Redefining Labiaplasty: New Anatomical Classification and Innovative Treatment Algorithm for Vulvar Aging

Labiaplasty has emerged as a widely accepted procedure for addressing both aesthetic and functional concerns of the female external genitalia. However, the heterogeneity of vulvar aging patterns presents a challenge for standardized surgical planning. To address this, we developed a novel six-type clinical classification of vulvar aging aimed at guiding individualized surgical strategies.

We conducted a multicenter observational study over an eight-year period (2016-2024) across two private aesthetic surgery centers in Italy. A total of 142 patients presenting with vulvar complaints underwent clinical evaluation, photographic documentation, and surgical intervention. Of these, 14 were excluded due to incomplete follow-up or documentation, leaving 128 patients for final analysis. Patients were classified into one of six clinical types based on labial morphology, including hypertrophy, hypotrophy, and tissue laxity. Surgical techniques were selected according to classification type and included established and customized procedures.

Type 1 (isolated labia minora hypertrophy) was the most common presentation (32.8%), followed by Type 2 (labia majora hypotrophy, 21.9%) and Type 3 (combined hypotrophy and hypertrophy, 17.2%). Tailored surgical approaches-ranging from resection and lifting to volumization-were applied. The overall satisfaction rate was 91.4%, with complication rates remaining low (7.8%), including minor wound dehiscence, transient edema, and fat graft resorption. Functional improvements and enhanced body confidence were reported in over 80% of sexually active patients.

This study introduces a new clinical classification of vulvar aging that enables precise, anatomy-based surgical planning in labiaplasty. The system proved practical, reproducible, and closely aligned with patient-reported outcomes. Its implementation may standardize future research and improve the personalization of vulvar aesthetic surgery.

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