I read with great interest the article by Motakef et al. entitled “Vaginal Labiaplasty: Current Practices and a Simplified Classification System for Labial Protrusion.”1 In their systematic review of the available literature regarding labiaplasty for aesthetic and functional indications, the authors included 1949 patients from 19 studies, reaching the conclusion that labiaplasty is a safe procedure that carries a high satisfaction rate. Excellent outcomes and low complication rates, consistent for all labiaplasty techniques, were also demonstrated by my recent review,2 which differs from the review of Motakef et al. because of the inclusion without restriction of time of English and non-English articles, considering 1981 patients treated in 38 studies. However, I noticed that two techniques, described in the English literature, were excluded from the analysis performed by Motakef et al.: (1) custom flask labiaplasty and (2) fenestration labiaplasty.
Custom flask labiaplasty was described in 2013 by Gonzalez et al.3 on a total of 50 patients. This procedure, performed under general anesthesia on an outpatient basis, permits precise reduction of the labia minora in the necessary regions, in a customized manner, to achieve symmetry and a natural appearance of skin and to maintain the neurovascular pedicles. The lateral incision is designed in the sulcus between the labia majora and the labia minora, whereas the medial incision is planned at the junction of the labia minora skin and the vaginal mucosa. The excess skin is removed from the labium medially and laterally with scissors and the needle-tip cautery on low current in a flask pattern. Preservation of the neurovascular supply of the labia, predictability and reproducibility of results, and a low rate of complications are listed as the main advantages of the custom flask technique by the authors. The high level of patient satisfaction (93 percent) reflects the natural and aesthetically pleasing result.
Fenestration labiaplasty was described in 2014 by Ostrzenski.4 With this technique, reductions in both height and length of the labia minora are obtained. On determining the size of the labia minora volume being reduced, the base of the lower margin of incision is determined, and outlining of the amount of tissue being removed is marked in the shape of a “bicycle helmet” within the anterior labial surface. In this process, the arch of the new labium is also determined. The resection in the bicycle helmet shape is accomplished and excised, and an inferior flap transposition is performed. In the three patients that underwent the procedure, symmetry was established, the natural color and contour of the labium minus were preserved, and a natural appearance of the labium frenulum (posterior edge of the fossa navicularis) was restored or created. All patients experienced meaningful improvement in body image and self-confidence, with improvement of social openness and increase of intimate interaction.
The author has no financial interest to declare in relation to the content of this communication.
Carlo M. Oranges, M.D.
Plastic, Reconstructive and Aesthetic Surgery School
Marche Polytechnic University
1. Motakef S, Rodriguez-Feliz J, Chung MT, Ingargiola MJ, Wong VW, Patel A.. Vaginal labiaplasty: Current practices and a simplified classification system for labial protrusion. Plast Reconstr Surg. 2015;135:774–788
2. Oranges CM, Sisti A, Sisti G.. Labia minora reduction techniques: A comprehensive literature review. Aesthet Surg J. 2015;35:419–431
3. Gonzalez F, Dass D, Almeida B.. Custom flask labiaplasty. Ann Plast J. 2013;75:266–271
4. Ostrzenski A.. Fenestration labioreduction of the labium minus: A new surgical intervention concept. ISRN Obstet Gynecol. 2014;2014:671068
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