What are the pros and cons of posterior wedge technique?

Thank you for your questionYes there are doctors who perform posterior natural edge labiaplasty. The reason few surgeons perform this technique is that there is a 7-15% risk of of separation of the pedicles (just as with the central wedge) leaving holes or separation of the tips. There is a technique called posterior delamination which preserves blood supply and avoids this complication.( The labia are like lamina with flat inner and outer surfaces. Instead of excising the posterior wedge, It can be delaminated thereby preserving the blood supply which allows better healing and prevents the separations.) It is technically more complicated to perform and has only recently been published so not many people are familiar with the technique. When done correctly this technique can give the most natural and aesthetic results. I am in the process of publishing a series of over a hundred cases using the posterior delamination technique with no holes or separations. You can get more information from the video below.

A labiaplasty must be performed by a surgeon with experience. I am the inventor of the central wedge technique​ 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 labiaplasty 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. The trim can cause asymmetry, scalloping, over-removal, and occasionally chronic pain. 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. I do not like the posterior wedge because , in contrast to the central wedge, it leaves the darkest and thickness tissue behind and has inferior blood supply. The posterior portion is instead removed and the central portion is advanced posteriorly. I have performed the central wedge thousands of times, and it is very rare for me to have holes or significant healing issues. The causes of healing problems are the surgeon's technique and experience and smoking. If fact, about 40% of my female genital surgeries are revisions of botched labiaplasties from other surgeons.

If you have extra tissue on your clitoral hood, it can be reduced at the same time. A clitoral hood 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.

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY
Assistant Clinical Professor of Plastic Surgery,
UCLA School of Medicine