Aesthetic Reconstruction of the Interlabial Sulcus: from Anatomical Rediscovery to Surgical Approach

Background:

To explore the anatomy of the interlabial sulcus and introduce a simple surgical technique for its reconstruction, and evaluate its efficacy and safety.

Methods:

Anatomical (macroscopic and microscopic) analysis was performed on 18 hemi-perineum specimens. A total of 723 patients undergoing labiaplasty between January 2016 and December 2024 was retrospectively reviewed. Among 315 patients who had composite labia minora and lateral clitoral hood reduction, 274 were identified with an absent interlabial sulcus and were the focus of this study. Of these, 109 patients (198 sides) underwent the four-step sulcal reconstruction (Group 1), while 165 patients (299 sides) received conventional surgery without reconstruction (Group 2). Operative duration and complications were recorded. Satisfaction questionnaires via the Female Genital Self-Image Scale (FGSIS) were completed during follow-up either in the outpatient clinic or online.

Results:

Macroscopic examination reveals a clear demarcation between the labia majora and labia minora. Microscopic analysis showed that collagen and smooth muscle fibers at the interlabial sulcus exhibited a disordered, interwoven pattern. The sulcal reconstruction prolonged operative time by approximately 20 minutes ( p < 0.05), but did not increase complications ( p =0.52). Patients in the reconstruction group reported higher satisfaction compared to those without reconstruction ( p < 0.05).

Conclusions:

Anatomical study indicates a distinct tissue boundary at the interlabial sulcus, accompanied by a localized alteration in fiber architecture. The four-step reconstruction technique proved safe and effective, with satisfactory outcomes. Given its advantages of simple steps and natural aesthetic outcomes, this approach holds promising potential for application in vulvar aesthetic surgery.

Level of Evidence: IV