Keywords
HoodplastyResection of the clitoris hoodGenital rejuvenationIntimate surgeryAesthetic genital surgery
Look at the whole picture, think of the genital area as one single piece.
The old belief that cutting labia minora is all we can give our patients is wrong. Aesthetic/plastic genital surgery is much more than that, which is why considering labiaplasty or hoodplasty procedures only for many patients is not appropriate.
Most patients having enlarged labia minora have some degree of clitoris hood hypertrophy, that’s why it is also very common to perform both labiaplasty and hoodplasty as one single procedure.
We have now seen many options to treat labia minora and clitoris hood individually. Having these concepts clear in our minds, we can start visualizing procedure combinations to better meet our patients’ needs.
Anatomy
It is very important to remember that genital anatomy, especially labia minora and clitoris hood structures, is intimately related.
Labia minora , being two mucocutaneous folds located on each side of the vaginal opening, divided on their anterior portion into clitoral hood and frenulum, explain why do we usually need to work on both structures to have better results.
The clitoris itself is located near the anterior junction of labia minora, above the opening of the urethra and vagina, and its final portion; the clitoris body ends at the clitoral glans usually covered by the hood, which is the end point of labia minora. This clitoris hood is formed by superior end portion of labia minora.
An important landmark for this procedure is where the clitoris hood joins labia minora. This anatomical point is key to correctly combining labiaplasty and hoodplasty techniques.
Assessment: Longitudinal Resection
First of all, always ask your patient about the reason for her visit. Try to understand why she wants that procedure . Ideally, these questions should be asked before taking her to the exam room while she’s still wearing her regular clothing; this will give the patient more confidence to be open to speak with you as her doctor.
Then, have your patient go to the exam room and take her clothes off; examine her standing up first, then have her lay down in a lithotomy position but always in front of a mirror. While looking on the mirror, have your patient tell you what bothers her before you even examine her.
In the past chapters, we have gone through several questions patients would commonly ask during the appointment and what is it that—as their doctors—we need to look for during the assessment.
(a) Treatment algorithm for labia minora excess; (b) treatment algorithm for clitoris hood excess; (c) treatment algorithm for clitoris overexposure; (d) treatment algorithm for large labia minora plus clitoris hood excess
What Can Be Achieved with Combined Labiaplasty and Hoodplasty Techniques?
Advantages
Better aesthetic look for genital area.
Avoid going back to OR for secondary procedures.
No extra recovery period for the patient.
No significant surgical time increase.
No significant surgical risk increase.
Cost-effective .
Disadvantages
Higher complexity to reproduce technique
More scars
More scarring tissue on the area increases scarring issues
Presurgical Tests
Blood tests
Haemogram
PT and PTT
Creatinine
Other, according to medical records
Urine test
Vaginal smear
Surgery Plan
Anesthesia
Local anesthesia and/or pudendal block
Use a pudendal block kit.
If no pudendal block available, a Spinocath catheter can be used for easier needle injection.
General anesthesia can also be administered but is not necessary for this surgery.
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