A New Modified Labiaplasty Combined with Wedge De-Epithelialization on the Medial Side and Edge Resection.

BACKGROUND: Labiaplasty (labia minora reduction) has been increasingly requested in recent years. The surgical procedures previously reported in the literature may have some complications that affect patient satisfaction. METHODS: Patients who underwent a new bilateral labiaplasty procedure that combined wedge de-epithelialization on the medial side with edge resection on the lateral side were retrospectively reviewed. Satisfaction rates were assessed, and questionnaires, namely the Female Sexual Function Index (FSFI) and Genital Appearance Satisfaction (GAS) scale, were distributed and analyzed. The data from the study group were compared with data from cases who underwent traditional labiaplasty with wedge resection (control group). RESULTS: From October 2015 to February 2020, fifty-one women underwent modified labiaplasty, while 26 women underwent traditional labiaplasty. A total of 94.1% (48/51) of patients in the modified group were satisfied with the genital appearance. Compared with the 96.2% (25/26) satisfaction rate in the control group, the difference was not statistically significant. A total of 43/55 valid questionnaires were returned, including 29 in the modified labiaplasty group and 14 in the control group. There was a significant improvement in the postoperative GAS scale compared to the preoperative scale in both groups (P<0.05). The new modified method had a significant FSFI improvement after the operation compared with preoperative scores (P<0.05), while the FSFI improvement was not significant in the control group (P>0.05). There was no significant difference in the FSFI score improvement, postoperative GAS score or postoperative FSFI between the two groups (P>0.05). CONCLUSION: This new modified labiaplasty is a satisfying and safe method with low risks, and it may result in better sexual sensitivity for the patients LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Labia Minora Repair.

BACKGROUND: Labia minora reduction has become part of the treatment spectrum offered by most plastic surgeons. The author has performed many corrective procedures involving the outer female genital region, most of which involved reducing the labia minora of approximately 4300 women. Over the years, the number of corrective procedures to rectify poorly performed initial operations increased significantly at the author's practice. The most common iatrogenic deformity is the overresection of the labia minora below the clitoris, leaving behind excess tissue in the area around and above the clitoral hood (small penis deformity). METHODS: Two basic procedures may be used to reconstruct the labia minora below the clitoris: reconstructing the labia minora by redundant labial tissue above the clitoris to form bilateral preputial flaps being rotated downward into the defect and reconstructing the labia minora by vaginal skin advancement. Other reconstructions depend on the deformity itself. The postoperative outcome was assessed in an anonymous questionnaire answered by 544 patients. RESULTS: The outcome showed a significant improvement in functional and psychological impairment as a result of the deformities caused by the initial operation. Even if the reconstruction of the labia minora did not produce the desired initial result, overall satisfaction with the corrective surgery was very satisfactory. CONCLUSION: The increase of iatrogenic deformities after the initial labia reductions is alarming. The causes of this growth are manifold: underestimation of the procedure, misjudgment and a lack of detailed knowledge. This has a heavy psychological and physical impact on patients. Reconstruction of excessively shortened labia minora is often not easy and not always satisfactory. Training and the establishment of surgical standards should be used to avoid errors and achieve the best result. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction of Hypertrophic Labia Minora by Posterior-Lateral Wedge Resection with Preservation of the Central Blood Vessels and Nerve Bundle.

OBJECTIVE: The aim of this study was to introduce a new method of labiaplasty. Here, we describe the surgical procedure, outcomes and the advantages of this method. METHOD: The medical records of 21 patients aged between 20 and 45 years who underwent reduction of the labia minora from February 2015 to June 2017 were reviewed. The procedures performed in these studies used posterior-lateral wedge resection with preservation of the central blood vessels and nerve bundle. RESULTS: All the surgeries were performed successfully, and 21 patients experienced an uneventful postoperative period. A minor dehiscence occurred in one patient, who recovered with no requirement for additional treatment. All of the patients were satisfied with the eventual esthetic appearance. CONCLUSION: The posterior-lateral wedge resection with preservation of the central blood vessels and nerve bundle is a simple and safe method that is associated with satisfactory outcomes. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomy and Aesthetics of the Labia Minora: The Ideal Vulva?

Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Labia minora hypertrophy: pathologizing diversity?

