Female genital rejuvenation, and in particular labiaplasty, is an increasingly requested procedure.
On many occasions, an isolated labiaplasty is not enough to achieve an optimum result. Surgical techniques that address hypertrophy of the labia minora in an isolated way may produce a disproportion with the clitoris.1,2
Some authors also emphasize the importance of the surgical approach to the clitoris. Alter3 refers to the fact that some of his patients required clitoropexy but does not describe a specific clitoropexy technique.
The goals that we set ourselves with this surgery are as follows:
- -to decrease the size of the labia minora, eliminating the hyperkeratotic and hyperpigmented edge and
- -to reduce the hood skin of the clitoris, and the clitoris projection in an anteroposterior direction.
A trim labiaplasty is designed, maintaining at least 1–1.5 cm in height. The marking into the hood has an inverted V shape. The lateral mark continues down with the lateral labiaplasty mark, and the medial marks come together under the frenulum of the clitoris (seevideo, Supplemental Digital Content 1, which displays design of the labiaplasty with clitoropexy. This video is available in the “Related Videos” section of the Full-Text article on prsglobalopen.com or at http://links.lww.com/PRSGO/B53).
The intervention is made by nerve block to avoid distortion of the tissues. Intravenous sedation is offered.
A 20-mL syringe of bupivacaine 0.5% is used with epinephrine 1:200,000. A total of 10 mL are injected intravaginally medial and anterior to the ischial tuberosity in a fan-like injection. With the remaining 10 mL, another fan-like injection is made some 2 cm cranial at the beginning of the clitoris and in the labia majora.
Full-thickness skin resection is made (seevideo, Supplemental Digital Content 2, which displays skin resection in labiaplasty with clitoropexy. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or at http://links.lww.com/PRSGO/B54).
Dissection of the connective tissue is performed on both sides of the body of the clitoris, until the pubic periosteum is reached. The body of the clitoris is then attached to the pubic periosteum using 2 Vicryl 3–0 sutures, holding the Buck´s fascia and the tunica albuginea approximately in the 4 and 8 o’clock positions to avoid the dorsal nerves of the clitoris (See video, Supplemental Digital Content 3 which displays clitoropexy. This video is available in the “Related Videos” section of the full text article on PRSGlobalOpen.com or at http://links.lww.com/PRSGO/B55).
Closure of the Incisions
The clitoral hood is closed using subcutaneous stitches, and the labia minora are closed using horizontal mattress stitches with Vicryl Rapide 4–0. The medial skin excess formed at the frenulum level is corrected (seevideo, Supplemental Digital Content 4, which displays incisions closure. This video is available in the “Related Videos” section of the Full-Text article on PRSGlobalOpen.com or at http://links.lww.com/PRSGO/B56).
In the postoperative period, intermittent local cold is applied. Intimate hygiene with neutral soap, antibiotic ointment, and protection with gauze is recommended.
Because we have introduced clitoral hood reduction and clitoropexy, we have improved our aesthetic results. During 2016, 101 labiaclitoplasties with clitoropexy were performed. Ninety-three of these patients (92,7%) were either satisfied or very satisfied. We have not observed any increase in complications. We obtained 2 cases of labial hematoma and 6 patients required correction of asymmetries in the interface between the clitoral hood and the labia. With our technique, we have not observed any case of sensory disturbance in the clitoris or changes in orgasm.
We believe that the surgical approach to the clitoris should be considered an integral part of feminine genital rejuvenation when performing a labiaplasty.
The authors thank the nursing team at IM Clinic for always helping in the daily job, especially to Anna Malvesi Izquierdo for the English voice over the video and helping with the translations.
1. Furnas HJ. Trim labiaplasty. Plast Reconstr Surg Glob Open. 2017;5:e1349.
2. Hamori CA. Postoperative clitoral hood deformity after labiaplasty. Aesthet Surg J. 2013;33:1030–1036.
3. Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2008;122:1780–1789.
Supplemental Digital Content
Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.