Including Labiaplasty of The Labia Minora & Labia Majora, Clitoral Hood Reduction & Clitoral Hoodectomy
Anatomy relevant to labia surgery
To discuss cosmetic labia surgery and the various methods by which labiaplasty (labioplasty) can be performed, one must have some familiarity with the anatomy of normal female external genitalia. This is well depicted in the following figure, with the important features labeled:
Various Forms of Labiaplasty
- A. Clitoral hood (Labeled as "Prepuce of clitoris")
- B. Clitoris (Labeled as "Glans of clitoris")
- D. Labia minora (Labeled as "Labium minus")
- E. Labia majora (Labeled as "Labium majus")
Confusion occasionally arises in the use of the word "labiaplasty" (also spelled "labioplasty") because, as a general term, it can imply different forms of genital surgery. For example, there are two different labiaplasty methods for reduction of the labia minora (D. in Fig.1, above). Labiaplasty, on occasion, is also the term used for procedures limited to just the clitoral hood (A. in Fig.1, above), and there are also forms of labiaplasty surgery for diverse problems affecting the labia majora (E. in Fig.1, above). I'll attempt to explain each of these several types of labiaplasty, following this same sequence.
Labiaplasty for the Labia Minora (Inner Lips of the Genitals)
Surgical reduction of the labia minora
This (by far the most frequently requested form of labiaplasty) is the procedure that reduces the size or length of the labia minora, and it is the method we shall discuss in greatest detail. This operation began for legitimate medical purposes many decades ago. Prior to the late 1990's, it was exclusively performed using what is now called the "trim method" or "strip method". Then, in the late 1990's, the "Wedge" method (also called the "V"method) was introduced. Consequently, we now have two distinct types of labiaplasty to reduce the size of the labia minora. I'll describe each, since I utilize both methods, individualizing my choice to the varying needs of my labiaplasty patients. Always, I discuss with patients which of the two methods would be their best option.
The "Trim" method of labiaplasty
Figure 2 - Trim Method of Labiaplasty
This type of labia reduction for the labia minora is the simplest to perform and the easiest to understand. Because of this, it's the technique utilized by the largest number of labiaplasty surgeons, and for many of these surgeons it is, unfortunately, the only method with which they are familiar. Since many patients request that their labia minora be reduced to the level of their labia majora (or even below that level) and that the dark labia minora edges also be removed (to give them a pinker and more youthful appearance) the trim method is frequently chosen.
With this type labia reduction, the surgeon trims off a long strip of the edge of the labium, removing that unwanted portion. The new cut edge is then sutured so it will heal promptly and, hopefully, form minimal scar. This accomplishes two significant changes for the patient. It achieves labia reduction, removing the thick, dark labia margin, and leaving a pinker and more delicate labial edge. It also reduces the excess length of the labia minora, positioning them more inconspicuously just within the natural folds of the labia majora.
As a concession, the new pinker labial edge does contain a surgical scar that, on occasion, may be overly sensitive. In addition, many believe this technique excessively alters the natural appearance of the female genitals, because it has removed the normal appearing edge and replaced it with an edge different in color (pinker) and different in texture. You, as a patient should help your labiaplasty surgeon with this decision.
The "Wedge" method of labiaplasty
Figure 3 - Wedge Method of Labiaplasty
This labia reduction technique (sometimes referred to as the "V"method) was first introduced by Beverly Hills plastic surgeon, Dr. Gary Alter. He initially published a description of this technique in 1998, in the plastic surgery literature. Following his lead, I too have incorporated this method into my own labiaplasty practice.
This operation serves to reduce the size and length of the labia minora by removing a "V" shaped wedge of unwanted labium. The edges of this open space (resulting after removal of the unwanted area of labium) are then sutured together, forming a straight line (or "I" shape) with no visible scar along the labial edge. It not only reduces labial size, but it does so without stripping away the natural margins of the labia, therefore preserving a completely normal appearance of the female genital structures. Also, this avoids the need to create a scar running the length of the labium, thereby minimizing the possibility of prolonged uncomfortable oversensitivity during an extended healing phase.
However, if it happens to be the appearance of the labial edge itself, to which you mainly object (because of the dark labia margin color and/or thickness) then this method may not be your ideal choice. Again, as a labiaplasty patient you must help your plastic surgeon with this important decision.
