Labia minora enlargement is usually congenital in origin. It may appear in childhood but becomes more obvious in adolescence. Occasionally, a woman will state that her labia minora increased with pregnancy, birth control pills, aging, or male hormone supplements. Ideally, the woman wants thin, straight, light-colored, non-redundant, symmetrical labia minora.
Traditionally, labia minora reduction has been performed by trimming the protruding labia along the entire labial edges. The trimming is performed using a scissor, knife, clamp, or laser. This procedure has the advantages of eliminating some of the dark pigmentation disliked by some women and the short operative time. However, the disadvantages are elimination of the natural labial edge which is replaced by an incision line and oftentimes a wide, irregular scar; difficulty making symmetrical labia; an often unnatural transition between the labium, clitoral frenulum, and clitoral hood; the possibility for over-removal of the labia; and the potential for a higher incidence of postoperative and chronic discomfort from irritation of the scar-line. Because of the disadvantages, the extended central wedge technique was developed which may also include partial reduction of the clitoral hood.
The central wedge labia reduction with extended clitoral hood resection (“Alter technique”) was developed in response to the issues of the trimming labioplasty. A wedge or “V” is excised from the most protuberant portion of each labium. Since the labia are often asymmetrical, the amount of the wedge removed is varied to achieve symmetry. The top of the wound is then sutured to the bottom resulting in a much smaller labium with a normal edge and anatomy. The suture line goes from inside the opening of the vagina across the labial edge and then along the outside of the labium.
If there is enlargement or extra folds of the clitoral hood during central wedge labial reduction, the outside excision on each side is often curved up to remove the sides of the hood.
Complications are extremely uncommon if meticulous surgery is performed. Approximately two per cent will have a slight separation at the labial edge. However most of the visible small separations will resolve in four to six months and not require revision. Less than one percent will have a wound disruption. Rare surgical revisions may need to be performed for asymmetry of the labia minora or clitoral hood, unsightly or stretched scars, or separations of the labial edges. Revisions are delayed a minimum of four months after initial surgery to allow for healing.
The success rate of the central wedge reduction has been published in the plastic surgery literature with almost universal patient satisfaction rate with minimal complications, if performed by an experienced surgeon.
Alter’s recent study in 407 patients revealed an average patient satisfaction rate of 9.2 out of 10 (10 most pleased). Improvement in self-esteem (93%), sex-life (71%), and discomfort (95%) occurred with a low significant complication rate (4%).