Video

Operative Technique
Trim Labiaplasty
Heather J. Furnas, MD
Summary: A labiaplasty is a surgical procedure that reduces the length of redun-
dant labia minora. The trim, also known as edge excision, linear, and amputation
labiaplasty, is a technique commonly used. Complications associated with a trim
labiaplasty include overresection and scalloped labia edges. This video features
an operative technique that aims to reduce labia minora to an appropriate final
length with smooth, unscalloped edges. (Plast Reconstr Surg Glob Open 2017;5:e1349;
doi: 10.1097/GOX.0000000000001349; Published online 23 May 2017.)

A
labiaplasty is a surgical procedure that reduces the
length of redundant labia minora. The procedure
is increasing in popularity, with patients requesting
it for both functional and appearance-related symptoms.1
The best technique is the one the plastic surgeon is
most comfortable with and which achieves consistent re-
sults. Nonetheless, specific techniques offer unique advan-
tages. For example, the wedge, among the most commonly
performed techniques, can be an excellent option for the
patient with thin, well-defined labia edges.2 The trim tech-
nique, on the other hand, can be a good choice in patients
who dislike their thick, darkly pigmented, or rough edges.35
When performing a trim, also known as an edge ex-
cision, linear, or amputation labiaplasty, a surgeons good
technique can help reduce complications, including bleed- Video Graphic 1. See video, Supplemental Digital Content 1, which
ing, hematoma, scar contracture, painful or hypersensitive features an operative technique that aims to minimize such compli-
scars, and scalloped edges35 (see video, Supplemental cations by observing anatomic landmarks to preserve sufficient la-
Digital Content 1, which features an operative technique bia length while also incorporating suture techniques that promote
that aims to minimize such complications by observing smooth, flat scars. This video is available in the Related Videos sec-
tion of the Full-Text article on PRSGlobalOpen.com or available at
anatomic landmarks to preserve sufficient labia length
http://links.lww.com/PRSGO/A445.
while also incorporating suture techniques that promote
smooth, flat scars. This video is available in the Related Vid-
eos section of the Full-Text article on PRSGlobalOpen.com dundant clitoral hood can result in an imbalance that can
or available at http://links.lww.com/PRSGO/A445). be distressing to the patient after a labiaplasty alone has
During the initial examination, the patient can hold a been performed.
hand mirror to view her genitalia while she is positioned The case presented in the accompanying video shows
in stirrups as the surgeon discusses both her anatomy and a simple trim technique. Reducing a heavy clitoral hood
the procedure. A redundant clitoral hood should prompt and extremely long labia is a complex procedure beyond
the surgeon to discuss reduction. Failure to reduce a re- the scope of this video.
A labiaplasty is easily performed under local anesthesia
with oral sedation. After being lightly sedated, the patient
From the Division of Plastic Surgery, Department of Surgery, is placed on an operative table equipped with padded,
Stanford University, Stanford, Calif. supportive stirrups.
Received for publication February 25, 2017; accepted April 7, The frenulum serves as a landmark for marking. If it is
2017. transected, the frenulum will heal like a small ball, which
Each of the two patients featured signed a PRS-GOspecific video may be distressing to the patient. Using a sterile marker,
consent.
Copyright 2017 The Author. Published by Wolters Kluwer Health, Disclosure: The author has no financial interest to declare
Inc. on behalf of The American Society of Plastic Surgeons. This in relation to the content of this article. The Article Processing
is an open-access article distributed under the terms of the Creative Charge was paid for by the author.
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the
work provided it is properly cited. The work cannot be changed in Supplemental digital content is available for this
any way or used commercially without permission from the journal. article. Clickable URL citations appear in the text.
DOI: 10.1097/GOX.0000000000001349

www.PRSGlobalOpen.com 1

the surgeon should mark a gentle arc from the frenulum
to the posterior labium.
Next the patient is injected with 1% xylocaine
with 1:100,000 epinephrine, buffered 4:1 with sodium
bicarbonate. Patients typically tolerate injection with a
30-gauge needle without topical anesthesia, which can
swell and distort the labia.
Although a scalpel, scissors, radiofrequency, or laser
can be used for resection, scissors allow fine control with-
out thermal injury. After hemostasis, the central lamina
of the labium is sutured with a horizontal running 5-0
chromic suture. One or 2 additional lengths of suturing,
each more distal, help control hemostasis, prevent wound
dehiscence, and create a pleasing shape. The mucosa is
3. Oranges CM, Sisti A, Sisti G. Labia minora reduction tech-
closed with a subcuticular 5-0 chromic suture.
Patients are instructed to take it easy for a week, during
which they ice, elevate, and urinate in the shower or with
a squirt bottle on the toilet. Tampons and intercourse are
avoided for 4 weeks, and activities like cycling may be re-
sumed after 6 weeks. Swelling can last 36 months.
PRS Global Open 2017
Heather J. Furnas, MD
Adjunct Assistant Professor,
Division of Plastic and Reconstructive Surgery,
Stanford Medical School
4625 Quigg Drive
Santa Rosa, CA 95409
E-mail: DrFurnas@enhanceyourimage.com
REFERENCES
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using extended central wedge resection. Plast Reconstr Surg.
2008;122:17801789.
niques: a comprehensive literature review. Aesthet Surg J. 2015;35:
419431.
4. Hamori CA. Aesthetic surgery of the female genitalia: labiaplasty
and beyond. Plast Reconstr Surg. 2014;134:661673.
5. Lista F, Mistry BD, Singh Y, et al. The safety of aesthetic labiaplas-
ty: a plastic surgery experience. Aesthet Surg J. 2015;35:689695.