Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2023; 50(01): 017-025
DOI: 10.1055/a-1938-0991
Breast/Trunk
Review Article

An Algorithm for Labia Minora Reduction Based on a Review of Anatomical, Configurational, and Individual Considerations

Maurits Lange
1   Departments of Plastic and Reconstructive Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
,
J. Joris Hage 
1   Departments of Plastic and Reconstructive Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
,
Refaat B. Karim 
2   Department of Plastic Surgery at the A-Klinieken, Huis ter Heide, The Netherlands
,
Frédéric Amant 
3   Departments of Gynecology at The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
4   Department of Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
5   Department of Oncology, KU Leuven, Belgium
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

A variety of reduction labiaplasty techniques have been introduced to date, but no single technique will offer the optimal solution for every patient. Rather, the technique should be chosen based on anatomical, configurational, and technical considerations, as well as on patients' personal preferences regarded maintenance of the labial rim, maintenance of labial sensitivity, and prevention of iatrogenic thickening of the labium. We reviewed, defined, and assessed labial configurational variety, neurovascular supply, reduction techniques, and patient's preferences as the considerations relevant to the choice of labiaplasty technique. Based on this review, an algorithm was constructed that leads to a choice of reduction technique through five decisions to be made regarding (1) resection or (partial) retention of the labial free rim, (2) the measure of required labial width reduction, (3) labial vascular status, (4) prevention of iatrogenic labial thickening, and (5) preservation of labial sensibility. The choice of techniques includes edge trimming, central spindle form de-epithelialization or full-thickness resection, and three modifications of the wedge resection or de-epithelialization technique. These three modifications comprised a modified anterior resection or de-epithelialization combined with posterior flap transposition, a custom flask resection or de-epithelialization, and a modified posterior wedge resection or de-epithelialization combined with anterior flap transposition. Use of the five decisional steps and the inclusion of modifications of all three conventional reduction techniques offer an improved algorithm for the choice of labioplasty technique.

Keywords

algorithm - female - vulva - cosmetic surgery - review

Research Involving Human Participants

This article does not contain any studies with humans performed by any of the authors.


Research Involving Animals

This article does not contain any studies with animals performed by any of the authors.


Patient Consent

Informed consent was obtained from the individual participants of whom photographs were included in the study.


Ethical Approval

The Institutional Review Board confirmed that no ethical approval is needed for this review study.


Authors' Contributions

M.L. contributed to the conceptualization, investigation, data curation, methodology, and formal analysis of the study, and to the visualization and writing of the original draft and final manuscript. He accepts full accountability for all aspects of the work.

J.J.H. contributed to the project administration, conceptualization, investigation, methodology, formal analysis, and supervision of the study, and to writing the original draft and final manuscript. He accepts full accountability for all aspects of the work.

R.B.K. contributed to the conceptualization, formal analysis and interpretation of data, and to the writing of the original draft and final manuscript. He accepts full accountability for all aspects of the work.

F.A. contributed to the project administration, the conceptualization, resources, investigation, methodology, formal analysis and supervision of the study, and to writing the original draft and final manuscript. He accepts full accountability for all aspects of the work.




