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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3181d62a3d
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Labia Minora Reduction: Guidelines for Procedure Choice

Ellsworth, Warren A. M.D.; Rizvi, Mort M.D.; Smith, Bruce M.D.; Cohen, Benjamin M.D.; Dinh, Tue M.D.

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Division of Plastic Surgery; Baylor College of Medicine; Clinical Care Center (Ellsworth)

Division of Plastic Surgery; The Methodist Hospital; Houston, Texas (Rizvi, Smith, Cohen, Dinh)

Correspondence to Dr. Ellsworth; Division of Plastic Surgery; Baylor College of Medicine; Clinical Care Center; 6701 Fannin, CC 610.00; Houston, Texas 77030; we042844@bcm.edu

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Sir:

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The number of patients who undergo labia minora reduction continues to rise at an alarming rate. Affected women most commonly complain of social embarrassment and aesthetic concern; however, most women also report some functional limitation, including chronic infections or pain with sexual intercourse.

Perhaps because of significant variation in labial appearance and patient goals, no ideal procedure for labia reduction has been identified. In our experience, three techniques are useful in labia minora reduction. Each technique carries with it a unique set of advantages that may be more appropriate in one patient over another. It is our belief that frank discussion of aesthetic goals with the patient will aid in identification of the appropriate procedure.

In our series of 12 patients, all women complained of the aesthetic appearance of their labia minora and six of the patients (50 percent) complained of difficulty wearing certain clothing. Four patients suffered pain with sexual intercourse (33 percent) and two patients suffered from chronic irritation and infections (17 percent). In addition to examination of the genitalia, we have found that an open conversation with the patient to identify her ideal labial aesthetic is advantageous. Some patients associate the normally darker, corrugated appearance of the labial edge with an “aged” appearance and prefer to have it removed. Others, however, prefer to keep this “natural” aesthetic. Because of the wide spectrum of patient desires, we find it important to identify the patient's aesthetic goals before choosing surgical technique.

The three techniques used most commonly in our practices include the edge excision technique as described by Capraro1 and Felicio,2 which simply involves amputation of protuberant tissue, thus removing the dark, corrugated labial edge. A second procedure, the deepithelialization technique, introduced by Choi and Kim,3 has been found useful for smaller labia in women who prefer to keep the labial edge aesthetic. The third and final technique is the superior pedicle technique with inferior wedge resection as described by Alter4 and modified by Rouzier et al.5 In this procedure, an inferior area is delineated for resection and a superior flap is designed for closure, again preserving a natural labial edge aesthetic in larger labia (Fig. 1).

Fig. 1
Fig. 1
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In parallel with the increase in the number of women requesting aesthetic surgery of the female genitalia, the number of different techniques for labia minora reduction has increased as well. Labia minora reduction is usually and perhaps most easily performed by simple amputation of protuberant segments and closure of the edge.1 We have found that a frank discussion with the patient regarding her aesthetic goals will identify a group of women more appropriately treated with a technique that preserves the labial edge aesthetic. For these women, other techniques such as deepithelialization and the superior pedicle technique should be considered.

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DISCLOSURE

The authors have no financial interests to disclose.

Warren A. Ellsworth, M.D.

Division of Plastic Surgery

Baylor College of Medicine

Clinical Care Center

Mort Rizvi, M.D.

Bruce Smith, M.D.

Benjamin Cohen, M.D.

Tue Dinh, M.D.

Division of Plastic Surgery

The Methodist Hospital

Houston, Texas

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REFERENCES

1.Capraro VJ. Congenital anomalies. Clin Obstet Gynecol. 1971;14:988–1012.

2.Felicio Y. Labial surgery. Aesthetic Surg J. 2007;27:322.

3.Choi HY, Kim KT. A new method for aesthetic reduction to the labia minora (the deepithelialized reduction labioplasty). Plast Reconstr Surg. 2000;105:419–422; discussion 423–424.

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

5.Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of the labia minora: Experience with 163 reductions. Am J Obstet Gynecol. 2000;182:35–40.

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GUIDELINES

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