Surgery of The Clitoral Hood
Clitoral Hood Reduction (Labiaplasty of The Clitoral Hood)
This procedure reduces the projection and visibility of the clitoral hood ("Prepuce of clitoris" in Fig.1, above), which often protrudes excessively beyond the level of the adjacent labia majora. The size and length of the clitoral hood can be reduced by the removal of a strip along each side of the hood near its attachment. This keeps the scar well hidden. It is very often combined with reduction labiaplasty of the labia minora, because the labia minora are so intimately associated with the hood itself (A. and B. in Fig.1, above).
On occasion, hood reduction is performed as a separate procedure without also reducing the labia minora (when excessive size of the clitoral hood is the only problem). I normally encourage hood reduction as part of labia minora reduction labiaplasty. This, however, is another decision that must be made by the patient before surgery and, hopefully, during her first consultation. Hoodectomy (Clitoral Hoodectomy)
The clitoral hood ("Prepuce of clitoris" in Fig. 1) is the most forward extension of the labia minora that naturally drapes and conceals the clitoris ("Glans of clitoris" in Fig.1), unless the hood is "lifted" out of the way. Clitoral hoodectomy is the permanent surgical removal of that portion of the clitoral hood, which hides the clitoris from direct view. This "uncovering" of the clitoris is done with the intention of permitting greater exposure of the clitoral glans. There are many claims that this enhances sexual clitoral stimulation, and this is often the primary motivation for women to undergo this operation.
As with labiaplasty, hoodectomy can be performed under "twilight sleep" anesthesia, but, considering its limited area of involvement as well as its shorter operating time, it also lends itself well to a combination of topical and local anesthesia. Because it is such a brief and straight-forward procedure, a quite rapid recovery normally follows.
Objectionably Large, Unequal or Wrinkled Labia Majora (Outer Labial Lips) Surgically defining the "Cameltoe"
The choices for labia majora labiaplasty include either labia majora reduction or labia majora augmentation, depending upon a patient's concerns.
Most recent public attention has focused on surgery to alter the size or the appearance of the labia minora, and little has been stated about surgery to improve the appearance of wrinkled labia majora or labia majora that appear too large, uneven or too long. This is unfortunate, because the current trend toward "cleanly shaven" female genitalia, and social recognition of the feminine, so called, "cameltoe" has also exposed the labia majora to far greater scrutiny. Some women become self-conscious about the "look" of their labia majora and, hence, request either surgical reduction (to make the labia majora smaller, "tighter" and more balanced) or, alternatively, augmentation (to enlarge or "fill up" their "deflated” and wrinkled labia majora).
While these labia reduction procedures all fall under the term labiaplasty, they are not offered by every labiaplasty surgeon due to the special plastic surgical skills are required for some of the necessary techniques. If the labia majora (and frequently the adjacent pubic area) are bulging because of excessive fat (to the point of producing an unattractively large "cameltoe") liposuction and frequently the removal of excess labia majora or pubic skin is performed. On the other hand, when wrinkled labia majora are the problem and they are lacking sufficient tightness or fullness (creating a poorly defined "cameltoe"), skin tightening and, possibly, fat transfer into the deflated and wrinkled labia majora may be required.
The selection of technique is usually determined during the initial consultation, but in some cases can be made in advance, by assessing photographs submitted by the prospective patient. The costs associated with labiaplasty of the labia majora obviously must depend upon the method of surgery necessary. My fee is usually determined during my first visit with a patient, but, if photos have been submitted, the fee can also be provided in advance.
A good example of the improvement possible after labia majora reduction may be seen with "Patient Number 11" in the Labiaplasty Photo Gallery.
Hopefully, this brief discussion of the various "labiaplasty" procedures serves not only to provide you adequate understanding of the several labiaplasty options, but also prepares you for a careful surgical examination during your initial consultation followed by a frank "to the point" discussion of the exact results you would like see.
Fortunately, labiaplasty is considered a minor surgical procedure and thus is relatively safe. The most common potential complications are bleeding, minor infection, incision breakdown, scarring, and/or irritation and pain. When all healing has occurred, there may also be alteration of sensation, changes in pigmentation and even asymmetry. Your plastic surgeon can provide help with any of these problems.
In spite of my effort to present somewhat technical information in an understandable manner, it's expected that some questions may arise. If so, please do not hesitate to contact me directly.
Labiaplasty questions or concerns? Email them directly to Dr. Gruenwald...