Labiaplasty/vaginal rejuenation - Wedge, trim or laser? (Photos)

It's not the method of labiaplasty that gives the best results, it's the skill of the surgeon. In expert hands, all techniques are tailored and modified to suit the specific needs of your anatomy. Since no two labia are exactly alike, no two labiapasty procedures are designed or conducted identically. Laser is not a procedure. It is a tool for conducting labiaplasty and can be utilized with any method of labiaplasty. Other tools include radiofrequency scalpels, electrosurgery, and precision stainless steel instruments. For vaginoplasty, correcting the gap without overtightening requires experience and it can be safely combined with labiaplasty. Your best first step is to schedule a virtual consultation.

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. 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 inferior wedge because, in contrast to the central wedge, it leaves the darkest and thickness tissue behind and has inferior blood supply. I have performed the central wedge thousands of times, and it is very rare for me to have holes or significant healing issues. The cause of healing problems that are the surgeon's technique and experience and possibly smoking. If fact, about 60% 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.

You are an excellent candidate for a wedge labiaplasty and clitoral hood reduction.

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

THANK YOU FOR YOUR QUESTIONThe laser treatment is practically worthless. As to the labia: The trim method should leave a centimeter height to prevent problems of overesection that is common with trim method especially the Barbie technique. The central wedge method has high complication rate(7-15%) as I frequently see patients coming in to correct holes and separations and you must really know your surgeon's work. The posterior wedge still has that complication rate but can be fixed more easily and aesthetically. A new method called posterior delamination can give petit natural edge appearance you are looking for and avoids the complications. VERY IMPORTANT TO KNOW: there are actually two pair of inner labia- a lower pair that inserts into the clitoris and an upper pair called PREPUCE that forms the hood and inserts into and can overwhelm the lower pair. It must be treated first to get a good aesthetic effect. If your surgeon doesn't know how to treat the prepuce you need to find someone else. Be careful and do your homework to minimize risk. The gap from childbirth can usually be fixed with a "perineoraphy" and can be done at the same time. Look at the attached video for more information

There isn’t really a single “best” method, the best technique is always the one most suitable for your anatomy. For example, if anterior elongation is more dominant, the wedge technique is often preferred, whereas in other cases a curvilinear excision (trim) may provide a better outcome. Clitoral hood reduction is needed in around 70% of cases to achieve a balanced and natural look.
As for vaginoplasty, the most accurate decision can only be made during a detailed pre-operative examination according to your anatomy . We also recommend considering your partner’s evaluation, so that both of you have the best experience and avoid any issues afterwards.

Hello Sunsetlover_xo,
Thank you for submitting photos with your question. You have excess prepuce and long, dark labia making you an excellent candidate for clitoral hood reduction and labiaplasty. You should focus your energy in identifying the best surgeon for you by researching their experience, reviews, and B&A photo results.
Go to the link below to see hundreds of before and after photos where you will find many examples that are similar to you. From that link you can schedule a virtual consultation via phone or zoom, at which time we can discuss in depth your anatomy, expectations and concerns. Women from all over the world travel to my Center for their Intimate Makeover.
Best of luck,

When you meet with your cosmetic gynecologist to discuss vaginoplasty and labiaplasty, the two of you will work together to decide on the best approach to achieve the results you’re hoping for. There isn’t a single method that works for every woman, since each vagina is unique. Your treatment plan will be tailored specifically to your needs and goals, ensuring that your vaginoplasty and labiaplasty results feel natural and right for you.

OMG you do NOT need to know how to perform your labiaplasty, this is a decision made jointly with your surgeon who should simulate the result of each alternative with Q-tips in the mirror so you'll see your result with each alternative in advance. All you need to know is the result you want. It is your place to decide what result is best for you, but it is the surgeon's place to know how to do it.

Consider with your surgeon whether labia majoraplasty may be an additional possibility if you believe excessive labia majora is part of your issue.

Thank you for your question and photos. Based on these photos, you are a great candidate for a wedge resection labiaplasty and clitoral hood reduction. You do have excess vertical length to your labia, which a trim method will not address. You also have deflated labia majora, which would benefit from fat grafting at the same time. I do these procedures under local anesthesia with minimal oral sedation in our certified office surgery suite. See a board certified plastic surgeon or gynecologist who specialize in female genital rejuvenation for an in person consultation/evaluation. Good luck.

Thank you for your questions and photos. All of your concerns are legitimate. Rather than trying to devise your own treatment plan, it is best to consult with an experienced board certified plastic surgeon or gynecologist who can evaluate you in person and devise an appropriate treatment customized for you.

This is my exact approach for all of my labiaplasty patients. The vast majority of patients such as you would do well with a trim approach and conservative CHR. The vaginoplasy techniques when performed correctly by an experienced surgeon should have minimal risk of being over tightened.

Do your research and make sure your plastic surgeon or gynecologist is someone you feel you can trust. Best of luck to you.

There are several approaches to labiaplasty, and the choice depends on your anatomy, concerns, and desired outcome:

Trim method – Removes tissue along the edge of the labia minora. It can reduce excess length but may alter the natural contour of the labial edge.

Wedge method – Removes a V-shaped wedge of tissue from the central portion of the labia while preserving the natural edge, often resulting in a more natural appearance with preserved folds.

Laser-assisted labiaplasty – Uses laser technology for cutting and coagulation, which may reduce bleeding and recovery time. The outcome depends more on the surgeon’s technique than the tool itself.

For clitoral hood reduction, this can be performed in conjunction with labiaplasty if there is excess tissue. Care must be taken to avoid over-reduction, as this could leave the clitoris more exposed than desired. A conservative, balanced approach is key.

Regarding vaginoplasty, the goal is to restore tone and reduce laxity often caused by childbirth. It is possible for the vaginal canal to be tightened excessively, which may lead to discomfort. A skilled surgeon will aim for functional improvement while preserving comfort and balance.

In summary, the wedge method is often preferred for those who want a natural look with preserved labial folds, while trim and laser can also be effective depending on the anatomy and goals. A thorough preoperative discussion with your surgeon will help ensure the right balance between function and appearance.