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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181cb68a4
Letters

Comparison of Wedge versus Straight-Line Reduction Labioplasty

Murariu, Daniel M.D., M.P.H.; Jackowe, David J. M.D.; Parsa, Alan A. M.D.; Parsa, F. Don M.D.

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Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii

Correspondence to Dr. Parsa, Department of Surgery, John A. Burns School of Medicine, University of Hawaii, 1329 Lusitana Street, Suite 807, Honolulu, Hawaii 96813-2421, fdparsa@yahoo.com

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Sir:

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Patient demand for labioplasty—the surgical reduction of the labia minora—is growing. However, these procedures are not without controversy, among both the lay public and medical professionals. One reason for this controversy is a paucity of studies describing the natural course of potential complications.1 One such study was published by Alter in 2008 (Plast Reconstr Surg. 2008;122:1780–1789), where complications with wedge labioplasty were reported.2 We present one of the largest studies to date that follows the natural course of a multitude of complications associated with labioplasty, and also compares them between the straight-line and wedge techniques.

We analyzed a total of 24 consecutive patients (mean age, 36 years) requesting elective labioplasty between 1988 and 2008 with the senior author (F.D.P.). Before 1999, all 14 patients (58 percent) received straight-line excision with intradermal reapproximation; the rest of the patients [n = 10 (42 percent)] received a central wedge resection (Table 1). Follow-up at 1 week, 6 weeks, 3 months, and 6 months was 24 (100 percent), 22 (92 percent), 18 (75 percent), and 14 (58 percent), respectively. A large percentage of patients were lost to follow-up after 3 months. At 6 weeks, 21 of 22 patients (95 percent) reported being happy with the outcome (no other quantifying measures were undertaken). Complications were recorded as they developed from the time of the first follow-up at 1 week, and their natural course followed at 6-month intervals until resolution (Table 2). None of the complications required reoperation.

Table 1
Table 1
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Table 2
Table 2
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This study shows that the frequently encountered complications of reduction labioplasty such as partial wound separation and infection will respond to conservative therapy. None of our patients experienced any urinary symptoms, such as spraying, a complication reported by other authors.3 Although limited by a small cohort, our data may serve as a guideline for clinicians when treating complications of reduction labioplasty, and when educating patients both in the preoperative and the postoperative settings as to the natural course of potential complications. Based on our observations, we recommend central wedge reduction labioplasty as described by Alter4 as the method of choice because of better aesthetic outcome with absent hypopigmentation of the labia minora, and the lack of troublesome symptoms of pruritus that were only seen in women undergoing straight-line reduction (Table 2).

Daniel Murariu, M.D., M.P.H.

David J. Jackowe, M.D.

Alan A. Parsa, M.D.

F. Don Parsa, M.D.

Department of Surgery

John A. Burns School of Medicine

University of Hawaii

Honolulu, Hawaii

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REFERENCES

1. Goodman MP. Female cosmetic genital surgery. Obstet Gynecol. 2009;113:154–159.

2. Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2008;122:1780–1789.

3. Ryan KJ, Barbieri RL, Berkowitz RS, Dunaif AE. Kistner's Gynecology & Women's Health. 7th ed. St. Louis: Mosby;1999.

4. Alter GJ. A new technique for aesthetic labia minora reduction. Ann Plast Surg. 1998;40:287–290.

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