title: Labia Majora Augmentation with De-epithelialized Labial Rim (Minora) Flaps as an Auxiliary Procedure for Labia Minora Reduction.
abstract: BACKGROUND
  Esthetic surgery of external female genitalia remains an uncommon procedure. This article describes a novel, de-epithelialized, labial rim flap technique for labia majora augmentation using de-epithelialized labia minora tissue otherwise to be excised as an adjunct to labia minora reduction.
  
  
  METHODS
  Ten patients were included in the study. The protruding segments of the labia minora were de-epithelialized with a fine scissors or scalpel instead of being excised, and a bulky section of subcutaneous tissue was obtained. Between the outer and inner surfaces of the labia minora, a flap with a subcutaneous pedicle was created in continuity with the de-epithelialized marginal tissue. A pocket was dissected in the labium majus, and the flap was transposed into the pocket to augment the labia majora.
  
  
  RESULTS
  Mean patient age was 39.9 (±13.9) years, mean operation time was 60 min, and mean follow-up period was 14.5 (±3.4) months. There were no major complications (hematoma, wound dehiscence, infection) following surgery. No patient complained of postoperative difficulty with coitus or dyspareunia. All patients were satisfied with the final appearance.
  
  
  CONCLUSIONS
  Several methods for labia minora reduction have been described. Auxiliary procedures are required with labia minora reduction for better results. Nevertheless, few authors have taken into account the final esthetic appearance of the whole female external genitalia. The described technique in this study is indicated primarily for mild atrophy of the labia majora with labia minora hypertrophy; the technique resulted in perfect patient satisfaction with no major complications or postoperative coital problems.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Reconstructive Aesthetic Surgery, Osmangazi University Faculty of Medicine, ESOGÜ Meşelik Yerleşkesi, 26040, Eskisehir, Turkey.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Karabağlı
authors.forename: Emre Atacan
authors.initials: EA
authors.lastname: Kocman
authors.forename: Melih
authors.initials: M
authors.lastname: Velipaşaoğlu
authors.forename: Aydan A
authors.initials: AA
authors.lastname: Kose
authors.forename: Sezi
authors.initials: S
authors.lastname: Ceylan
authors.forename: Ozlem
authors.initials: O
authors.lastname: Cemboluk
authors.forename: Cengiz
authors.initials: C
authors.lastname: Cetin
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D016896:Treatment Outcome; D014844:Vulva / Q000473:pathology* / Q000601:surgery*