Laguna Beach, CA
View My Professional Profile
November 25, 2014 1:38 AM
Great question. I am happy to give my opinion on this topic. I perform curved linear excisions and avoid the wedge technique for many reasons. First, curved linear excisions are also
Great question. I am happy to give my opinion on this topic. I perform curved linear excisions and avoid the wedge technique for many reasons. First, curved linear excisions are also referred to as the Trim Method or the Amputation technique. The Trim and Amputation terminology are somewhat derogatory in tone so most gynecologists do not use those terms. They are terminology used by plastic surgeons in general. Since there is no set terminology on these techniques the most widespread ones used are "linear excision" and wedge excision. I do both techniques but I do have my biases as explained below.
Here are some facts about Wedge labiaplasty techniques. It is true that this excision of a pizza shaped area of the labia minora is the best method to give you the natural look of labial edges and maintains the darkness and waviness of the edges. You reduce the size by removing one or several wedges sometimes called "Z-Plasties." If you can picture the old Pac Man then you can picture how a wedge labiaplasty is done. You cut out the wedge and then sew the edges together. You get a horizontal scar that forms on the inside and outside parts of the labia minora. The downsides is that you do maintain that dark edges that 99+% of my patients want removed. I have never heard from any of my patients in 20+ years that they desired to keep the dark and wavy edges. Almost all universally want those dark edges reduced, removed, and made less prominent. Another downside is that a wound breakdown of wedge labiaplasties (up to 25% in published and anecdotal reports) is a disaster and very heartbreaking. The bloodflow for the edges to heal sometimes is just not there and is interrupted. Sometimes those edges just do not line up well and you have holes in the middle, swiss cheese look, or jagged rims that occur. Most of my repair work for botched labiaplasties are attempts at wedge techniques. Lastly, the wedge technique is very very limited in the amount of tailoring you can do. You can only remove so much before there is too much tension on the edges and separation of the wound occurs. You cannot do a Barbie Look labiaplasty using the wedge technique. On the good side, wedge labiaplasties rarely if ever result in "Dog Ears" when labiaplasty and clitoral hood reductions are done.
Now my comments on the linear excision technique. It is not perfect but does have fewer complications in my humble opinion. Wound breakdowns are significantly less. When done properly there is almost no tension on the edges. Wound breakdowns are extremely rare. You do not get the "Pac Man" look when the wound occasionally breaks down. In fact, even if all the sutures of a curved linear labiaplasty breaks down, like a Barbie or Hybrid or a Rim labiaplasty that I do, the tension is limited and healing is still quite satisfactory to beautiful as long as the patient keeps her legs together. The scars are usually better hidden and invisible months after surgery. Sensitivity is maintained and the numbness on the suture line is the same as in wedge labiaplasty surgery. It eventually comes back to various extent and has no affect on arousal, getting wet, having orgasms. Here is the major point I want to make: linear excisions give your surgeon the best opportunity for extreme precision on how you want your labiaplasty to look. With an experienced surgeon and the right tools you can design labial reductions in millimeters, layer by layer, to remove little or remove all. You can remove just the rim of dark labial edges or do the whole labia minora reduction to achieve the Barbie or Hybrid Look. Curved linear excisions can provide the most comfort for athletes who do not want any protuberance of their labia. Cannot do that with the wedge.
1. Wedges heal faster: Not true at all. No matter what technique tissue heals at a rate inherent to the patient.
2. Wedges give more natural looking results: No, not really. It is true that you can keep the dark edges if you want but do you really want to keep those dark edges with the wedge technique? When a linear excision is done properly it can look every bit as natural as a wedge surgery. Linear excision labiaplasty can be made so natural that your own gynecologist will not know you had surgery. The same can be said for wedge labiaplasty surgery. Think of what you want, the look you prefer, and find the best surgeon for that look.
3. Trim technique has more side effects: Definitely false here. "Side Effects" probably refer to nerve damage or sexual dysfunction or pain. When done properly either technique can achieve beautiful results with none of these "side effects." More accurately speaking, the complication rates when comparing the two techniques are probably very very similar. Same bloodless, same anesthesia complication, same infection rates. But it is true that wedge labiaplasties have more tension on the suture lines and break down more. In my practice, it is true that I fix lots more wedge disasters than linear resection disasters. The one knock on linear resections is that it results in more "Dog Ears" when just excised or "chopped off." The surgeon must make deliberate and delicate excisions at the right locations to make the flow from the clitoral hood to the frenulum to the labia minora smooth and flowing. That is where experience comes in. One last thing, linear resections do not result in more "permanent numbness" than wedge surgery. Absolutely no proof of that one. That is just something said by many surgeons based on inexperience, innuendos, or deliberate deception. Ask for proof on this question.
1. Plastic surgeons probably do more wedge labiaplasties than linear excisions. Their literature is full of various wedge and Z-Plasty articles.
2. Gynecologists do more linear resections. They were usually not trained in wedge or Z-Plasties.
3. One technique does not cover all the various requests for specific appearances requested by patients. Better to know both techniques even if one is primary over the other in your practice.
4. I am not the perfect surgeon for all patients. Do your homework and check out credentials and results. If your surgeon has a hard time showing you his results, his Before and After photos, if he or she has funky reasons for not showing you his work, then be suspicious regarding his skill level and volume of work done in this area. Make sure your surgeon passes the Sniff Test.
Hope this helps.
Red Alinsod, MD