Labia minora hypertrophy is usually congenital and can also be caused by excessive androgen use, persistent local stretching, long-term chronic inflammatory irritation, excessive masturbation or sexual intercourse. It is usually diffusely enlarged bilaterally or can be limited to one side and can range from the clitoral prepuce to the labial tether [1]. Labia minora hypertrophy can cause local irritation and hinder the maintenance of local hygiene during menstruation and after defecation. In addition, because the structural morphology of these parts can now be understood in a variety of ways, an aesthetic evaluation of female vulvar morphology has emerged, and excessively enlarged and asymmetrical labia minora are considered a deformity, causing psychological stress to patients and affecting their normal lives [2, 3]. With the awareness of its harmful effects, the concept of treatment of labia minora hypertrophy has changed, and the vulvar shape can be restored by surgical excision of the hypertrophied part of the labia minora. Regarding the indications for surgery, Friedrich [4] believed that the width of labia minora should be less than 5 cm in a state where the labia minora are gently pulled to the side, and Rouzier et al [5] considered that if the width of labia minora is greater than 4 cm and does cause physical discomfort, it is an indication for surgery. The normal range of labia minora in Chinese women [6]: length, left side (30.05±6.75)mm, right side (29.67±6.79)mm; width, left side (9.91±2.95)mm, right side (10.20±2.95)mm. in standing position, both labia minora are close together between labia majora and slightly exposed, if labia minora are thick or hypertrophied, the exposure is very obvious, beyond labia majora If the labia minora are more than 1 cm, causing discomfort by friction when walking, affecting the direction of urine flow, or even affecting sexual life, surgical treatment can be considered [7]. According to the literature [1~3, 8], there are four more common surgical procedures for labia minora hypertrophy reduction: ① linear excision and suturing. (ii) “W”-shaped excision and plastic surgery of the labia minora margin. (iii) “Wedge” excision. ④Central debridement suture. The emergence of these procedures reflects the deepening of the understanding of labia minora reduction surgery and the accumulation of clinical experience, which are summarized below. 1 Linear excision and suturing Straight excision and suturing is the first procedure to appear in the reduction of labia minora hypertrophy. The specific method is to remove the protruding part of labia minora hypertrophy in a straight line [8], and then suture it directly. The advantage is that the operation is simple and easy to perform. If the hypertrophy of labia minora is caused by local chronic infection or obstruction of lymphatic vessels, and the hypertrophied tissue has undergone obvious pathological changes and lost its original softness, linear excision and suturing is a better choice to reduce the size of labia minora while removing the diseased tissue. However, for those with congenital hypertrophy and no pathological changes in the labia minora, this procedure will remove the edges of the original soft and rounded labia minora, forming a thin and stiff incision scar, which often causes local irritation and discomfort when walking. This scar often causes local irritation and discomfort when walking. The straight scar also has a tendency to contract, which will pull the labial ties forward and cover part of the vaginal opening. In addition, when the melanin-rich part of the labia minora edge is removed, the appearance looks unnatural. In 2000, Maas et al [2] first reported a “W” shaped excisional plastic surgery of the labia minora edge. The inner and outer lateral incision lines should correspond to each other and complement each other. The labia minora are flattened by an assistant, the hypertrophied labia minora edges are removed along the incision line, and the bleeding is thoroughly stopped, and the medial and lateral incision edges are staggered and sutured together with 6-0 absorbable thread, and the incision line is serrated after suturing (Figure 1). Its advantages: the scar on the labia minora edge is “Z”-shaped without long linear scar, which prevents longitudinal scar contraction, and the rounded contour of the labia minora edge is also preserved. However, the disadvantage is that the normal color of the labia minora edge is not preserved and the pigmented part is removed. 