Trim vs Wedge - can I request the wedge technique?

Thank you for your questionYou are correct to avoid the barbie technique as there is significant risk of complication and common complaints of discomfort. Just look at all the questions in real self being asked on how to help with pain after the surgery. The trim method should leave a centimeter height to prevent problems of overresection. The central wedge method also has high complication rate(7-15%) as I frequently see patients coming in to correct holes and separations. 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 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. Look at the attached video for more information

Each labiaplasty procedure is designed specifically around the patient’s anatomy, needs and requests. The technique itself depends mainly upon the desired outcome. The surgeon will be able to explain to you why a specific technique should be performed in your case. Pictures of what you wish may help the surgeon understand your needs.

Hello SyrNurse23!
I’m so glad you asked this question - it’s going to help a lot of women! Thank you!
I want to be really clear: You deserve to get the results you want. It’s your body, notyour plastic surgeon’s. And if that means, after you’ve done significant research, thatyou’d prefer the results offered by the wedge method… then you need to work with aprovider who has meaningful experience with that method (Or a provider who has areally good reason why they believe that particular technique isn’t the right fit for yourgoals and anatomy.)
Now, let’s talk “trim vs. wedge.” Here’s the big difference between the two: Trim has the advantage of removing dark skin edges. It's disadvantages are risk of retraction and limited shortening. The Modified wedge allows for a more cleaner, more seamless appearance and greater reduction of excess skin while preserving the natural skin edge.
At Labiaplasty Center of Los Angeles, I do labiaplasty using a modified wedge technique for the majority of patients with the right anatomy because it provides superior results based on what patients goals are.
And now, a word of caution. Most plastic surgeons are not experts in labiaplasty orvaginal surgeries - they might do a nose job one day and a breast augmentation thenext, but few are consistently performing intimate procedures. Simply put: Theirspeciality, in the vast majority of cases, is not with a woman’s intimate organs andtissues.
Here’s why that matters: Because you need your vagina, labia, vulva, perineum, etc. tonot only look the way you want it to look - you need these parts to function as they areintended so that you’re as physically comfortable as you are confident.
Most plastic surgeons do not have the experience and knowledge required to ensurethat form and function are meaningfully addressed in a vaginal surgery.
One of my specialties is in repairing botched labiaplasties - and, in many of those cases, those botched procedures were performed by plastic surgeons. I hope I have answered all of your questions.
Best Wishes,
~Dr. Poucher

Hello SyrNurse23,
You shouldn't focus your energy on the type of labiaplasty but rather on the expertise and experience of your surgeon. Look at their B&A results and read their reviews. Will your surgeon be accessible postoperatively to answer your questions, follow your progress, and be willing to revise your procedure to attain your desired outcome.
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,

The labiaplasty technique selected should be based on your unique anatomy and surgical goals. If you do not feel comfortable with the technique proposed by your surgeon then I recommend getting a second opinion.

Thank you for your question. The most common labiaplasty techniques are the edge trim and wedge resection. There are advantages and disadvantages to each approach. It has never been shown that one approach is "better" than the others. The edge excision removes a portion of the labia minora edge. The wedge technique removes a wedge of tissue from the most protuberant portion of the labia minora. There is significant variability in genital anatomy and each patient has different concerns and goals. All of this is discussed in detail at the consultation and taken into account when creating the surgical plan. In some patients the edge trim may best address their concerns and in others the wedge is preferred. However, I do tend to favor the wedge in many patients as the scars are short and well concealed, and the natural labial edge is preserved. Despite the approach, the surgical plan should be designed to address the patient's concerns and result in aesthetic proportion and balance of the vulvar structures.I think you should discuss your concerns with your surgeon. It may help for you to understand why they chose that approach for you. I find that reviewing before and after labiaplasty photos with your surgeon to show what your aesthetic preference is can be very helpful.

It’s great that you’re learning about the different labiaplasty techniques for the labia minora. Understanding your options is a key first step. Just as important is knowing how your cosmetic surgeon chooses the right approach for your specific goals. Labiaplasty isn’t one size fits all, and a thoughtful decision-making process really matters.

Be sure to consult a surgeon who has extensive labiaplasty experience and truly takes the time to hear your concerns. Take a close look at their labiaplasty before and after photos, too. This will give you a feel for their aesthetic style and results.

Remember, labiaplasty is as much about artistry as it is about precision. Choosing the right technique for your labiaplasty can make all the difference in how confident and comfortable you feel with your outcome.

It depends on the skill set of your surgeon. I ask my patients what the look is that they are going for. Some say a natural look, some say a Barbie look, some say I want no dark tissue and some say I want it smooth! All of this determines the technique and often I find myself using a combination or modification in techniques to achieve the result my patient wishes for. As others have stated, look at your surgeons work and see if the results he’s presenting is what you like. Wedge done in an unskilled hand can go very wrong. Too much removed and tension created can cause a separation. And now you have PAC Man labia….so make sure you’re comfortable with the surgeon you pick.

And just look at the results of the doctor. Choosing a surgeon is like commissioning a piece of artwork. Arguably the most important and finest piece of artwork you will ever behold: yourself and your own beauty. So that makes this easy. Look at the work. Does it look pretty to you? Would you want your own body to look like that? Once you decide that the doctor has an excellent understanding of universal beauty (and there is such a thing, though I’m not sure exactly why god chose certain elements of beauty—despite some evolutionary-based and reproductive fitness clues) then the pressure is off you and on THEM. They have to do the worrying about how they are going to make you beautiful happy and safe.

I invented the central wedge labiaplasty surgery in 1995 and only reported the seminal article in the plastic surgery literature in 2007. 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, I remove 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, I can reduce it at the same time. My technique is performed with magnification to ensure an accurate approximation of the normal labial edges, whereas the other technique takes 15-30 minutes and results in a linear scar as the labial edge. That scar can cause chronic discomfort and aesthetic disfigurement.

The surgery is relatively minor and is not very uncomfortable. It is performed as an outpatient in a fully accredited surgical center. General anesthesia is usually used, but sedation with local anesthesia is possible.

Above all, choose an experienced surgeon as over half of my surgeries are for reconstructing women, who have been botched by other doctors.

Sincerely,

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY