Wedge vs Trim
I think it mainly comes down to which method the surgeon is comfortable performing. I prefer the wedge labiaplasty technique because it preserves the natural anatomic edge of the labia. Before surgery have more communication with your surgeon or have another consultation with a different surgeon. As surgeons, we want our patients to be comfortable with their decision for surgery and to have all of their questions answered. Best wishes!
To Trim or Not To Trim
Women seek labiaplasty for many
reasons ranging from discomfort with intercourse and pinching in tight clothing
to purely cosmetic reasons. Labiaplasty most often involves reducing the size
of one or both of the labia minora through one of two basic techniques. A
straight line (trim) excision removes the excess tissue in a lazy curve from
front to back. This technique is more straightforward, however, it removes the
free border of the labia, which can decrease sensitivity in some women. A wedge
excision removes a pie-shaped wedge of tissue from the central portion of the
labia. The remaining tissue at the front and back is then brought together and
closed. This technique preserves the free border, however, it is more complex
and requires additional incisions to remove the dog-ear that forms. Both
techniques can be extended to the front to remove some of the excess clitoral
hood. The choice of technique is based on patient preference and is tailored to
each patients needs. A detailed examination will help delineate the best
surgical treatment. Consultation with a plastic surgeon would be the next best
I reviewed your photos. Your labia minora and clitoral hood are vey 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. 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 it at the same time. Your clitoral hood is long, wide, and protuberant. It can be decreased somewhat by reducing the sides but can be reduced in length also by a clitoropexy with hood reduction. 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 decreased. 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.
The two most popular technques which are talked about are as you stated, the "trim" and "wedge" techniques. To me, the trim technique which describes only trimming the labia minora, does not address ptosis of the clitoral hood which is almost always present to some degree.
The goal should always be to create natural anatomy and function. If the details of the anatomy are studied and treated appropriately, a reduction of the labia minora, removing both the external skin excess and the internal mucosal excess, leaving 7-10mm, provides a natural appearance with the incision falling at the mucocutaneous junction. The same priniciples are used all over the body when planning incisions and trying to camouflage or hide scars.
Your photo shows significant ptosis of the clitoral hood which needs excision of the skin excess. The clitoral folds should be preserved to maintain the natural anatomy. The attention to detail and elevation of the clitoral hood creates the proper proportions of the external genitalia and can also have a positive effect on function. This technique is much more involved than what the "trim method" would indicate.
I personally do not like the "wedge technique" because it cuts across anatomical lines and results in scarring in the mid portion of the labia minora. There also can be more bleeding involved during the procedure. Finally the wedge technique can result in even more ptosis of the clitoral hood.
Labiaplasty- Which technique is best for me? Trim or Wedge?
I think both techniques of labia minora reduction surgery can produce excellent outcomes; both are utilized both in our practice, maybe depending on the patient's presentation (examination) and goals.
Ultimately good advice would necessitate in person examination, a discussion of what your concerns are, and a full communication of your goals. Enlarged labia minora or majora can be functionally or psycho-socially bothersome. Local irritation, problems with personal hygiene, interference or discomfort with sexual intercourse and discomfort during cycling, horseback riding, wearing exercise clothing, walking or sitting are common complaints related to enlarged labia minora. For these patients, judicious reduction of the labia minora may serve to improve the physical comfort during specific activity. Often, patients may not have symptoms related to the labia minora but are simply not pleased with the appearance of the redundant and/or dark skin. Surgical correction for these patients may help improve the patient’s self image or confidence.
In regards to the recovery after labia minora reduction surgery here are my suggestions for patients.
I ask that a responsible adult transport the patient home. Bed rest is requested for 2 days with ice on the area during that time. Patients may resume light activity and “desk job” after 3 days but should avoid strenuous activity / sports for at least 3-4 weeks. Sexual intercourse may be resumed carefully after 4 weeks.
My best advice: select your plastic surgeon carefully. Ask to see lots of examples of his/work achieving the types of outcomes you will be pleased with. You may find the attached link helpful to you as you learn more.
Wedge or trim
Each surgeon has their own preference, and beautiful natural looking results can be achieved by both the wedge and trim. Generally speaking, the trim technique is more suitable for more extensive correction. However, you should find a surgeon you’re comfortable with then trust their advice on which technique to apply.
Most surgeons will advocate a wedge technqiue or modified wedge technique over the so called trim. Properly performed techniques, which ever is chosen by an experienced surgeon will typically result in good outcomes.
Labiaplasty- Which technique is best for me? Trim or Wedge?
Labiaplasty and clitoral hood reduction would seem reasonable based upon the photos presented. I perform both methods.
Kenneth Hughes, MD
Los Angeles, CA
Picking the Best Labiaplasty Surgeon
It is the surgeon that is more important than the technique. The most critical decision to be made in achieving the best plastic surgical result is picking the most experienced with labiaplasty and most talented, that is the best, plastic or gynecologic surgeon possible. Too often, patients choose a physician based on a catchy ad, the brand name of a technique, the basis of one or two before and after photos, or their web site’s search engine ranking. These criteria will not find the most experienced and talented plastic surgeon. See the below link on suggestions on finding the most experienced plastic surgeon or gynecologist for your labiaplasty.
Which technique is best for me? Trim or Wedge
I think the most plastic surgeons find that the wedge technique is a reliable technique which has a superior scar compared to the trim technique. Although with a wedge technique the scar extends a bit into the vagina, this heals very nicely and is usually imperceptible. The trim technique can leave an unnatural appearance. There are a number of modifications to the trim technique that we utilize depending on an individual's particular anatomy.