Publication History

Received: 07 April 2022

Accepted: 17 August 2022

Accepted Manuscript online:
07 September 2022

Article published online:
06 February 2023

© 2023. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Vieira-Baptista P, Almeida G, Bogliatto F. et al. International Society for the Study of Vulvovaginal Disease recommendations regarding female cosmetic genital surgery. J Low Genit Tract Dis 2018; 22 (04) 415-434
    CrossrefPubMedGoogle Scholar
  • 2 Chibnall K, McDonald K, Kirkman M. Pathologising diversity: medical websites offering female genital cosmetic surgery in Australia. Cult Health Sex 2020; 22 (01) 64-80
    CrossrefPubMedGoogle Scholar
  • 3 Boddy J. Re-thinking the zero tolerance approach to FGM/C: the debate around female genital cosmetic surgery. Curr Sex Health Rep 2020; 12: 302-313
    CrossrefGoogle Scholar
  • 4 Society TA. The Aesthetic Plastic Surgery National Databank Statistics 2020 2021 Accessed September 28, 2022, at: https://cdn.theaestheticsociety.org/media/statistics/aestheticplasticsurgerynationaldatabank-2020stats.pdf
  • 5 Munhoz AM, Filassi JR, Ricci MD. et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast Reconstr Surg 2006; 118 (05) 1237-1247
    CrossrefPubMedGoogle Scholar
  • 6 Ellsworth WA, Rizvi M, Lypka M. et al. Techniques for labia minora reduction: an algorithmic approach. Aesthetic Plast Surg 2010; 34 (01) 105-110
    CrossrefPubMedGoogle Scholar
  • 7 Ellsworth WA, Rizvi M, Smith B, Cohen B, Dinh T. Labia minora reduction: guidelines for procedure choice. Plast Reconstr Surg 2010; 125 (05) 216e-217e
    CrossrefPubMedGoogle Scholar
  • 8 González PI. Classification of hypertrophy of labia minora: consideration of a multiple component approach. Surg Technol Int 2015; 27: 191-194
    PubMedGoogle Scholar
  • 9 Kaya AE, Dogan O, Yassa M, Basbug A, Çalışkan E. A novel technique for mapping the vascularity of labia minora prior to labiaplasty: cold light illumination. Geburtshilfe Frauenheilkd 2018; 78 (08) 775-784
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Yang E, Hengshu Z. Individualized surgical treatment of different types of labia minora hypertrophy. Aesthetic Plast Surg 2020; 44 (02) 579-585
    CrossrefPubMedGoogle Scholar
  • 11 Choi HY, Kim KT. A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty). Plast Reconstr Surg 2000; 105 (01) 419-422 , discussion 423–424
    CrossrefPubMedGoogle Scholar
  • 12 Giraldo F, González C, de Haro F. Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast Reconstr Surg 2004; 113 (06) 1820-1825 , discussion 1826–1827
    CrossrefPubMedGoogle Scholar
  • 13 da Cunha FI, da Silva LM, de Araújo Costa L, Paes Vasconcelos FR, Trombetta Amaral G. Nymphoplasty: classification and technical refinements. Rev Bras Cir Plást 2011; 26: 507-511
    Google Scholar
  • 14 Furnas HJ, Canales FL, Pedreira RA, Comer C, Lin SJ, Banwell PE. The safe practice of female genital plastic surgery. Plast Reconstr Surg Glob Open 2021; 9 (07) e3660
    CrossrefPubMedGoogle Scholar
  • 15 Franco T, Franco D. Hipertrofia de ninfas. J Bras Ginecol 1993; 103: 163-165
    Google Scholar
  • 16 Hamori CA, Stuzin JM. Female cosmetic genital surgery. Plast Reconstr Surg 2018; 141 (04) 916-918
    CrossrefPubMedGoogle Scholar
  • 17 Chang P, Salisbury MA, Narsete T, Buckspan R, Derrick D, Ersek RA. Vaginal labiaplasty: defense of the simple “clip and snip” and a new classification system. Aesthetic Plast Surg 2013; 37 (05) 887-891
    CrossrefPubMedGoogle Scholar
  • 18 Smarrito S. Classification of labia minora hypertrophy: a retrospective study of 100 patient cases. JPRAS Open 2017; 13: 81-91
    CrossrefGoogle Scholar
  • 19 Dickinson RL. The Vulva and Breast. A Topographical Hand Atlas of Human Sex Anatomy. 2nd edition. Baltimore, USA: Williams Wilkins; 1949: 40-70
    Google Scholar
  • 20 Hodgkinson DJ, Hait G. Aesthetic vaginal labioplasty. Plast Reconstr Surg 1984; 74 (03) 414-416
    CrossrefPubMedGoogle Scholar
  • 21 Filho OP, Ely JB, Lee KH, Paulo EM. Labiaplasty with stable labia minora retraction-butterfly-like approach. Plast Reconstr Surg Glob Open 2020; 8 (04) e2664
    CrossrefPubMedGoogle Scholar
  • 22 Jayle III F. Les nymphes ou petites lèvres. La gynécologie, Tome 1 - Lánatomie morphologique de la femme. Paris: Masson; 1918: 365-95
    Google Scholar
  • 23 Heusse J-L, Cousin-Verhoest S, Aillet S, Watier É. Mise au point sur les techniques de nymphoplastie de réduction. Ann Chir Plast 2009; 54: 126-134
    CrossrefPubMedGoogle Scholar
  • 24 Gress S. Aesthetic and functional labiaplasty. Cham, Switzerland: Springer Nature; 2017. Accessed September 28, 2022, at https://link.springer.com/content/pdf/10.1007%2F978-3-319-60222-6.pdf
