Hoodplasty

(1)

Plastic Surgery, Universidad del Valle Plastic Surgery, Cali, Valle del Cauca, Colombia

Keywords

HoodplastyResection of the clitoris hoodGenital rejuvenationIntimate surgeryGenital aesthetic surgeryFemale penis-like appearance

Take away the penis-like appearance, have a really happy patient.

Hoodplasty is a nowadays a common term to describe the correction of excess mucosa on clitoris hood . When looking back at the history of genital aesthetic/plastic surgery procedures, the most common term was labiaplasty. Labiaplasty would traditionally refer to the resection of excess mucosa of labia minora without anything else.

As labiaplasty procedures became known, we plastic surgeons found ourselves compelled to improve our results and discovered that just cutting labia minora excess was not enough. For many patients the cutting of excess mucosa on labia minora can actually be more dissatisfying. Why? Well, once you remove excess mucosa from labia minora, other excesses in the genital area may show up; such is the case of clitoris hood mucosa.

After conventional labiaplasty (the mere cutting of labia minora excess), many patients will end up with a “penis-like” appearance, since excessive mucosa around clitoris hood will stick out more. That’s why it is very important to always address this area when found excessive, along with resection on labia minora. This doesn’t mean we need a hoodplasty for every patient having a resection of labia minora, but once again it highlights the importance of a very good assessment prior surgery.

Clitoris hood resections are usually achieved by simple mucosa excisions. Mild to moderate excess of clitoris hood can be treated by a longitudinal resection (a resection laterally performed on each side of the clitoris body).

Anatomy

The vulva and clitoris comprise the female external genitalia .

The mons pubis, labia majora, labia minora, vaginal vestibule, and bulb of the vestibule are parts of the vulva.

The clitoris is a sexual organ present only in females. The visible round portion is located near the anterior junction of labia minora, above the opening of the urethra and vagina. It is homologous to male’s penis but without distal urethra. The clitoral body is about 2.5 cm long and attached to pubic bone by the suspensory ligament. Final portion of the body is a round mass, the clitoral glans, covered by the hood which is the end point of labia minora.

The clitoris hood is formed by the superior end portion of labia minora. Labia minora divide on their anterior portion into clitoral hood and frenulum (Fig. 5.1).

../images/456687_1_En_5_Chapter/456687_1_En_5_Fig1_HTML.png — Fig. 5.1

Clitoris hood anatomy

An important landmark for the procedure is where the clitoris hood joins labia minora. This anatomical point will be addressed later, as it is crucial for the correct development of a hoodplasty surgical technique .

Assessment: Longitudinal Resection

First:

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.

What Will the Patient Tell Me?

She is unhappy or uncomfortable with her clitoris hood :

I don’t like the appearance of my genital area; it just looks like extra stuff is showing off!”
“It’s like having a penis in between my labia.”
“I would love it if my clitoris hood wouldn’t stick out so much.”
“It just looks worse than before I had my labiaplasty done.”
“I am unhappy with this situation, I did not like how it looked before, but now I just hate it, it looks like a penis!”

Hygiene, bad smell issues:

“Can this extra skin cause a bad smell?”
“I am concerned because, although I’m very clean down there, it still smells.”

Second:

Have your patient go to the exam room and take her clothes off; examine her standing up first, and 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.

What to Look for in My Patient?

Clitoris hood:

Secretion accumulated under the hood, near the frenulum, and clitoris gland area
Redundancy
Longitudinal excess or horizontal excess (Fig. 5.2)

../images/456687_1_En_5_Chapter/456687_1_En_5_Fig2_HTML.png — Fig. 5.2

(a) Longitudinal clitoris hood excess. (b) Pinching clitoris hood on the sides to see how much longitudinal excess is present. (c) Moving clitoris hood up and down to see how much horizontal excess is present

Clitoris hood insertion :

The higher the insertion of clitoris hood is located in labia minora, the better it will look.

Frenulum location
Where is clitoris hood insertion in labia minora?
- Is it low?
- Is it at frenulum level?

What Can Be Achieved with the Longitudinal Hoodplasty Technique?

Important Fact

Always remember it is best to leave some longitudinal excess of clitoris hood instead of a visible scar.

Advantages

Ideal when there is a longitudinal excess of clitoris hood.
Easy learning curve .
Easy to connect with lazy S or edge technique labiaplasty.
When clitoris hood insertion needs to be corrected and repositioned higher on labia minora, it is the best approach.
A longitudinal hoodplasty is easier to transform into a horizontal one during the procedure when needed.

Disadvantages

If there is horizontal excess of clitoris hood, correction will be insufficient with this technique.
If too much excess of clitoris hood is present, scar may not only be on genital mucosa, and there’s a risk of leaving too long a scar that shows visibly on genital skin.
If there is too much excess of clitoris hood and only a longitudinal hoodplasty is being done, it is preferable to leave some excess mucosa on clitoris hood rather than to having a visible scar on the patient.