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Inverted-Y Plasty Clitoral Hoodoplasty

The inverted-Y plasty clitoral hoodoplasty is a midline-based reduction technique described by Eserdağ and Anğın in 2021 (J Minim Invasive Gynecol). It is a central longitudinal excision of excess prepuce in an inverted-Y design. The two oblique limbs extend from the labial edges to meet at the hood midline; the central longitudinal tail extends superiorly from that junction toward the anterior commissure.[12] The authors state that the geometry allows removal of both vertical and horizontal redundancy and lifts the clitoral hood.[1] In their single-surgeon series, all 63 patients underwent curvilinear labiaplasty with inverted-Y hoodoplasty; 96.9% reported aesthetic satisfaction at 2 months, and no major complications were reported.[1] For positioning versus other female cosmetic options see Cosmetic Genital Surgery — Female.

Society positioning. ACOG Committee Opinion No. 795 (2020) lists clitoral hood reduction among female genital cosmetic procedures. It states that these procedures are not medically indicated without a clinical indication, that their safety and effectiveness have not been established, and that published data on risks and benefits are limited. It advises assessment for body dysmorphic disorder (BDD) if indicated.[2] The German, Austrian, and Swiss S2k guideline states that aesthetic genital surgery must not be performed when BDD is suspected and the patient should be referred for specific evaluation (expert consensus; strong consensus [+++]).[13] The FIGO 2025 statement asserts that it is ethically inappropriate for obstetrician-gynecologists to recommend, perform or refer patients for cosmetic genital surgery.[10] The hoodoplasty literature is largely retrospective single-surgeon case series without validated outcome instruments.[1][3]

Rationale and indications​

Clitoral hood reduction is most commonly performed concurrently with labiaplasty. Labiaplasty alone in patients with concurrent clitoral-hood excess is described as producing aesthetic disharmony, with the hood appearing disproportionately prominent or "sagging" once the labia are reduced.[1][3][4] In Eserdağ's combined-procedure cohort, 57/63 patients (90.5%) cited aesthetic dissatisfaction and 60/63 (95.2%) requested minimal residual labia; the authors used concurrent hood reduction to address the resulting proportions.[1]

The inverted-Y plasty has been proposed for:

  • Combined vertical and horizontal hood redundancy. The inverted-Y geometry addresses both axes, where a simple midline strip addresses only vertical excess.[1]
  • Concurrent labiaplasty. All 63 patients in the founding series had curvilinear (edge / trim) labiaplasty with the hoodoplasty.[1]
  • Patients in whom a lifting effect is desired. The authors describe lifting of the hood in addition to reduction.

Surgical technique​

StepDetail
1. Patient positioning and anesthesiaLithotomy. Local or regional anesthesia (lidocaine with epinephrine), with or without sedation; general anesthesia per patient preference and concurrent procedures.[1]
2. MarkingMark the bilateral skin folds from the labial edges onto the hood so the lines meet at the hood midline as an inverted V. Extend the central longitudinal tail superiorly from the junction toward the anterior commissure; tailor its length and the resection width to the pattern of redundancy.[1]
3. ExcisionExcise the marked redundant preputial tissue while avoiding deep dissection and deep sutures near the clitoral body. The dorsal clitoral nerves can be injured when dissection extends from the preputial midline toward the inferior pubic rami. Preserve sufficient coverage to avoid painful clitoral exposure or altered sensation.[11]
4. HemostasisBipolar electrocautery; selective suture ligation.
5. ClosureApproximation in layers with fine absorbable suture. The final scar is largely concealed within the natural folds of the prepuce.
6. Combination with labiaplastyMost series combine the hoodoplasty with curvilinear / edge labiaplasty under the same anesthetic.

Operative metrics (Eserdağ 2021)[1]:

  • Median operative time for the hoodoplasty component: 34 min (range 25–42).
  • Median operative time for the labiaplasty component: 45 min (range 35–62).
  • Single-surgeon private-practice setting; local or regional anesthesia.

Safety points. Avoid deep dissection and deep sutures near the clitoral body; the dorsal clitoral nerve may be injured along the course from the preputial midline toward the inferior pubic rami.[11] Avoid over-resection, which can produce clitoral exposure or altered sensation.

Outcomes​

In the founding n = 63 series (median age 33.2, range 19–47)[1]:

  • 96.9% aesthetic satisfaction at 2-month follow-up after combined labiaplasty and inverted-Y hoodoplasty (n = 63).[1]
  • No major complications.

In retrospective composite-reduction series, Xia reported 91.0% overall satisfaction within 14 days[7], while Shi reported 99.2% aesthetic satisfaction at a mean 1.9-month follow-up[5]. Complications occurred in 34/789 (4.3%) in Liu’s hood-reduction cohort[6] and 5/68 (7.4%) in Duan’s composite-reduction cohort[8]. The most common issues were delayed wound healing, perceived asymmetry and revision (1.5–3.7%).[5][6][7][8] Shi's 738-patient composite-reduction series had mean follow-up of 1.9 months, while Liu treated 789 patients with hood reduction and reported outcomes at 6 months; most studies lacked validated outcome instruments and comparison groups.[3][5][6]