    CrossrefGoogle Scholar
  • 25 Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM. Female genital appearance: “normality” unfolds. BJOG 2005; 112 (05) 643-646
    CrossrefPubMedGoogle Scholar
  • 26 Lykkebo AW, Drue HC, Lam JUH, Guldberg R. The size of labia minora and perception of genital appearance: a cross-sectional study. J Low Genit Tract Dis 2017; 21 (03) 198-203
    CrossrefPubMedGoogle Scholar
  • 27 Bergh R. Symbolae ad cognitionem genitalium externorum foemineorum II. Monatshefte für praktische Dermatologie 1897; 24: 74-86
    Google Scholar
  • 28 Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg 2008; 122 (06) 1780-1789
    CrossrefPubMedGoogle Scholar
  • 29 Hunter JG. Labia minora, labia majora, and clitoral hood alteration: experience-based recommendations. Aesthet Surg J 2016; 36 (01) 71-79
    CrossrefPubMedGoogle Scholar
  • 30 Alter GJ. A new technique for aesthetic labia minora reduction. Ann Plast Surg 1998; 40 (03) 287-290
    CrossrefPubMedGoogle Scholar
  • 31 Maas SM, Hage JJ. Functional and aesthetic labia minora reduction. Plast Reconstr Surg 2000; 105 (04) 1453-1456
    PubMedGoogle Scholar
  • 32 Yurteri-Kaplan LA, Antosh DD, Sokol AI. et al. Interest in cosmetic vulvar surgery and perception of vulvar appearance. Am J Obstet Gynecol 2012; 207 (05) 428.e1-428.e7
    CrossrefPubMedGoogle Scholar
  • 33 Hayes JA, Temple-Smith MJ. What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy. Aust N Z J Obstet Gynaecol 2021; 61 (03) 331-338
    CrossrefPubMedGoogle Scholar
  • 34 Jiang X, Chen S, Qu S. et al. A new modified labiaplasty combined with wedge de-epithelialization on the medial side and edge resection. Aesthetic Plast Surg 2021; 45 (04) 1869-1876
    CrossrefPubMedGoogle Scholar
  • 35 Gonzalez F, Dass D, Almeida B. Custom flask labiaplasty. Ann Plast Surg 2015; 75 (03) 266-271
    CrossrefPubMedGoogle Scholar
  • 36 Georgiou CA, Benatar M, Dumas P. et al. A cadaveric study of the arterial blood supply of the labia minora. Plast Reconstr Surg 2015; 136 (01) 167-178
    CrossrefPubMedGoogle Scholar
  • 37 Ginger VA, Cold CJ, Yang CC. Structure and innervation of the labia minora: more than minor skin folds. Female Pelvic Med Reconstr Surg 2011; 17 (04) 180-183
    CrossrefPubMedGoogle Scholar
  • 38 Tremp M, Oranges CM, Schaefer DJ, Waldkircher NJ, Schleh AC, Kalbermatten DF. The butterfly technique: a retrospective study for labia minora reduction using an integrated approach. Plast Reconstr Surg Glob Open 2021; 9 (09) e3810
    CrossrefPubMedGoogle Scholar
  • 39 Salmon M. The trunk. In: Taylor GI, Tempest MN, eds. Arteries of the Skin. London, UK: Churchill Livingstone; 1988: 85-128
    Google Scholar
  • 40 Alter GJ. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast Reconstr Surg 2007; 120 (01) 358-359
    CrossrefPubMedGoogle Scholar
  • 41 Hage JJ, van Turnhout AA. Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Ann Plast Surg 2006; 57 (03) 312-316
    CrossrefPubMedGoogle Scholar
  • 42 Laub DR. A new method for aesthetic reduction of labia minora (the de-epithelialized reduction labioplasty) by H.Y. Choi and K.T. Kim - Discussion. Plast Reconstr Surg 2000; 105: 423-424
    CrossrefPubMedGoogle Scholar
  • 43 Bucknor A, Chen AD, Egeler S. et al. Labiaplasty: indications and predictors of postoperative sequelae in 451 consecutive cases. Aesthet Surg J 2018; 38 (06) 644-653
    CrossrefPubMedGoogle Scholar
  • 44 Kelishadi SS, Omar R, Herring N. et al. The safe labiaplasty: a study of nerve density in labia minora and its implications. Aesthet Surg J 2016; 36 (06) 705-709
    CrossrefPubMedGoogle Scholar
  • 45 Solanki NS, Tejero-Trujeque R, Stevens-King A, Malata CM. Aesthetic and functional reduction of the labia minora using the Maas and Hage technique. J Plast Reconstr Aesthet Surg 2010; 63 (07) 1181-1185
    CrossrefPubMedGoogle Scholar
  • 46 Motakef S, Rodriguez-Feliz J, Chung MT, Ingargiola MJ, Wong VW, Patel A. Vaginal labiaplasty: current practices and a simplified classification system for labial protrusion. Plast Reconstr Surg 2015; 135 (03) 774-788
    CrossrefPubMedGoogle Scholar
  • 47 Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynecol 2000; 182 (1 Pt 1): 35-40
    CrossrefPubMedGoogle Scholar
  • 48 Mayer HF, de Elizalde MLB, Duh N, Loustau HD. Bidimensional labia minora reduction. Eur J Plast Surg 2011; 34: 345-350
    CrossrefGoogle Scholar
  • 49 Felicio YdeA. Labial surgery. Aesthet Surg J 2007; 27 (03) 322-328
    CrossrefPubMedGoogle Scholar
  • 50 Kreklau A, Vâz I, Oehme F. et al. Measurements of a ‘normal vulva’ in women aged 15-84: a cross-sectional prospective single-centre study. BJOG 2018; 125 (13) 1656-1661
    CrossrefPubMedGoogle Scholar