Trim vs Wedge Labiaplasty – Making the Choice

All labia have distinct personalities. You will never find two that look the same (sometimes, even in the same person!) Given that there are many sizes and shapes of vulva, it just doesn’t make sense that there would be a “one-size-fits-all” method of performing a labiaplasty. In addition to taking into consideration the size and shape of the patient’s labia, the surgeon also must account for the patient’s objectives in performing a labiaplasty. Once this information is obtained, the surgeon can determine which method of labiaplasty would best meet the patient’s goals. A clitoral hood reduction is often performed at the same time.

The two main types of labiaplasty are the trim method and the wedge method.

Trim Labiaplasty

The trim labiaplasty works well for most of my patients. If both labia are large or elongated, or if the patient does not like the darker edges of the labia, then the trim technique is a good option. In the trim labiaplasty, the edges of the entire labia, from top to bottom, are removed and contoured to match each other. The suture line then runs the whole length of the labial edge.

The Wedge Method

During a wedge labiaplasty, I remove a triangular piece of the labia and then suture the two edges together to reduce size and protrusion. This retains the natural contours and pigmentation of the labia minora, which may or may not be desirable, depending on the patient’s preference. The wedge may be a good way to correct asymmetry if only one labia needs correction.

Certain shapes of labia really lend themselves well to the wedge labiaplasty. For example, this shape…

You can see that if we just took out a wedge of tissue that included the longer, thinner, protruding part of the labia and brought the edges of the wound back together, the patient would continue to have their natural labial edge. The suture line is not on the edge of the labia, but rather it is buried within the labia.

Asymmetric Labia

The other situation I find myself using the wedge technique is when the patient has asymmetric labia (one labia is bigger or longer than the other).

The patient may only want me to operate on the larger labia and leave the smaller labia alone. Taking out a wedge of tissue will leave the patient with borders of the labium that match the one not operated on. If I did a trim technique in this scenario, the edges of one labium would not match the other.