Comparison with other hoodoplasty techniques​

TechniqueDescriptionDescribed useReference
Inverted-Y plastyCentral longitudinal excision with inverted-Y design; reduction + liftCombined vertical + horizontal hood excessEserdağ 2021[1]
Simple longitudinal excisionMidline strip excision of prepucePrimarily vertical excessTriana 2024[3]
Horseshoe (U-shaped) excisionU-shaped excision around the hoodHorizontal excessTriana 2024[3]
Bilateral triangular / inverted-V resection (Liu classification)Tailored by Liu Zone-C / Zone-L classificationZone-tailored procedures (789 treated of 1,135 classified; 95.7% overall hood-reduction satisfaction at 6 months; revision 15/789 [1.9%] across procedures)Liu 2022[6]
Extended (hockey-stick) central wedgeWedge resection extending from labia into lateral hoodCombined labia + lateral-hood excessAlter 2008[9]
Three-step excisionSequential lateral hood + labial wedge + junction triangleLateral hood + labial hypertrophy (n = 136; 95.5% overall satisfaction after 3 months)Xia 2021[7]
Modified wedge for composite reductionWedge with concurrent hood reductionComposite labia + hood (n = 738; 99.2% aesthetic / 96.2% overall; mean follow-up 1.9 months)Shi 2026[5]

Advantages​

  • Maximum trimming. The authors report that the design allows maximum trimming of excess hood tissue.[1]
  • Lifting effect. The authors describe lifting of the clitoral hood area.[1]
  • Easily combined with curvilinear / edge labiaplasty under the same anesthetic.[1]
  • Concealed scar within the natural prepuce folds.

Limitations​

  • Single-surgeon case series (n = 63) without a comparison group.[1]
  • No validated outcome instruments. In the founding series, satisfaction was assessed with non-validated questionnaires.[1][2]
  • No long-term follow-up beyond 2 months in the original series.
  • Anatomy-driven technique selection. Liu's Zone-C / Zone-L classification describes different excisions for central and lateral redundancy. Triana's series likewise describes selection by the pattern of excess, without a comparative cohort.[6][3]
  • Safety overhead. Clitoral neurovascular bundle injury risk applies across all hoodoplasty techniques.

Postoperative management​

  • Activity restriction. Avoid intercourse, tampon use, and strenuous exercise for 4–6 weeks.
  • Wound care. Ice 48–72 h; sitz baths 24–48 h onward; topical antibiotic ointment; loose-fitting clothing.
  • Sensory counseling. Altered sensation is among the potential complications ACOG lists for genital cosmetic surgery.[2] Liu 2022 reported no paresthesia at 6 months.[6]
  • Follow-up. 1 week (wound check), 6 weeks (clearance), 3–6 months (final outcome). The founding series reports outcomes only to 2 months.
  • PRO assessment. FSFI and FGSIS at baseline and ≥ 6 months postoperatively.

See Also​

References​

1. Eserdağ S, Anğın AD. Surgical technique and outcomes of inverted-Y plasty procedure in clitoral hoodoplasty operations. J Minim Invasive Gynecol. 2021;28(9):1595–1602. doi:10.1016/j.jmig.2021.01.015

2. Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. Elective female genital cosmetic surgery: ACOG Committee Opinion No. 795. Obstet Gynecol. 2020;135(1):e36–e42. doi:10.1097/AOG.0000000000003616

3. Triana L, Harini BS, Liscano E. Hoodplasty: individualized approach for labiaplasties. Aesthet Plast Surg. 2024;48(11):2197–2203. doi:10.1007/s00266-023-03777-2

4. Triana L, Robledo AM. Aesthetic surgery of female external genitalia. Aesthet Surg J. 2015;35(2):165–177. doi:10.1093/asj/sju020

5. Shi Y, Sun Y, Chen L, Gao Y, Li Q. Clinical observations of the modified wedge resection in composite labia minora and clitoral hood reduction surgery. Aesthet Plast Surg. 2026;50(4):1621–1627. doi:10.1007/s00266-025-05593-2

6. Liu M, Li Q, Li S, et al. Preliminary exploration of a new clitoral-hood classification system and treatment strategy. Aesthet Plast Surg. 2022;46(6):3080–3093. doi:10.1007/s00266-022-02874-y

7. Xia Z, Liu CY, Yu N, et al. Three-step excision: an easy way for composite labia minora and lateral clitoral hood reduction. Plast Reconstr Surg. 2021;148(6):928e–935e. doi:10.1097/PRS.0000000000008589

8. Duan L, Li Z, Zhang H, Zhang B. Composite labia minora and clitoral hood reduction: an optional surgical method. Aesthet Plast Surg. 2026;50(8):3035–3042. doi:10.1007/s00266-025-05075-5

9. Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg. 2008;122(6):1780-1789. doi:10.1097/PRS.0b013e31818a9b25

10. Capito L, Antsaklis A, Gupte S; FIGO Committee on Ethical Aspects of Human Reproduction and Women's Health. FIGO statement: cosmetic genital surgery. Int J Gynaecol Obstet. 2025;170(1):11-14. doi:10.1002/ijgo.70203

11. Jackson LA, Hare AM, Carrick KS, Ramirez DMO, Hamner JJ, Corton MM. "Anatomy, histology, and nerve density of clitoris and associated structures: clinical applications to vulvar surgery." Am J Obstet Gynecol. 2019;221(5):519.e1–519.e9. doi:10.1016/j.ajog.2019.06.048

12. Eserdağ S. "Clitoral Hoodoplasty and Frenulaplasty." In: Aesthetic and Functional Female Genital Surgery. Springer; 2023:143–161. doi:10.1007/978-3-031-16019-6_10

13. Beckmann MW, et al. "Reconstructive and Aesthetic Surgeries on the Female Genitalia: Guideline of the DGGG, DGPRÄC, OEGGG and SGGG (S2k-Level, AWMF Registry No. 009/019, May 2022)." Geburtshilfe Frauenheilkd. 2023;83(7):802–826. doi:10.1055/a-2065-4458