3 “Wedge” excision Alter [3] reported a “wedge” excision of the hypertrophied protruding part of the labia minora along the design line, followed by thorough hemostasis and interrupted suturing in layers, which can reduce both the width and length of the labia minora (Figure 2). The advantage of this procedure is that the normal color, texture and contour of the labia minora edges are preserved. Maas et al [2] pointed out that although this method preserves the pigmented part of the labia minora margin, the “wedge” excision removes the “middle” pigmented part of the labia minora, which is deeply pigmented, because the anterior part of the labia minora is lightly pigmented and the posterior part is deeply pigmented. However, since the front part of the labia minora is lightly pigmented and the back part is deeply pigmented, the “wedge” excision removes the middle part of the color transition, and there is an obvious division between the dark and lightly pigmented parts on both sides of the incision line, which is not natural in appearance. If excision is excessive, postoperative wound dehiscence can easily occur, resulting in anterior displacement of the labial tether and tautness of the vaginal opening, which can cause pulling discomfort during intercourse. Rouzier et al [5] treated 163 patients with a “V” shaped excision and achieved satisfactory results. Two hemostatic forceps with teeth were used to define a “V”-shaped area on the hypertrophied labia minora. One hemostatic forceps was placed at the posterior part of the labia minora, parallel to the base of the labia minora, and the other hemostatic forceps was placed at the middle of the labia minora according to the size of the part to be excised. The “V”-shaped part of the labia minora is removed, and the part left in front of the labia minora forms a labial flap, which constitutes a new labia minora of appropriate size. Due to the rich blood supply of the labia minora, the labial flap is less likely to have blood flow disorders. The labial flap is flattened and the two “V”-shaped incisions are sutured together under no tension. Rouzier’s method is similar to Alter’s method, but the location of the scar is more concealed and the appearance is more natural. 4 Central debridement suture of the labia minora Choi et al [1] reported a central debridement suture of the labia minora (Figure 3). The labia minora are gently drawn away to the side, and the epidermal portions to be removed are marked on the medial and lateral surfaces of the labia minora, respectively, according to the hypertrophy of the labia minora, and the marked area is de-epithelialized, and the wound edges are closed with continuous 4-0 intestinal sutures after thorough hemostasis. The labia minora should be kept about 1 cm wide so that it can cover the vaginal opening. Compared with the previous approach, this procedure preserves well the rounded contour of the labia minora margin, the soft tissue and the normal pigmented portion. The operation of removing the epidermis does not injure the blood vessels and nerves passing under it, so postoperative complications such as necrosis of the labia minora edge and loss of sensation will not occur. The disadvantages are: ① The labia minora tissue is thin and there is no subcutaneous fat, but only a small amount of smooth muscle tissue and vascular sinus, so it is difficult to remove the epidermis of the inner and outer side of the labia minora, and if the operation is not careful, the weak subcutaneous tissue of the labia minora can often be damaged, resulting in a hole in the inner and outer side. ②Because the full-length tissues of the labia minora edge are preserved, and after the central debridement suture of the labia minora, the labia minora edge shrinks and all the preserved longer edges will crumple together, which is unattractive. ③ From a horizontal view, the de-epithelialized part of the labia minora crumples under the skin, making the newly formed labia minora thicker. To address the shortcomings of this procedure, Choi et al [9] proposed two improvements: ① Performing labia minora suspension and tightening at the same time as the central labia minora debridement suture. A “Y”-shaped incision was made at the clitoral foreskin above the labia minora, and the clitoris was lifted and fixed on the pubic bone periosteum, and the incision was sutured in a “V”-shape, thus tightening the labia minora that were previously wrinkled together and making the appearance more natural. ②The removal of the inner and outer lateral epidermis of the labia minora can also be done by laser technology, which makes the actual operation simpler and easier, but the setting of the appropriate parameters during the operation needs further study. In conclusion, due to the recognition of the adverse physiological and psychological effects of labia minora hypertrophy on patients, the attitude toward its treatment has changed from conservative to more aggressive. The ideal procedure for labia minora enlargement reduction should be one that can address both functional and cosmetic aspects. The surgical method of straight-line excision and suturing of the protruding part has obvious drawbacks, which have been improved to a certain extent by the surgical methods that have emerged since then, but still have their shortcomings. In comparison, the central debridement suture method of the labia minora has more advantages and better maintains the normal shape of the labia minora while treating it, but because of the small number of cases reported in the literature and the limited follow-up time, its effectiveness needs further observation.