Labiaplasty trim or wedge?

Your labia minora and clitoral hood are  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 at the same time. Your clitoral hood is thick, wide, and protuberant.  It 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 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.

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

Your story and concerns are in good company with almost ever other patient that undergoes labiaplasty and/or clitoral hood reduction (aka hoodectomy).  Based upon your photos, your anatomy is very typical of someone who seriously considers having these procedures and experiences a major boost in (sexual) self-confidence and pleasure thereafter. 

Labiaplasty, which most commonly involves surgical reduction of the labia minora (inner/thinner lips) but not infrequently trimming or tucking of the labia majora (outer/thicker lips), has become a relatively common procedure over the last ten and even more so last five years.  Most commonly it is done under light sedation (aka twighlight sleep) with local anesthesia, in which case the patient should feel no pain during the operation.  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.  To achieve these three most important elements, I have found that the "Trim Method" satisfies best.  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.  Typical (all inclusive) fee at my office/surgery center is $4500. Although there is no guarantee, women frequently do seek clitoral hood reduction (Hoodectomy) to improve exposure of the clitoris and hence better stimulation during sexual activity. By removing some of the excess &/or redundant skin concealing the clitoris, it becomes more readily exposed to sexual stimulation and hence a heightened sexual experience/orgasm is possible.  Sometimes I recommend adding hoodectomy to labiaplasty to better harmonize the aesthetic outcome.  Again, the key is seek consultation with a board certified plastic surgeon or gynecologist who performs this procedure regularly (>2-3 x/month) so that just the right amount of tissue is removed and just the right amount remains such that the clitoris is not constantly exposed and rubbing on clothing, etc... Typical fee for a hoodectomy is ~$3000 but reduced to about half that price if done along with a labiaplasty. Now for recovery, because the labia tissue is so robust with blood supply it has an amazing ability to heal relatively quickly.  Most patients are sore for 4-5 days before things start to get a lot better from there.  Some patients can resume work before this time depending upon their occupation.  No exercise for two weeks, no baths/jacuzzi or swimming for 3 weeks, and no sexual activity for typically 4 weeks.  My patients are given an oral pain medication such as Vicodin or Percocet but icing the area for the first 48 hours and applying some custom  made take-home topical local anesthetic cream seems to work the best.  Glad to help.

There is a trend to have less prominent labia, but this is a matter of choice and there are no medical reasons to do so other than improving your appearance down there. Candidates for a Labiaplasty procedure are women who are concerned about the appearance of their labia or experience discomfort due to exceptionally large or long labia of either the inner our outer lips. Labia unevenness can result in discomfort with intimate contact, chronic rubbing, as well as psychological discomfort, which leads to the inability to wear certain types of tight clothing. Most women live with these symptoms, and actually are not even aware that a certain surgical procedure exists to help to correct this problem and restore their femininity.

Thank you for your question! You could undergo either procedure, however, if I saw a patient similar to yourself, I would probably chose the trim technique. Using this technique I am also able to reduce the hood slightly to help uncover the clitoris.Ankur Mehta MD

A wedge will pull your clitoral hood toward your anus and linear labiaplasty won't. LInear scars are much stronger than wedge scars. Expert work looks better than non-expert work. What else can I say?

Trim or wedge is in the skill of the surgeon.  Either technique in the wrong hands can cause devastating results.  Choose a surgeon based upon skill, expertise, experience, reputation and results.  There are many different techniques to decrease the protruding the labia minora and the two most common techniques are 1) the curvilinear reduction or linear reduction and 2) a wedge resection.  NO matter which technique you pursue choose a surgeon with experience, expertise, reputation and one who achieves great results.  These qualities are not achieved by being a "plastic surgeon" or even being "board certified" but instead they come through great training, years of surgical experience, common sense, logic and innate talent.    All too often surgeons tell patients what post operative cosmetic results should be instead of asking a patient : " what results do you hope to achieve"?   The surgeon should be able to communicate with a patient and discuss whether her postoperative desired results are achievable. A surgeon should communicate with a patient what is and what is NOT achievable for that individual patient. 



