offers superior results. Just make sure your surgeon has extensive experience in this type of surgery.

Ronald Blatt, MD
New York OB/GYN
5.0 out of 5 stars 23 reviews

Depends on your anatomy and surgeon's training

Ultimately, the best method comes down to what you need to have addressed, what you want your results to look like, and your surgeon's skills and training. Do your homework. Interview several surgeons, look at their Before and After photos and listen to your gut when you go in for consultation.

Every woman is shaped differently and requires her own unique cosmetic correction. What is often overlooked by most surgeons is the prepuce, or clitoral hood, which may require reduction and even lifting to achieve the optimal youthful appearance and enhanced sensation for ultimate pleasure.

As a student, or even if you worked full time, you would be able to return to your usual activities by post-op day 4. If your surgery is on a Thursday, you'd be back to school or work by Monday. Sutures are removed around post-op day 7-10 which immediately relieves most of your discomfort. You may resume light exercise by week 3 but you should refrain from sexual activity or strenuous exercise for 4-6 weeks, depending on the extent of work you have performed.

See link below for a sample Labiaplasty Diary.

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 20 reviews

Trim vs Wedge

I commonly do labiaplasty procedures in my practice.  It is important that the surgeon be familiar with both techniques because the procedure should be tailored to the patient.  That being said, I tend to do the trim technique more often because I find the healing to be easier on the patient and the final results more predictable. Most importantly, have the surgeon show you photos of patients they have treated so that you can form your own opinion about that technique in their hands.

Cynthia Diehl, MD
Durham Plastic Surgeon
5.0 out of 5 stars 7 reviews

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.