Trim or Wedge Method? Please advise me on what procedure would be best for me to achieve the neat tucked-in look.

Question

Please advise me on what procedure would be best for me to achieve the neat tucked-in look. Thank you. I have had a consultation and the surgeon offers wedge, however, I am researching and it seems to leave much more labia length and looks a little bulkier.

Ryan A. Stanton, MD · Answer

Labiaplasty, which most commonly involves surgical reduction of the labia minora (inner/thinner lips) but not infrequently trimming or tucking of the clitoral hood (aka “hoodectomy “) or labia majora (outer/thicker lips), has become a relatively common procedure over the last ten and even more so last 8+ years. Most commonly it is done under light sedation (aka twilight sleep) with local anesthesia, in which case the patient should feel no pain during the operation and experience a more speedy recovery. Whether the surgery is done using a laser, scalpel, or scissors does not really matter but what does matter is "symmetry". Symmetry is the most important aspect to the final aesthetic result. Most women, just like yourself, prefer to have as much of the darker pigmented edges removed as possible. Also, it's not how much tissue is removed but how much is left remaining because a certain amount is necessary to maintain proper form and function - typically ~10 mm or so of the dry part of the labia. Finally, I have found the scar along the edge of the labia after "Trim Method" to be much more imperceptible compared to the scar running perpendicular through the entire labia minora after "Wedge Method". Thus to achieve these four most important elements, I have found that the Trim Method satisfies best and most consistently.  One unique potential complication after Wedge Method is that the clitoris gets pulled downward which sometimes is annoying and sensory changing to women.  Another much more common  complication with Wedge method is wound separation and splitting of the suture line leaving dents or holes in the middle of the labia minora and/or complete separation between the top and bottom halves.  Thus it is extremely important to consult with a board certified plastic surgeon that specializes in this operation (does at least 1 - 2 per week). It may cost you a bit more but it is this type of result you will want to live with for the rest of your life.

Irena Karanetz, MD · Answer

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 KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Mark N. Scheinberg, MD · Answer

Thank you for your question There are actually two pair of labia, a lower pair that inserts into the clitoris and a second pair that forms the hood,called prepuce, which can attach and distort the lower pair which appears to be the case in your photos. The reduction of your prepuce will highly affect your results and the success of the reduction of your lower pair. The central wedge leaves a horizontal scar on a vertical organ(labia) and interferes with blood supply which can lead to notching so I avoid that option . You may also consider the natural edge technique. I strongly suggest you research your surgeon well and find one who can knows how to manage your prepuce and and will show you how your options will look so you can make an informed decision

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  I find the trim procedure to be the most reliable to achieve a tucked-in appearance as well as address the tissue hyperpigmentation.  Hope this helps.

Marco A. Pelosi III, MD, FACOG, FACS · Answer

Thanks for your question. See how a woman whose labia look exactly like yours was able to achieve the look you are seeking. The video is narrated and very clear. The other thing that is clear is that an expert tailors the procedure to your exact specifications. It's not the name of the procedure that matters. It's the skill and the eye of the surgeon every single time. It's worth travelling sometimes and it's always convenient to do a virtual consult with an expert to learn more.

Ram Kalus, MD, FACS · Answer

In skilled hands both methods can accomplish an excellent outcome. In my own hands the trim message is successful in the vast majority of patients. A physical examination in person would be required to properly evaluate and recommend the best option for you. Please consult with an experienced board certified plastic surgeon or gynecologist in whom you have confidence that he or she can help you achieve your goals. Best of luck to you.

Erika Sato, MD, FACS · Answer

I offer both options in my practice, but personally prefer the wedge for a more natural end result and less risk of pain with intercourse from scar tissue. There are plus/minus to both options. If you desire very little labia minora and all the thicker darker tissue removed, it sounds like the trim method might be the way to go. Have a consultation with a PS and have them go over both options so you can make an informed decision.