My partner and I have been performing labiaplasty surgery for more than 15 years and we have written the largest single center study in the world addressing just this question: What are your postoperative aesthetic expectations?  What we learned in one study  from 550 labiaplasty patients over a 3.5 year period actually dictates whether we perform a) the curvilinear reduction or b) a wedge resection.  99% of caucasian women do NOT want the so called "natural border and skin" of their labia.  They do NOT want a dark labia minora skin edge if it is at all possible----- 99% of women prefer a lighter, pinker skin edge which is NOT attainable with a wedge resection.  The wedge resection can remove some of the more darkened edge but not lighten the labia through its entire length..The lighter/pinker ( more youthful appearance) is only achievable through a linear resection.  The normal anatomy of the bulk of the labia minora is preserved and just the edge of the labia is removed.  This doesn't mean that a wedge resection is not a great technique. The results of the wedge and the linear resection are only as good as the surgeon performing the procedure. 



The second part of your procedure is the reduction or lifting of the clitoral hood.   This can be reduced at the time of labia minora reduction surgery with minimal discomfort.   I would discourage you from complete clitoral unhooding or complete removal.  I personally would not ever do that surgery as it could potentially leave you permanently dysfunctional sexually or overly sensitive creating dysfunction during daily activity.  

Please choose a surgeon wisely and do NOT allow location and costs limit your choice in a qualified and experienced surgeon.



John R Miklos MD Urogynecology & Cosmetic Vaginal Surgeon Atlanta ~ Beverly Hills ~ Dubai

Thank you for sharing your question and photograph.  Though nothing replaces an in-person examination to assess the degree of tissue laxity and location of excess to both your labia and clitoral hood, both techniques can successfully achieve your desired results.  I would recommend researching and finding a labiaplasty surgeon skilled with both techniques for consultation in order to maximize your results.  

Hi, it appears to me by your picture that you would be an excellent candidate for labia linear contouring type Labiaplasty, i.e. Also called trimming. The wedge technique is an excellent technique if you just want to debulk the tissue or have the labia reduced in bulk so they don't hang as much. We have found that the majority of women coming for Labiaplasty also care very much about the appearance and would like in addition to the decrease in size also thinner labia without the very dark pigmented edges. The only way to accomplish this is with linear contouringctechnique in association with clitoral hood reduction if necc. Done by an experienced cosmetic vaginal surgeon, there is barely a visible suture line and typically heals without any scarring. Most important however is to choose your vaginal cosmetic surgeon very carefully and travel if necessary to find that expertise. it is a procedure that is very amenable to travel. Best of luck to you, Dr Robert D MooreCosmetic and Reconstructive Vaginal SurgeryAtlanta - Beverly Hills - Dubai

It appears that you would benefit from labiaplasty which would shorten the length of your darker labia minora. Honestly you would do well with either technique. Your clitoral hood does not appear to be particularly elongated but it is really impossible to tell without a physical exam. Over-resection of either the labia minora or clitoral hood can be disastrous, so please communicate your expectations carefully with your surgeon and make sure he/she is experienced in this procedure. 

I am another very experienced genital plastic/cosmetic surgeon weighing in, and I heartily endorse others' answers here. Dr. Miklos says it well: consult with at least two VERY experienced (takes > 100 procedures before a surgeon has honed his or her technique), find out what is possible with both wedge and curvilinear/trim, and make your own decision. Your anatomy "fits" either technique: a "Wedge" will leave you with more "natural" but darker lips, and can (with a "Y" extension) do your reduction with a single suture line on each side. I "Linear" can "pinken" the edge, but great care must be taken to not remove too much, and would require separate, second, bilateral incision lines, to reduce the amount of skin blanketing the clitoral glans. (Great care here to not remove too much!) The weblink below can help you further understand the difference between techniques...Best wishes,Michael O Goodman, MDDavis, CA, USA