INTRODUCTION: Labia minora hypertrophy can be characterized by the labial tissue extending beyond the labia majora; however, the exact definition of hypertrophy is a matter of debate. While the prevalence of labia hypertrophy is very common among women, taboo/controversial attitudes and surgical interventions still dominate. The recognition and study of labia minora hypertrophy will increase our knowledge of this underrepresented anatomic diversity. OBJECTIVES: To provide a report of the current literature on labia hypertrophy and discuss the definition, etiology, attitudes, management, and medicalization surrounding labia minora hypertrophy and the implications. METHODS: Comprehensive review of literature pertaining to labia minora hypertrophy. RESULTS: Labia minora appearance and measurements vary extensively, and hypertrophy is extremely prevalent in the population and largely nonpathologic. There remains a lack of standardized criteria to define labia hypertrophy. Attitudes surrounding labia hypertrophy differ globally, but in Western nations the overwhelming sentiment toward labia hypertrophy has largely been medicalized. CONCLUSION: Negative attitudes and unnecessary medicalization of nonpathologic instances of labia hypertrophy is unjustifiable and comes with potential risks. There remains an impending need to demedicalize nonpathologic elongated labia, educate the public on diverse genital appearance, and improve understanding of the long-term outcomes and risks of genital cosmetic surgery.

Labia Minora Reduction Using Central Wedge Technique: Central Wedge Technique.

The central wedge labiaplasty removes a "V" or a pie-slice piece of the most protuberant portion of the labium to make it smaller. The anterior and posterior edges of the labium are reapproximated to preserve the normal labial edge and anatomy with minimal scarring. The lateral or medial-lateral clitoral hood can be reduced at the same time. The complication rate is very low if done using meticulous technique, thus avoiding the problems with alternative labiaplasty methods. The patient satisfaction level is well over 90%.

The Aesthetic Genital Consultation: Inquiry to Scheduling.

Consultation for female esthetic genital concerns is unique in that the topic is shrouded in secrecy. Few opportunities exist for the improvement of female sexual health and well-being when compared with male counterparts. Women concerned with the appearance of their genitalia seek help with improving their confidence and reducing mental and physical discomfort attributed to large labia minora. Validated questionnaires given to patients beforehand, a detailed sexual history, and a comprehensive vulvar examination help define the esthetic and functional issues. Providing informed consent and setting realistic expectations are the key final steps to a successful esthetic genital consultation.

Easy way to perform a labia minora reduction.

BACKGROUND: Labia minora reduction is a surgery in the rise. Surgeons are left with a large choice of described techniques yet there is a paucity of visual data to guide surgeons through this procedure. Also, many gynecologic surgeons are reluctant to perform this operation emphasizing potential complications. TECHNIQUE: We present a step by step visual support of a wedge resection technique. EXPERIENCE: This technique of labia minora reduction is safe and carries a great satisfaction rate among patients. CONCLUSION: We believe that a visual description of a simple and quick technique will help standardized patient care and achieve good outcomes.

[Labiaplasty: Motivations and post-surgery satisfaction]. / Nymphoplastie : motivations et satisfaction postopératoire.

OBJECTIVES: In France, the number of labiaplasty increased by 57% between 2008 and 2016. To date, only one prospective study with low-power evaluated postoperative satisfaction has been performed. This observational prospective study aims to evaluate the motives and post-surgery satisfaction of patients who had a labiaplasty. METHODS: This observational prospective study include all patients over 18 years old operate at the hospital of Angers during an 18-month period. The exclusion criterion was a positive screening test to the Body Dysmorphic Disorder Questionnaire. Patients were interviewed by a written questionnaire on the day of the surgery and by phone 3 and 6 months after the surgery. RESULTS: A total of thirty patients were included in the study, with an average age of 31.5 (± 10.58). Twenty-three patients answered 3 months after and 19 answered 6 months after. Eighteen patients (95%) expressed satisfaction at 6 months and 16 (84%) "extremely" satisfied. Functional discomfort improved in 18 patients (94%) at 6 months. Eighty-four percent have felt an improvement regarding esthetical discomfort. All patients would recommend the surgery. The main motive was the discomfort when getting dressed for 27 patients (90%). CONCLUSION: The patients expressed a real functional discomfort and are mostly very satisfied with their surgery at 3 and 6 months after.

[Functional or aesthetic labia minora reduction: Complications, revision surgeries and results - a comparative study]. / Nymphoplasties de réduction fonctionnelle ou esthétique. Complications, réinterventions, résultats : étude comparative.

