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.

Hello and thank you for your question.

Both Trim and Wedge are reliable techniques used to perform Labiaplasty in the experienced hands.

Trim Labiaplasty is more commonly performed than Wedge Labiaplasty and has slightly lower risk of wound healing issue because the blood supply disruption is less than in Trim Labiaplasty. But generally speaking, depending on patient's anatomy, either technique can be used successfully to achieve cosmetically pleasing results.

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. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.

Best wishes and good luck.

Best regards,

Dr. Irena Karanetz
Fellowship-Trained
Board Certified Plastic Surgeon

Hello, more complications are seen in patients who underwent posterior or middle wedge technique. These complications are loss of sensation and wound healing problems . Because the vessels required for the feeding of the labia can be damaged in wedge resections. Therefore, wedge resections are now only performed if there is a special situation. In terms of scarring, the probability of scarring in correct labiaplasty sutures made with very thin stitches is very, very low.

In my humble opinion, there are no pros and only cons with any wedge technique. The edge technique leaves lighter pigment, a smoother labia edge, a more symmetrical labia edge, and zero obvious scarring or transition areas. The wedge on the other hand has a high risk of separation leading to a visible notch in the labia minora, and a rough edge of the labia minora, a pigmented edge of the labia minora, and a pigment transition where the darker color of the upper portion of the labia connects with the lighter color of the lower portion of the labia. So in essence, there is virtually no reason to have a wedge technique. The healing is slower. The results are worse and the surgeons who perform that technique should be very few and far between at this point. Your best chance to find a great surgeon is simply to look at their results - photos, videos and reviews.

Techniques change over time. They get better. That’s the beauty of life. That’s the beauty of medicine. And the beauty of the practice of medicine. Like anything we practice, we improve. Those who don’t learn from the past are doomed to repeat it. In this case, the past is a wedge labiaplasty.

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

Hello there, I perform posterior wedge, central wedge, and trim labiaplasties. That is the beauty of my style. I do not have just one approach to every patient. Each patient's labia and anatomy is different and calls for different techniques. As previously mentioned by other surgeons, the wedge technique has a higher risk of wound separation and wound healing issues, but can leave a nicer more natural scar. It is less commonly performed because it is technically more difficult to perform and many surgeons were not trained on how to perform it or have no experience. Those who perform the wedge typically do central wedge because that is where the most excess skin is. I design each incision based on the patient's anatomy and excess skin. Review before and after photos and go with a surgeon who you feel comfortable with. Good luck!

As you understand, from your research, there are different approaches. Several of them are dependent upon the anatomy of each individual. It also is dependent upon the comfort of the surgeon to deliver results. The posterior wedge approach is very safe with good aesthetic results in the end. Much of this will depend on your unique scenario. Remember that each operation should be tailored to each individual.

Great question, eloquently stated. Your question is one I am asked a lot. If you look around, you will notice that the huge majority of labial genital plastic/cosmetic surgeons do either wedge of linear ("trim")- type procedures. And those surgeons who are skilled in wedges perform only the "central wedge" technique.

So... which is better, and- if a wedge is performed, what type of wedge? Central or Posterior wedge? What about the "V-Y wedge" technique? Or my new technique (research article newly submitted to the journal "Plastic & Reconstructive surgery"), the "Angel-Wing Labiaplasty," which combines a central or posterior wedge with a labia majora lift, to correct "sag."

This answer could be a 5-page treatise, as-personally- I perform both linear (both "trim" and "straight-shot"), central wedge, posterior wedge, and Angel-Wing, and in the surgeon-training-program I run ("The Labiaplasty and Vaginoplasty Training Institute of America, Inc."), I teach all of the techniques to trainees, and have lectured extensively on the differences and choices involved in the different techniques. (See RealSelf's web reference attached...) For you personally, the important thing is to work with a surgeon who is savvy (and can prove this to you with multiple "before & after" photosets) that he or she is competent in BOTH wedge- and linear-type techniques, so that (s)he can CHOOSE the technique which will work best for your goals, personal anatomy, and recovery realities.

To specifically answer your question: yes, there are a few surgeons who are comfortable with posterior wedges (also termed "superior/inferior flap technique.") (see "Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction." by
Munhoz et al, Plastic and Reconstructive Surg. 2006, and "Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction," a "Comment" by Gary Alter, Plast Reconstructive Surgery, 2007.)

Locally, Dr. Gary Alter is in Beverly Hills (and is a fine, inventive surgeon,) and I am in Northern CA. I'm sure there are others around (I have trained Dr. David Ghozland in Los Angeles) who "do" posterior wedge flaps. When you speak with someone at the office of your prospective surgeon, ask specifically if (s)he performs "posterior wedge;" you may need to speak directly with the surgeon. While posterior wedge is basically a wedge technique modification, which technique is best FOR YOU depends on a careful evaluation of your personal anatomy and a close "listening" of what you wish to accomplish. Also, check the "out-the-door" total prices of the surgeons you research; you may find it cost-effective to look outside of the more expensive L.A. area...

The more research you do, the better off you will be. However, bottom-line is your personal anatomy. While you seek a posterior wedge, this may not be the best technique for your individual labia. Make sure you see a surgeon who is not "stuck" with only 1 or 2 techniques.

Very best wishes for success,

Michael P Goodman, MD,, FACOG, IF, AAACS
Davis, Northern CA, USA

Dear patient, thank you for your question.Mostly doctors perform trim technique because it doesnt cause too much bleeding. We also perform posterior wedge labiaplasty.