Labial reduction is a term used to describe any surgical procedure that is intended to reduce the size and volume of the labia minora. The criteria for labial reduction are either functional or aesthetic, though in the majority of cases the latter is predominant. This is ironic in view of the fact that the ideal female vulva does not exist, rather a wide range of labial lengths and widths, as well as clitoral sizes.
The labia minora are the 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.
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:
- 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
There is often a high patient satisfaction rate, from 94-100%. Postoperative complications do occur, though rarely, 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.
This procedure is also called direct excision and was the earliest form of labia reduction. It consists of marking oval areas along the most protuberant part of the labia on both medial and lateral aspects. This is followed by making an incision along the outer edge of the redundant labia to directly trim off the thick and/or dark skin at the edge. The shape of the labia may be adjusted at the same time. The skin is then sutured for cosmetic appearance and healing, as well as to achieve good hemostasis.
This procedure removes enough loose labial skin to make the resulting labia look smaller and thinner. At the same time the entire edge of the labia is preserved and any rugosity is tightened up to make the labia look smoother. The edge is usually the part which shows hyperpigmentation, and this is also resolved in patients who dislike the darker coloration. By removal of the labial edges, the pinker interior parts become visible in many cases. It is important to keep the labial length at 1 cm or more, to prevent adverse effects. Proper technique results in the absence of postoperative tautness, thereby ensuring that intercourse will not be affected.
Indications for edge resection include
- congenital labial hypertrophy
- lax or rugose labia minora
- darkening of the labia
- hypertrophy following aging or pregnancy
The chief disadvantage of labiaplasty is that it leaves a scar along the outer or free edge of the labia. It might disrupt the neurovascular supply to part of the labia and reduce future sensation and enjoyment, though this is rare because of the removal of tissue only from the central part of the labia. The potential for over-zealous excision and consequent over-reduction of the labia also exists, which may lead to exposure of the vaginal opening. This procedure may result in asymmetrical labia minora.
A poor surgical technique may lead to dog’s ears appearing anteriorly and posteriorly as unappealing protrusions on either end of labia which are very small centrally. Finally, it is sometimes possible that the clitoral hood may become excessively conspicuous and overhang the labia minora after the procedure, creating dissatisfaction with the aesthetic results and necessitating a revision surgery later. This itself is difficult because of the lack of labial tissue for reconstruction following the previous procedure.