Vaginal Labiaplasty

Sir: I read with great interest the recent article by Motakef et al. in which a simplified labial classification system based on the distance of the lateral edge of the labia minora from that of the labia majora, rather than from the introitus, is proposed.1 As their well-written article also provides a comprehensive and systematic review of the different methods of labiaplasty, I would like to take the opportunity to further expand on this topic. In 2011, my colleagues and I published a labiaplasty technique named "bidimensional labia minora reduction."2 Further communications were published later in other major plastic surgery journals.3,4 Our technique involves the central deepithelialization of the upper labium associated with a lower wedge resection less than 90 degrees (Fig. 1). Such association allows the preservation of the naturally darker corrugated edges and reduces both labial width and labial length. In this way, the festooned appearance, sometimes observed when applying just labial deepithelialization, is avoided.2,5Fig. 1: Schematic representation of the technique showing the area of deepithelialization and the posterior wedge resection.By resecting a smaller wedge of labium, a tension-free closure and good vascularization to the healing edges are ensured, thus reducing the chances of wound dehiscence, which is the most common complication for all techniques according to the authors.1 In contrast, the scar resulting from wedge resection is placed posteriorly, where it is easily hidden, with a reduced chance of labial distortion in case of scar contracture. Because just a partial-thickness repair takes place on the deepithelialized sides of the upper labium, this usually results in imperceptible scars that heal very well, with excellent aesthetic results. The technique has proven useful for treating class I and II defects according to this recently proposed classification of labial protrusion.1 Because the closure of deepithelialized areas telescopes the labial tissue, cases of labia with excessive subcutaneous tissue or width (class III) might not be good candidates for the bidimensional technique. In summary, our technique is a valid resource that attains an effective reduction in both length and width, preserving the dark corrugated labial border and avoiding a festooned appearance. Because in plastic surgery "no key fits every lock," each technique should have its own indication according to the characteristics of every case. We, as plastic surgeons committed to delivering the best possible surgical result, should be aware of all available techniques and choose the most applicable one in every case. DISCLOSURE The author has no financial interest to declare in relation to the content of this communication. Horacio F. Mayer, M.D. Department of Plastic Surgery Hospital Italiano de Buenos Aires Peron 4190, 1er. Piso Buenos Aires C1181ACH, Argentina [email protected]