De-Epithelialization Technique for Labial Reduction

The labia minora are part of the vulva, or female external genitalia. They consist of two small folds of thin and delicate skin that lie on each side of the actual vaginal introitus.

They are about 0.4 to 6.4 cm in length, and about 2 cm wide, on average. It is important to note that the actual range is much wider, with normal variants being anywhere from 1.2 to 10 cm in length and 0.7 to 5 cm in width. interestingly, the two labia of the same woman are very often of different lengths.

This shows that significant variations in labial size from one side to the other, as well as between different women, are perfectly normal and should never be interpreted as hypertrophy or abnormal in any way.

The clitoris is also between 0.2 to 3.5 cm long, and up to 1 cm wide. Contrary to popular thought, a larger clitoris is associated with greater enjoyment and a higher chance of orgasm with sexual intercourse.

What is Labiaplasty?

Labiaplasty is the name given to any procedure which is intended to reshape the labia minora, by changing the shape or size. Several different techniques exist, some of which are no longer in use. Some of them include:

  • De-epithelialization
  • Direct excision or trimming of the redundant edge of the labia
  • Wedge resection including modifications such as central wedge, inferior wedge, extended wedge and posterior wedge resection
  • W-shaped resection and Z-plasty which uses alternative incisions to remove more skin without creating contractures and preserving the skin contour
  • Composite reduction which includes excision of part of the labia as well as extension of the lateral or external incision to remove part of the clitoris, or reposition it if desired
  • Laser labiaplasty which uses laser to remodel the labia

Most of them share a high patient satisfaction rate, from 94-100%; however, postoperative complications still rarely occur and include:

  • Wound dehiscence
  • Fistula formation
  • Wound hematomas
  • Wound infection
  • Unsightly scarring
  • Wound contracture
  • Need for revision surgery
  • Chronic postoperative pain

However, the surgery is thought to be among the safer operations.

Deepithelialization

The deepithelialization technique was introduced by Choi and Kim in 2000, after having performed it in a small group. The central part of the inner aspects of each labia was incised superficially in an oval manner, and the epithelial layer was removed, leaving the subcutaneous tissue largely intact. This was followed by reapproximation of the two edges.

Several modifications have been suggested, such as extending the deepithelialized area to the posterior part of the labium. This was found to have a good cosmetic result and resolve the feeling that the labia are abnormal in almost all patients.

Despite several studies reporting good results, a possible criticism was raised that the labial base became thicker after this procedure, possibly because the subcutaneous tissue was folded in a vertical fashion or telescoped, by the reapproximation of the skin edges.

Complications of this procedure were low, matching those of more complex procedures, and consisted mainly of wound dehiscence in less than 5%, and minor delays in healing.

Reviewed by Afsaneh Khetrapal BSc (Hons)

References

Further Reading

Last Updated: Aug 31, 2017

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