Barbie Deformity after Edge Labiaplasty: Classification and Repair Algorithm

Background: Influenced by the popularity of “Barbie” shape of labia minora, edge labiaplasty has become the preferred option among patients and surgeons alike. However, excessive or inappropriate resection of labial free edges may lead to morphological deformities and dysfunctional symptoms termed as “Barbie deformity”. This study aims to report a classification of Barbie deformity and a repair algorithm to help surgeons select appropriate surgical methods. Methods: A total of 216 patients with Barbie deformity were classified into 3 degrees. Among these, 119 patients underwent repair surgeries by different methods corresponding to the degree of deformity. The surgical outcomes of 87 patients were assessed via follow-up questionnaires. Preoperative and postoperative levels of general psychological distress and self-esteem were compared for 46 patients using standard scales. Results: Barbie deformity was identified on 338 sides: 158 were Grade I, 106 were Grade II, 74 were Grade III, and 187 had vestibular mucosa exposure. Repair surgeries were performed on 189 sides: 53 via edge trimming, 99 via wedge excision, 32 with an island clitoral hood flap, and 5 with Gress’s composite method. The complication rate was 4.8%. Genital appearance was improved in 96.6%, preoperative discomfort was resolved or significantly reduced in 74.2%, and overall satisfaction was 86.2%. The general psychological distress and self-esteem scores also improved significantly after surgery. Conclusion: The goal of repairing Barbie deformity is not only to improve the appearance of the genitals but to also restore the position and function of the mucosa. Preventing Barbie deformity is much more important than repairing it.