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Central wedge resection approach for labioplasty results in less morbidity

Article-Central wedge resection approach for labioplasty results in less morbidity

Key iconKey Points

  • Central wedge resection takes more time, is more technically challenging than traditional labioplasty
  • Wedge resection will not eliminate dark pigmentation but results in good symmetry and normal labial edges, surgeon says

Dr. Alter
NEW YORK — Labioplasty with clitoral hood reduction is a very safe procedure when performed in a meticulous manner, and the resultant improvements in aesthetic appearance and comfort lead to high patient satisfaction — and sometimes life-changing results, according to Gary J. Alter, M.D.

Speaking at the The Cutting Edge 2011 Aesthetic Surgery Symposium, Dr. Alter, assistant clinical professor, division of plastic surgery, University of California, Los Angeles, described the techniques he's developed for optimizing the outcomes of this female genital aesthetic surgery. He says his approach is to perform a central wedge resection in which a V-shaped portion of tissue is excised from the most protuberant portion of the labia minora on each side.

Dr. Alter first published on the technique in 1998 (Alter GJ. Ann Plast Surg. 1998;40(3):287-290) and has made modifications over time in the excision and closure so as to better address clitoral hood lateral excess and reduce postoperative morbidity (Alter GJ. Plast Reconstr Surg. 2008;122(6):1780-1789). Dr. Alter has also published on techniques for reconstruction of post-labioplasty deformities (Alter GJ. Plast Reconstr Surg. 2011;127(6):2356-2363).

Dr. Alter acknowledges the central wedge resection takes more time and is more technically challenging than traditional labioplasty performed by trimming of the labial edges. However, the wedge resection is a superior approach because it is associated with less postoperative morbidity and better aesthetic outcomes, he says.

"With the traditional trimming method, difficulty creating the transition zone between the labium and the frenulum and clitoral hood can result in an abruptly ending frenulum and a large, freely hanging clitoral hood," he says. "In addition, there is a tendency to over-resect with the trimming technique, and it is more likely to result in asymmetry as well as scalloped labial edges with wide vertical scars that can cause chronic discomfort.

A 40-year-old patient before (left two images) and six months after undergoing a labia minora reduction. (Photos credit: Gary Alter, M.D.)
"The wedge resection will not eliminate dark pigmentation as completely as traditional trimming, but it is difficult to over-resect when performing this procedure, and it results in good symmetry and normal labial edges and anatomy," Dr. Alter adds. "Furthermore, the recovery is easier for patients, and they rarely have discomfort from chronic scars."

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