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Alter, Gary J. M.D.

Plastic and Reconstructive Surgery: March 2010 - Volume 125 - Issue 3 - p 1047-1048
doi: 10.1097/PRS.0b013e3181cb68b8
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University of California, Los Angeles School of Medicine, 416 North Bedford Drive, Suite 400, Beverly Hills, Calif. 90210, altermd@altermd.com

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Sir:

Dr. Parsa et al. report a series of 24 cases of labioplasty performed over 20 years. Before 1999, they reduced the labia by straight-line or trimming excisions in 14 patients, then switched to a central wedge resection in the next 10 patients. They state that 95 percent of the women were pleased at 6 weeks. They recommend the central wedge technique reported by Alter, because it is superior aesthetically, with a lower complication rate.1,2

Labioplasty complications with straight-line trimming excisions are often technique dependent. This procedure has some inherent problems, such as loss of normal pigmentation and contour of the labial edges, difficulty achieving symmetry, and a tendency to overresect or underresect the labia. The tendency for separations along the labial length is high, especially if the labium is thick. In addition, it is difficult using the trimming technique in many women to achieve a natural transition at the junction of the clitoral frenulum, the clitoral hood, and the labia minora.

The authors report three partial wound separations in 10 patients who underwent central wedge resection, which is relatively high. Even though the authors do not explain the technical details, I doubt the surgeon used 5-0 Monocryl sutures (Ethicon, Inc., Somerville, N.J.) throughout the repair or placed vertical mattress sutures at the labial leading edge. These modifications were made approximately 5 years ago, which led to a much lower separation rate because of the relatively nonreactive Monocryl and the exact approximation of the wound edges. If a wound separation at the leading edge requires revision, it can be performed easily under local anesthesia in 4 months.

The wound infection rate in the central wedge labioplasty patients seems high at 20 percent. I wonder whether the urine was verified to be sterile preoperatively and whether prophylactic antibiotics were used. It is also possible that the patients were not infected but had reaction to suture material.

I agree with the authors' main points concerning the central wedge labioplasty, that (1) the complications are usually minor and can almost always be treated conservatively, (2) the patients are almost universally happy, and (3) the central wedge excision is aesthetically superior. I am confident that their complication rate will be further reduced with the modifications mentioned above and in the study published in 2008.2

Gary J. Alter, M.D.

University of California, Los Angeles School of Medicine

416 North Bedford Drive, Suite 400

Beverly Hills, Calif. 90210

altermd@altermd.com

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REFERENCES

1. Alter GJ. A new technique for aesthetic labia minora reduction. Ann Plast Surg. 1998;40:287–290.
2. Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2008;122:1780–179.

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