Labia Minora Reduction Using Central Wedge Technique: Central Wedge Technique.

The central wedge labiaplasty removes a "V" or a pie-slice piece of the most protuberant portion of the labium to make it smaller. The anterior and posterior edges of the labium are reapproximated to preserve the normal labial edge and anatomy with minimal scarring. The lateral or medial-lateral clitoral hood can be reduced at the same time. The complication rate is very low if done using meticulous technique, thus avoiding the problems with alternative labiaplasty methods. The patient satisfaction level is well over 90%.

Scrotum Reduction.

Scrotum reduction is a surgical procedure for the management of scrotal enlargement. Men with low-hanging scrotums may present with discomfort, skin chafing, and/or aesthetic concerns. A penoscrotal web frequently needs treatment. The approach to surgery is modified based on the patient's anatomy. Hematoma is the most common surgical complication, necessitating meticulous hemostasis. Recurrence requiring revision surgery is uncommon, and men are usually very pleased with the postoperative results.

Urethral reconstruction using a prefabricated pedicled gracilis flap.

This case study describes a patient who experienced an iatrogenic urethral injury because of a Fournier gangrene debridement. Because of the extent of the debridement, which resected all penile and scrotal dartos tissue, no local flaps that would typically be used to reconstruct a urethral disruption were possible. The authors chose to use a prefabricated pedicled gracilis flap to restore urethral continuity.

Pubic contouring after massive weight loss in men and women: correction of hidden penis, mons ptosis, and labia majora enlargement.

BACKGROUND: Weight gain and subsequent weight loss usually result in unsightly large fat deposition in the pubic areas along with ptosis of the fat pad and skin. Men also complain of burying of the penis and the woman complains of labia majora enlargement, both causing secondary sexual dysfunction, hygiene issues, discomfort, and aesthetic concerns. Even with weight loss, most of these deformities persist. METHODS: The hidden (buried) penis is characterized by a lack of firm attachments between the Buck fascia surrounding the tunica albuginea of the corpora and the dartos fascia and skin. Successful treatment requires the penile skin and dartos fascia to be stabilized to the penile corporal bodies to make the penis one integrated unit. The method of surgery is usually to excise and lift excess pubic skin, eliminate the pubic fat without creating a significant pubic concavity, and stabilize the penile skin to the corporal bodies with tacking sutures dorsally and ventrally. If inadequate penile skin is present, scrotal flaps or skin grafts are used to cover the penis. Treatment of the mons pubis requires similar pubic lifting, fat excision, and pubic tacking. Labia majora reduction requires skin and usually fat excision. RESULTS: Results are excellent with the use of these techniques. CONCLUSIONS: Pubic contouring after massive weight loss in men and women is very successful and safe if performed meticulously. Treatment improves self-esteem along with the associated physical and aesthetic deformities.

Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps.

BACKGROUND: Labia minora reduction (labioplasty, labiaplasty) is the most common female genital aesthetic procedure. The majority of labia reductions are performed by trimming the labial edges. Many of these women present with (1) asymmetry; (2) scalloping of the labial edges with wide, occasionally painful scars; and (3) abrupt termination and distortion of the clitoral hood at its normal junctions with the clitoral frenula and the upper labium. Reconstruction can usually be performed with wedge excisions, labial YV advancement, and touch-up trimming. Reconstruction of a labial amputation, however, required the development of a new clitoral hood flap. METHODS: Twenty-four clitoral hood flaps were performed on 17 patients from June of 2006 through May of 2010. An island clitoral hood flap randomly based on the dartos fascia of the lower clitoral hood and medial labium majus is transposed to the ipsilateral labial defect to reconstruct a labium. Of the 10 patients with unilateral flaps, nine of the patients had previous bilateral labial reductions. Reconstruction of the opposite side in these nine women was performed using one or a combination of the following: wedge excisions, YV advancement flaps, or controlled touch-up trimming. RESULTS: All 24 flaps survived, with four minor complications. Five patients underwent revision of a total of seven flaps, but only two were for complications. As experience increased, revisions for aesthetic improvement became less common. CONCLUSION: Reconstruction of labia minora defects secondary to trimming labia reductions is very successful using a combination of clitoral hood flaps, wedge excisions, and YV advancements.

Aesthetic surgery of the male genitalia.

Appearance of the male genitalia is linked with self-esteem and sexual identity. Aesthetic surgery of the male genitalia serves to correct perceived deficiencies as well as physical deformities, which may cause psychological distress. Attention to patient motivation for surgery and to surgical technique is key to achieving optimal results. In this review, the authors describe aesthetic surgical techniques for treatment of penile and scrotal deficiencies. They also discuss techniques for revision in patients with previous surgery.

Management of the mons pubis and labia majora in the massive weight loss patient.

The high incidence of female obesity and weight loss has resulted in common complaints of a large, protuberant mons pubis and labia majora (outer labial lips) related to unsightly fat deposits and skin ptosis. The author presents a technique to correct the protuberant mons and pubic descent by performing a pubic lift, fat excision, and liposuction, and then tacking the superficial fibrofatty tissue to the rectus fascia. The labia majora enlargement is treated by fat excision and/or liposuction and skin excision. These techniques eliminate difficulties with sexual intercourse, poor hygiene, and discomfort, while also improving self-esteem.

Aesthetic labia minora and clitoral hood reduction using extended central wedge resection.

BACKGROUND: The central wedge excision to reduce the labia minora was reported in 1998. The purpose of this article is to present recent modifications and results of this technique. METHODS: A central wedge or V is removed from the most protuberant portion of each labium minus. The outer portion of the V excision is usually curved lateral and anterior to excise redundant lateral labium and excess lateral clitoral hood. Postoperative examinations were performed when possible. Two separate mailings of questionnaires were sent, and follow-up phone calls were made to nonresponders. RESULTS: A total of 407 patients had labia reductions from January 1, 2005, to December 31, 2006. All but 14 (3 percent) were bilateral. Ages ranged from 13 to 63 years (average, 32.4 years). Almost all patients had some lateral clitoral hood excisions with the extension of the lateral hockey-stick design. Postoperative examinations at least 2 weeks after surgery were performed on 123 patients. The total number of patients undergoing reoperation was 12 of 407 (2.9 percent). Patients responding to the questionnaire (166 of 407) were pleased with the surgery by an average score of 9.2 of 10 (where 10 = most pleased). Improvement in self-esteem (93 percent), sex life (71 percent), and discomfort (95 percent) was reported with a low significant complication rate (4 percent); 163 of the respondents (98 percent) would undergo the surgery again. CONCLUSION: Central wedge reduction with lateral clitoral hood reduction is a safe, effective procedure with few complications and high patient satisfaction.