The Preliminary Study Of Female Genitalia Aesthetics And Modified Surgical Technique On Labial Minora Reduction Based On Fine Dissection Results

Part 1 A preliminary study on measurements of normal female genital appearance of Han and Uygur nationality in Xinjiang Objective:To provide fundamental data of normal Chinese female genital appearance, to compare the parameters of Han and Uygur nationality, to analyze the factors affecting female genital appearance, to assess the occurrence of labial asymmetry, to provide morphometric reference for the plastic and cosmetic surgeries involving the female genital area and tissue distribution in male-to-female transsexual operations.Materials and Methods:Our study design recruited healthy females referred to the out-patient clinic for physical examination from October 2014 to March 2015 in Xinjiang Petroleum Geological Survey Department Staff Hospital. The recruitment was based on rigid inclusion and exclusion criteria. Demographic data consists of nationality, age, height, weight, marital status, gravidity, parity, vaginal delivery, and sexual life frequency. Anthropometric measurements were taken in 234 females of Han group whereas 278 females of Uygur group. We measured 16 parameters for each individual, and compared the external genitalia appearance in Han and Uygur nationality and analyzed the significance of variations in age, height, weight, BMI, gravidity, parity, vaginal delivery and intercourse frequency.Results:Primary measurements of Han and Uygur nationality are showed as mean (95% confidence interval): clitoral prepuce length:(24.55Y25.60)mm, (21.30～22.44)mm; perineal body length:(20.77～22.00)mm, (21.19～21.96)mm; labia minora length:(48.00～49.97)mm, (52.05-53.55)mm; labia minora width(L):(12.14～13.70)mm, (10.49～11.59)mm; labia minora width(R):(12.14～13.68)mm, (9.45～10.65)mm; labia majora length:(84.00～86.43)mm, (83.56～85.20)mm; labia majora width:(25.08～26.15)mm, (27.14～27.86)mm.There are many differences in female genital appearance in Han and Uygur nationality. Several parameters were statistically associated with age, BMI, gravidity, parity, vaginal delivery and intercourse frequency. The females with complete labial asymmetry account for 5.6%(13/234) and 5.8%(16/278) in Han and Uygur normal adults, respectively.Conclusions:We presented the external genitalia measurements of normal Chinese female adults in Xinjiang, thus providing the preliminary data for normal female external genitalia database. Females of Han and Uygur nationality share many differences in external genitalia appearances. The parameters are associated with age, BMI, gravidity, parity, vaginal delivery, and intercourse frequency. The labial asymmetry is a universal phenomenon.Part 2 A preliminary experimental study on fine dissection of the labium minusObjective:To investigate the histological characteristics of labia minora in Chinese female adults, to explore the blood supply mode and distribution pattern of lymphatic vessels and neural structures, to provide anatomical and histological basis for labia minora reduction, and to evaluate the safety and effectiveness of the cosmetic surgery.Materials and Methods:The cadaver materials consisted of two fixed specimens and 12 fresh vulvectomy ones provided by Department of Human Anatomy in Peking Union Medical College. The labial samples from consecutive cases of labiaplasty performed for labial hypertrophy in Plastic Surgery Hospital of Chinese Academy of Medical Sciences were collected for clinical, histopathologic and immunohistochemical examinations. The entire specimens were used with patients’consents. The cadaver specimens were perfused with latex and were under micro-dissection thereafter. The tissue blocks were fixed in neutral buffered formalin, embedded in paraffin, serially sectioned and stained with hematoxylin and eosin, S-100 antibody and D2-40 antibody to examine general histologic features, neural and lymphatic elements, respectively. The sections were under pathological image analysis to elucidate distribution pattern of lymphatic vessels and neural structures.Results:1. The blood supply pattern in labia minora was variable, mainly composed of main trunk type and parallel type. Different blood types were correlated with the appearance of labia minora. The veins were not concomitant with arteries. The prepuce skin shared common blood supply with homolateral labia minora.2. There was no difference in the distribution of neural elements between the lateral and medial aspects of the labia minora (P>0.05).The nerve trunk was in the center of the labia minora with no difference in distances to lateral and medial epithelium.3.There was no difference in numbers of lymphatic vessels, lymphatic density and the maximal lymphatic dilation in different sizes of labia minora. Conclusions:We discovered two types of blood supply in different appearance of labia minora. The localized lymphedema theory cannot explain the pathogenesis of all types labial hypertrophy. The anatomical and pathological characteristics of labia minora should be taken into consideration in future modified labia minora reduction.Part 3 Aesthetic Labia Minora Reduction with Combined Wedge-ed Resection:a Modified Approach of LabiaplastyObjective:Nowadays, the demand for female genital rejuvenation procedures especially for labiaplasty is surging. Labia minora reduction has been the most practiced aesthetic procedure of female genitalia in China. Gyneacological plastic surgeons have proposed several methods of labia reduction, but there is no consensus on which one is the best choice. Here we present a modified method of labiaplasty combined wedge and edge resection and to discuss the appropriate indications of this method.Method:From January 2009 to March 2014, we performed 524 labia esthetic surgeries. The methods we used mainly include simple edge resection, wedge resection, modified de-epithelialization and combined method discussed in this article.49 patients aged from 25 to 45 years were selected to receive combined wedge-edge labial resection and were retrospectively reviewed. Patients were required to come back for follow-up assessment at 1 month and 6 months.Results:42.9%(21/49) of all the patients underwent unilateral labial reduction. Average time of the procedures is 56 minutes. The mean follow-up was 4.5months. All the surgeries were successfully performed and 47 patients experienced an uneventful postoperative period. A minor dehiscence occurred in two patients. One of them received a revision surgery correcting postoperative asymmetry malformation. Finally, all the patients were satisfied with the aesthetic appearance.Conclusions:The combined wedge-edge reduction of labia minora is a simple and safe method associated with high satisfactory and low complication rate. Therefore, we propose this combined procedure to bi-dimensional and/or unilateral hypertrophied labia minora especially to those who require removal dark margin of the labia.