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Trim Labiaplasty

Furnas, Heather J., MD

Plastic and Reconstructive Surgery – Global Open: May 2017 - Volume 5 - Issue 5 - p e1349
doi: 10.1097/GOX.0000000000001349
Original Article
Open
SDC
United States

Summary: A labiaplasty is a surgical procedure that reduces the length of redundant labia minora. The trim, also known as edge excision, linear, and amputation labiaplasty, is a technique commonly used. Complications associated with a trim labiaplasty include overresection and scalloped labia edges. This video features an operative technique that aims to reduce labia minora to an appropriate final length with smooth, unscalloped edges.

From the Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, Calif.

Received for publication February 25, 2017; accepted April 7, 2017.

Each of the two patients featured signed a PRS-GO–specific video consent.

Disclosure: The author has no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the author.

Supplemental digital content is available for this article. Clickable URL citations appear in the text.

Heather J. Furnas, MD, Adjunct Assistant Professor, Division of Plastic and Reconstructive Surgery, Stanford Medical School, 4625 Quigg Drive, Santa Rosa, CA 95409, E-mail: DrFurnas@enhanceyourimage.com

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

A labiaplasty is a surgical procedure that reduces the length of redundant labia minora. The procedure is increasing in popularity, with patients requesting it for both functional and appearance-related symptoms.1

The best technique is the one the plastic surgeon is most comfortable with and which achieves consistent results. Nonetheless, specific techniques offer unique advantages. For example, the wedge, among the most commonly performed techniques, can be an excellent option for the patient with thin, well-defined labia edges.2 The trim technique, on the other hand, can be a good choice in patients who dislike their thick, darkly pigmented, or rough edges.3–5

When performing a trim, also known as an edge excision, linear, or amputation labiaplasty, a surgeon’s good technique can help reduce complications, including bleeding, hematoma, scar contracture, painful or hypersensitive scars, and scalloped edges3–5 (see video, Supplemental Digital Content 1, which features an operative technique that aims to minimize such complications by observing anatomic landmarks to preserve sufficient labia length while also incorporating suture techniques that promote smooth, flat scars. This video is available in the Related Videos section of the Full-Text article on PRSGlobalOpen.com or available at http://links.lww.com/PRSGO/A445).

Video Graphic 1.

Video Graphic 1.

During the initial examination, the patient can hold a hand mirror to view her genitalia while she is positioned in stirrups as the surgeon discusses both her anatomy and the procedure. A redundant clitoral hood should prompt the surgeon to discuss reduction. Failure to reduce a redundant clitoral hood can result in an imbalance that can be distressing to the patient after a labiaplasty alone has been performed.

The case presented in the accompanying video shows a simple trim technique. Reducing a heavy clitoral hood and extremely long labia is a complex procedure beyond the scope of this video.

A labiaplasty is easily performed under local anesthesia with oral sedation. After being lightly sedated, the patient is placed on an operative table equipped with padded, supportive stirrups.

The frenulum serves as a landmark for marking. If it is transected, the frenulum will heal like a small ball, which may be distressing to the patient. Using a sterile marker, the surgeon should mark a gentle arc from the frenulum to the posterior labium.

Next the patient is injected with 1% xylocaine with 1:100,000 epinephrine, buffered 4:1 with sodium bicarbonate. Patients typically tolerate injection with a 30-gauge needle without topical anesthesia, which can swell and distort the labia.

Although a scalpel, scissors, radiofrequency, or laser can be used for resection, scissors allow fine control without thermal injury. After hemostasis, the central lamina of the labium is sutured with a horizontal running 5-0 chromic suture. One or 2 additional lengths of suturing, each more distal, help control hemostasis, prevent wound dehiscence, and create a pleasing shape. The mucosa is closed with a subcuticular 5-0 chromic suture.

Patients are instructed to take it easy for a week, during which they ice, elevate, and urinate in the shower or with a squirt bottle on the toilet. Tampons and intercourse are avoided for 4 weeks, and activities like cycling may be resumed after 6 weeks. Swelling can last 3–6 months.

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REFERENCES

1. Sorice SC, Li AY, Canales FL, et al. Why women request labiaplasty. Plast Reconstr Surg. 2017;139:856–863.
2. Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2008;122:1780–1789.
3. Oranges CM, Sisti A, Sisti G. Labia minora reduction techniques: a comprehensive literature review. Aesthet Surg J. 2015;35:419–431.
4. Hamori CA. Aesthetic surgery of the female genitalia: labiaplasty and beyond. Plast Reconstr Surg. 2014;134:661–673.
5. Lista F, Mistry BD, Singh Y, et al. The safety of aesthetic labiaplasty: a plastic surgery experience. Aesthet Surg J. 2015;35:689–695.

Supplemental Digital Content

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Copyright © 2017 The Author. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.