Is de-epithelization safe in terms of nerve damge prevention?

Question

Hello doctors I consider having prepuce fold reduction and labiaplasty (posterior or inferior wedge). I read that there is combined thechnique of de-epithelization and wedge. Is de-epithelization a common method? Is it safer in terms of nerve damage (both lost of sensation and pain)? Can it be perform on the prepuce fold? Thanks a lot

Gary J. Alter, MD · Answer

A labiaplasty must be performed by a surgeon with experience. One of the two most common 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. It has a better blood supply than a posterior or inferior wedge. With this technique, I do de-epithialize the wedge, which helps the closure to be more secure and prevents it from falling apart. It does not affect the nerves at all. 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. This can lead to scallops and irregularities. 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. 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. About 40% of the female genital cases I perform are revisions of labiaplasties and clitoral hoods botched by other doctors.

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY

Mark N. Scheinberg, MD · Answer

Thank you for your questionThere have been several publications on the Posterior wedge technique. It is not commonly done due to a 7-15% incidence of the pedicle not holding leaving leaving a defect. There is a new procedure called posterior delamination technique which avoids this complication and gives a beautiful natural edge. It is typically done in conjunction with prepuce reduction. You can see this in the video below on labiaplasty.

Adam J. Oppenheimer, MD, FACS · Answer

I’m sure it’s safe but it’s almost the wrong question. De-epithelialization is totally unnecessary in this procedure and it doesn’t give the same amount of control as a simple edge approach, which also has essentially zero risk of nerve damage. I’ve performed hundreds of labiaplasty procedures with hood reductions and have very happy patients with great symmetry. Nice contours, balanced, natural look. No visible scars, no pain, no nerve damage. Best to find a surgeon with before and after photos of results that you love and go from there.

Irena Karanetz, MD · Answer

Hello,

Thank you for the question.

Central de-epithelialization is one of the techniques which involves partial skinning of the labia to preserve neurovascular blood supply, but it only partially reduces the length of the labia.

Both Trim and Wedge are reliable techniques used to perform Labiaplasty with very low risk of nerve damage 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.

Dr. Irena Karanetz
Fellowship-Trained
Board Certified Plastic Surgeon

Michael P. Goodman, MD, FACOG · Answer

Your anatomy, your outcome ideals, and your surgeon's experience in specific techniques will dictate the best technique for you personally. Both curvilinear + separate elliptical hood excision; "straight-Shot labiaplasty; central V-Y wedge incorporating redundant hood, and posterior wedge incorporating de-epithelialization are viable techniques. Drs. Rafal Kuzlik and Dawid Serafin in Poland are the 2 experts I know in Europe who specialize in the technique you mention. They are both masters at this technique and would serve you well for a "natural-appearing" result and decompression of large prepucial folds.
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RealSelf's Web reference below will give you additional information. Best wishes,

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

Is de-epithelization safe in terms of nerve damge prevention?

Answers (5)

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