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Aesthetic surgery of women’s genitals: reduction of large labia minora
Large labia minora can result in chronic irritations, worsened hygiene, interfere with sexual intercourse and be aesthetically displeasing. The solution is surgical reduction, and the technique addressed here is inferior wedge reduction with superior pedicle flap reconstruction.(1, pdf)
See the article for the details and the pictures. The response to this article was published as the following Letter to the Editor,(2) which addresses how the procedure can be improved –
Sir:
I congratulate Dr. Munhoz and colleagues1 on their modification of the central wedge technique, which I reported in 1998.2 I applaud them for emphasizing the importance of preserving the natural labial borders to maintain a normal appearance and to prevent a possibly painful scar.
The authors used inferior wedge resection and superior pedicle flap reconstruction to perform a labia minora reduction. Although I agree that a wedge technique is preferable, I do not believe the inferior wedge gives a better result, for several important reasons. Women seeking this operation desire removal of the most bulky and protruding tissue. Removal of an inferior wedge leaves the bulky superior tissue as the labial edge. Often the inferior edge of the labium is the thinnest and least protuberant portion, as illustrated in their Figures 1 and 5. Removal of this area, therefore, is counterproductive. In contrast, a central wedge can be placed to remove the most objectionable portion of each labium. Perhaps the authors chose the superior pedicle as a solution to the difficulty in approximating the thicker upper labium, which is attached to a thick, convoluted, lateral clitoral hood to the thinner inferior labial edge. Approximating the inferior flap to the frenulum extension of the clitoris as it ends at the upper labial edge will solve this alignment quandary. Also, the outer wedge excision should then be curved laterally and anteriorly (“hockey stick” ) to excise this redundant lateral labium and excess lateral clitoral hood (if desired by the patient).3 Therefore, the internal and external V excisions are shaped differently, with the intervening subcutaneous tissue preserved while the leading labial edge is precisely re-approximated. Only enough subcutaneous tissue is excised to produce a good cosmetic result. This allows for better subcutaneous closure, which is necessary to prevent wound dehiscence and fistula formation.
The hockey stick lateral wedge excision allows for elimination of much of the unsightly lateral hood, which is a major aesthetic and often functional concern for these women; this issue is not addressed by these authors. In addition, the central wedge flaps are extremely healthy, with wide vascular bases that eliminate the tip necrosis problems seen with the superior flap technique. Therefore, a more predictable and better aesthetic outcome results with a central wedge excision combined with a lateral hockey stick V excision. A more detailed description of my technique and results will be forthcoming shortly.
Gary J. Alter, M.D.
Department of Plastic Surgery
UCLA School of Medicine
416 North Bedford Drive, Suite 400
Beverly Hills, Calif. 90210
altermd [@] altermd.comReferences
- Munhoz, A., Filassi, J., Ricci, M., et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast. Reconstr. Surg. 118: 1237, 2006.
- Alter, G. J. A new technique for aesthetic labia minora reduction. Ann. Plast. Surg. 40: 287, 1998.
- Alter, G. J. Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast. Reconstr. Surg. 115: 2144, 2005.
References
- Munhoz, A. M., Filassi, J. R., Ricci, M. D., Aldrighi, C., Correia, L. D., Aldrighi, J. M., and Ferreira, M. C., Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction, Plast Reconstr Surg, 118, 1237 (2006).
- Alter, G. J., Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction, Plast Reconstr Surg, 120, 358 (2007).
Comments
Here is the reply of the first author to Gary Alter’s comment:
Quote:
I love your site and your message, but this... this is a little twisted. How is this congruent with femininity vs. masculinity in women??? Female genitals, regardless of their size, shape, color, etc. are inherently feminine!
Adris: The information has nothing to do with masculinity-femininity, and is for those who might need it. Sometimes this website will mention surgical solutions to improving looks or functionality, but this doesn’t mean that I am saying that women with the condition addressed must undergo the procedure or that I endorse the procedure.
Medically, I can agree on the worsened hygiene portion, but anything argument beyond is just ludicrous. Are we saying that determining a woman’s beauty should also include the size of her labia?
I agree only with medical reasons for labiaplasty because of constant irritation in tight pants and discomfort when engaging in sports or other physical activities. In many of these instances, women are born with large labia—others may develop this condition with childbirth or age. Surgery of the labia represents a relatively safe solution to most medical reasons. I can understand why for some women with overdeveloped winged labia can be a curse than a blessing. Their lips get pinched in tight pants or get squeezed when riding a bicycle. They slip out of their undies at the worst moments or make an "embarrassing" bump in a bikini.
And why are there an ideal size for the labia minora and majora. They worry that their partner isn't happy with the length of their pussy lips, or that their lips might be either too large or too small to be esthetically pleasing.
But I do not agree with aesthetic reasons. Is there such a thing as the ideal labia size? While some men and lesbians may prefer inner labia that stick out past the outer ones, trying to describe the "ideal" dimensions of the vulva would be a wasted effort.
Some vulvas with smaller inner lips can still be very pretty to many men. Others men prefer a meaty vulva with thick and round outer lips and a fleshy and protruding clit is surely exciting. Large inner lips would simply be a great bonus in such case.
Even the vulvas with large inner labia vary in size and shape from woman to woman. Sometimes the inners are longer towards the front than towards the back, or vice versa. Some are round when spread open while others are pointy. With so many men liking so many different vulva styles, it is impossible to decide upon an "ideal" labia size or shape.
Size preferences can also vary for the same person depending on his or her age. Younger and less experienced men tend to care much less about labia size and may have no preference at all. As they grow a little older and get more experience, it seems that quite often they acquire a taste for larger and more sexually developed labia. For most of them large lips mean nothing more than a welcome novelty, although for others their love for large vulvas may evolve into a true labia fetish.
I think that smaller inner lips can remember to child vagina, so maybe most of men would prefer a slightly meaty vulva to display more sexual maturity.