OBJECTIVE: To evaluate and compare the complications, the rate of revision surgeries and the long-term patient postoperative satisfaction level for the two main indications of labia minora reduction: aesthetic or functional. METHODS: A comparative, retrospective and multicentered study was carried out in Belfort and Montbéliard hospitals between January 2010 and January 2017. Ninety-two primary labia minora reductions for labia minora hypertrophy have been listed. Each patient has been requested to fill in a questionnaire about the main indication of labiaplasty, any potential complication, a revision surgery and her level of the satisfaction. Patients who had agreed to respond were divided into two groups: a "functional indication" group (FI) and an "aesthetic indication" group (AI). RESULTS: Thirty-seven patients (40%) answered the survey: 19 (51%) have been included in the FI group and the remaining 18 (49%) in the AI group. The mean postoperative follow-up duration was 3.2 years. We identified 13 patients (35%) who encountered a postoperative complication. It predominates in the FI group (53% versus 17%, P=0.04). Seven patients (19%) were treated by revision surgeries. All of them belonged to the IF group. Whatever the indication of the labiaplasty, 86% of the patients have been satisfied by the outcomes. CONCLUSION: A labia minora reduction is a highly appreciated surgical treatment on the long term whatever the initial surgical indication. However, postoperative complications and revision surgeries are not negligible especially when the main indication is functional.

A Novel Technique for Mapping the Vascularity of Labia Minora Prior to Labiaplasty: Cold Light Illumination.

Objective Aim of the study was to assess the feasibility of a novel technique to determine the vascularity of labia minora prior to labiaplasty. Methods A cold light source employed in laparoscopic procedures was used to illuminate the outer surface of the labia minora as described in this prospective descriptive study. Results Of the patients, 46.1% (n = 41) had upper third prominence, 36% (n = 32) had middle third prominence, and 18% (n = 16) had lower third prominence according to the Banwell classification of morphologies. Right labia minora width was 0 - 2 cm in 51.7% (n = 46), 2 - 4 cm in 47.2% (n = 42) and > 4 cm in 1.1% (n = 1) of cases. Left labia minora width was 0 - 2 cm in 52.8% (n = 47), 2 - 4 cm in 41.6% (n = 37) and > 4 cm in 5.6% (n = 5) of cases. The incidence of Anterior 2 and Posterior 1 vessels in the different morphologies were statistically significantly different (p = 0.007, p = 0.018). The Anterior 2 vessel was higher in the lower morphology group whereas the Posterior 1 vessel was higher in the upper morphology group. A central vessel was observed in 93.3% (n = 83) of patients in the left labium minus and the right labium minus. The incidence of the Posterior 1 vessel was significantly higher in the left labium minus than in the right labium minus (p = 0.021). Discussion This novel technique to assess labial vascularity using a cold light source could be very useful to reduce dehiscence by avoiding excessive resection of highly vascularized tissue. Most units can easily access a cold light source, which can be used to assess labial vascularity prior to labiaplasty.

Personalized surgical effect of labia minora hypertrophy / 中华医学美学美容杂志

Objective:To explore an optimal surgical approach for different types of labia minora hypertrophy and to design a better personalized surgical treatment plan for patients.Methods:From October 2017 to October 2020, 71 patients with labia minora hypertrophy were treated in the plastic surgery department of Sichuan Provincial People＇s Hospital, aged 18-38 years, with an average of 26 years. According to the type and degree of hypertrophy, the appropriate surgical method was selected. The wound healing and complications were observed after operation, and the shape of labia minora was followed up.Results:Among the 71 patients, 1 patient had postoperative hematoma and no flap necrosis after active treatment. 1 patient had poor healing of distal labia minora incision and improved after dressing change. The other patients had good blood supply of labia minora, no necrosis, no postoperative infection, hematoma and other complications. The patients were followed up for 1-6 months. The appearance of labia minora was natural, bilateral symmetry, and the incision scar was hidden. The improvement was significant compared with that before operation. The patients were satisfied with the shape and function.Conclusions:According to the degree of hypertrophy of the labia minora, the specific shape and the psychological expectation of patients, we can choose the appropriate operation method, which can achieve the aesthetic standard of symmetry and beautiful shape of the labia minora, and meet the normal physiological function and aesthetic requirements of patients.

