The debate rages on among cosmetic gynecologic and plastic surgeons: which technique — linear/trim or V-wedge modification — is the best for performing a labiaplasty for excessive-sized, redundant labia minora, with or without redundancy of the clitoral hood? One has only to read popular, often-accessed, websites like RealSelf to realize that strong opinions abound. There are two major camps: the acolytes of the V-Wedge and the proponents of the linear/trim method.
Unfortunately, those surgeons who insist on only performing one of the two methods may not truly understand that a labiaplasty is an artistic undertaking, one that should be personalized for each individual.
“If all you have is a hammer, everything looks like a nail.”
Most practitioners stick with one method or the other, either because that is the only one they have learned or are comfortable with, or that they have had a couple of bad outcomes with a particular method and ever since studiously prefer the other.
The reality is that no one method holds the sacred key. The overriding goal of labiaplasty for a given woman should, in my opinion, be the right procedure for the right woman for the right reason. Given this philosophy and the fact that each woman’s labia are different, an ideal surgeon is one who is capable of and willing to perform different techniques so they can choose the proper approach for a given patient.
I have never seen two women who look exactly the same (or, for that matter, 2 sides on the same woman that look the same.) I favor individualizing technique dependent on a woman’s individual anatomy and her choice of post-surgical appearance. I can certainly perform either a linear (and its ”sisters” “trim” and “curvilinear”) or V-Wedge (and its “sisters” V-Y wedge, Z-plasty, and superior/inferior flap rotation) on any patient. But it is not at all rare to find that either because of anatomy, individual patient choice, or different recovery realities for different patients, one procedure choice stands out as best.
In an ideal world, your genital plastic/cosmetic surgeon should be an artist, and your individual labia his or her palette. This calls for your surgeon to be facile with more than one technique. When counselling patients as to their choice of surgeon, I always suggest that the surgeon should be comfortable performing linear, wedge, and their modifications so as to choose his or her technique based on your desires and your anatomy, not solely on what technique he or she knows how to perform.
An extremely important issue involves the clitoral hood. While there are serviceable techniques for encompassing enlarged and redundant hoods in either linear or wedge modifications, it is important that your surgeon be both experienced and comfortable with reducing an aesthetically or functionally robust hood. Avoid any surgeon who cannot prove to you by his/her knowledge, backed by many photos, that he/she is savvy and experienced with hood reduction.
You can see several before and after photos of labiaplasty/hood reduction procedures performed by both linear and wedge techniques, with explanations about each one, by clicking to visit this page.
You can begin to get an idea why it is important for your surgeon to be both an architect and an artist, to be savvy in alternative techniques, and to be able to design the procedure to specifically fit your anatomy.
To be sure, a fine and experienced surgeon can obtain a solid outcome in any woman 80-90% of the time, but there are many women whose anatomy and/or outcome choice better fits one technique or the other. While at least 6-7 different procedures for labiaplasty have been described in the page linked above, and indeed entrepreneurial surgeons have added their own names to their various modifications on a theme, all techniques and modifications thereof are based either on curvilinear resection (aka “trim”), V-wedge, or de-epithelialization/fenestration techniques.
So… “which technique is best?!”
As you can see, it is the technique that best fits the circumstances of the individual woman. In experienced hands, both V-wedge and linear resection modifications can fare well, but it takes patience, experience, an artistic bent, and knowledge of alternative techniques to adequately service all individual patients. Please access “Labiaplasty” from the dropdown “Genital Plastic” menu to view many more examples.