Adam Ostrzenski, MD, PhD · Answer

Q: Is trim or wedge procedure suitable for this case?
A: No, none of these methods, trim or wedge, is adequate in the presented here case. Any cosmetic surgery that changes the natural look of a structure is wrong. The labia minora is a rounded contour and free movable edge (protective function). Therefore, under no circumstance, the labial shape should be surgically changed without the specific request of a woman. I have never had such a request in my practice because a well-informed patient is not ready to change mather nature creation. A skillful surgeon can and should improve an appearance without changing the shape. The trim labioreduction surgical procedure is an old surgical operation and was mentioned in the Sixth Century AD and revitalized by a gynecologist and later by a plastic surgeon in the 1970s. From that time the progress was made, but only a few surgeons are adopting this progress. 
 Unfortunately, a piece of advice given by Dr. Michael P Goodman about either trim or wedge resection is wrong on both accounts. Additionally, he suggests performing “850 labiaplasties.” I tried to verify this number by reviewing Dr. Goodman’s website and could not justify this fact. Additionally, no complications rate among those 850 labioreduction cases. Therefore, it is simply a marketing trick.  Also, I reviewed Dr. Marko Pelosi’s III videos, which depicted the straightforward amputation procedure (a trim method). However, it is generally wrong for labia minora labioreduction since it changes the natural labia minora rounded appearance to a straight look. Interpreting submitted photos:1. The upper part of the labia minora resembles the scrotum’s skin, but the lower part is very feminine, Fig. 1-3. To cope with it, a surgeon can choose a technique to create a more miniature replica of both existing labia minora with an incision just above the fusion of the inner pink color with dark color, Fig. 2. 
2. The right labium minus thickness must be trim to get the symmetrical thickness of the labia minora. 
The clitoral prepuce must be reconstructed to eliminate anatomical multiple skin folds appearances, Fig. 1-3. 
3. Finally, the unnatural fusion between the upper part of the clitoral prepuce and anterior commissure (the fusion between the left and right thick labial tissues) should be address to remove a double suspension and existing groove between the clitoral prepuce and the anterior commissure. 
My comment about other advisors, in this case, was based strictly on scientific-clinical data and was not designed to make any personal criticism of practitioners. Instead, my remarks were designated to help women and assist surgeons without any hidden agenda. The decision to participate in the RealSelf answer to women's questions was based on observing the significant trend on rising severe complications in the cosmetic-plastic gynecology field in my corrective surgical practice. 
With regards,Prof. Dr. Adam OstrzenskiUS Cosmetic-Plastic Surgeons

Michael P. Goodman, MD, FACOG · Answer

I've performed ~ 850 labiaplasties virtually half by wedge modifications and half by linear/trim modifications. Different procedures for different anatomies and different outcome desires. As much as I love the potential elegance of wedges, in your case, with thickened, reticulated, and darkened edges, and your desire for a "...neat, tucked-in look," I would strongly recommend a careful curvilinear reduction, operating not at your inner pink line, but in the charcoal grey area of your inner labia, which should match the color of your skin inside of the interlabial fold laterally, and just barely skinning (not removing) the lower (posterior commissure) labia. Find the right surgeon, one who does both wedges and trims (linear) so as to choose the best for your personal anatomy. Make sure that you can see at least 2 dozen examples of hers or his work... In RealSelf's Web reference below you will see anatomy similar to yours...

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

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

Tarick K. Smiley, MD - Account Suspended · Answer

Id recommend seeing a few more doctors in your area to get more info and options. Some doctors prefer the wedge method so it's not so abrupt looking from your hood area to the labia, if that makes sense. If you cut too clean of a line like in the trim method, your hood will need to be altered as well so it'll blend evenly. I hope this makes sense as it's a little difficult to explain not being able to speak and explain in person. Good luck with your decision! I will say, this procedure is very minimal pain and my patients are back to normal in a week.

Trim or Wedge Method? Please advise me on what procedure would be best for me to achieve the neat tucked-in look.

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