Cirugía íntima femenina: nuestro enfoque actual / Female genitalia surgery: our current approach

Introducción y objetivo: La correcta identificación de las alteraciones estéticas de los genitales externos femeninos, junto a la planificación y realización de técnicas quirúrgicas simultáneas, son esenciales para lograr los mejores resultados. El objetivo de este estudio es presentar nuestra experiencia en cirugía íntima femenina combinando diferentes técnicas quirúrgicas para tratar simultáneamente las distintas alteraciones estéticas de los genitales externos. Como objetivo secundario, analizamos en la bibliografía las ventajas y desventajas de las diferentes técnicas quirúrgicas de reducción de labios menores en comparación con nuestra técnica de elección. Material y método: Desde abril de 2010 hasta abril de 2021, realizamos cirugías de la región genital por razones estéticas y funcionales a 213 pacientes. De ese total, a 114 (54%) se les realizó lipoaspiración y/o pexia del monte de Venus, como única cirugía o combinada con dermolipectomía abdominal o lipoaspiración abdominal, y a 99 (46%), resección en cuña de los labios menores como único procedimiento o combinado con otros procedimientos en la región genital, como reducción de capuchón de clítoris, reducción de labios mayores o aumento de labios mayores. La edad promedio de las pacientes fue de 43 años de edad (de 14 a 67 años). Resultados:La combinación de técnicas quirúrgicas demostró un alto grado de satisfacción (95%) estética y funcional de las pacientes consultadas a los 3 meses de postoperatorio. Las complicaciones fueron hematoma bilateral (0.5%), dehiscencia de la herida y/o fístula (1.4%), dolor postquirúrgico (2.8%), resección insuficiente del la longitud de los labios. (0.5%) y discrepancia de color entre la unión de los colgajos (0.5%). Ninguna paciente presentó infección, dispareunia ni cicatrices patológicas. (AU)

Background and objective: Correct diagnosis of the external aesthetic female genital alterations, besides planning and achieve simultaneous surgical techniques, are essential to reach the best results. The aim of this study was to present our experience in aesthetic female genitalia surgery, performing more than one procedure during the same surgical time to simultaneously treat different aesthetic genitalia disorders. Our secondary goal was to analyze in the literature the advantages and disadvantages of the different surgical techniques in labia minora reduction in comparison with our current technique. Methods: Genital rejuvenation surgeries were performed in 213 patients for aesthetic and functional reasons, from April 2010 to April 2021. Of this total number of patients, 114 (54%) had mons pubis reduction by liposuction and skin resection, as the unique surgery or in combination with abdominoplasty or abdominal liposuction, and in 99 patients (46%) labia minora wedge reduction were performed, alone or in combination with other procedures of the genital region, such as clitoral hood reduction, labia majora reduction, or labia majora augmentation. The mean age was 43-years-old (range, 14 - 67). Results: The combination of surgical techniques showed a high level of satisfaction (95%) at 3 months follow-up. Complications were bilateral hematoma (0.5%), wound dehiscence and/or fistula (1.4%), postsurgical pain (2.8%), insufficient resection of the length of the labia (0.5%) and the color discrepancy between the flaps (0.5%). No patient presented infection, dyspareunia or pathological scars. Conclusions: The correct diagnosis, considering all aesthetic aspects of the external genitalia, is essential to develop an appropriate surgical plan and carry out a simultaneous surgical approach and obtain the desired aesthetic result. The central wedge resection is our choice technique for the labia minora resection since it has a low rate of complications. (AU)

Reconstrucción estético - funcional de labios menores post amputación Iatrogénica amplia con colgajo de avance V - Y / Aesthetic-functional reconstruction of labia minora after extensive iatrogenic amputation with V-Y advancement flap

La hipertrofia de labios menores es la prolongación de estos más allá de los límites anatómicos de los labios mayores. La creencia de la simplicidad en la reducción de los labios menores y la falla en observar importantes aspectos de la técnica quirúrgica que llevan a la resección total del labio. En tales casos, la cirugía reconstructiva es la única forma posible de rectificar la situación. Presentamos el caso de una mujer de 36 años que acude por amputación de los labios menores secundario a cirugía de labioplastia por hipertrofia realizada por médico esteticista. Se realiza reconstrucción de labios menores en dos tiempos quirúrgicos. Los colgajos de avance en V-Y del capuchón del clítoris, con remanentes de tejido de la horquilla posterior, pueden lograr resultados satisfactorios y permitir la adaptación a la anatomía genital y los deseos estéticos únicos de cada mujer.

Labia minora hypertrophy is the prolongation of these beyond the anatomical limits of the labia majora. The belief in simplicity in the reduction of the labia minora and the failure to observe important aspects of the surgical technique that lead to total lip resection. In such cases, reconstructive surgery is the only possible way to rectify the situation. A 36-year-old woman with medical history of labia minora amputation secondary to labiaplasty surgery for hypertrophy of the labia minora performed by a beautician. The labia minora reconstruction is performed in two surgical stages. The V-Y advancement flaps of the clitoral hood with remnants of tissue from the posterior fork can be achieved with satisfactory results and allow adaptation to the genital anatomy and unique aesthetic wishes of each woman.