Hoodoplasty

Clitoral Hoodoplasty

Definition

Professor Ostrzenski defines clitoral hoodoplasty as a surgical intervention which transforms the clitoral prepuce to more pleasing appearance with preservation of function. The clitoral prepuce is the overlying skin fold over the clitoris, also is known as clitoral hood or clitoral foreskin. There are two distinct types of clitoral hoodoplasty: restorative clitoral hoodoplasty and reductive clitoral hoodoplasty.

Professor Ostrzenski conducted the clinical study (between 2006 and 2010) which assisted him to develop a new clitoral hoodoplasty classification and new surgical procedures. This classification is very useful for women and doctors to select the appropriate procedure.   Clitoral hood characteristics were used to establish a new classification:

  1. Occluded Clitoral Hood (the clitoris hood opening is partially or completely closed with the clitoris buried under the skin),
  2. Hypertrophic-Gaping Clitoral Hood (the clitoris foreskin can be elongated, too thick, or both)
  3. Asymmetrical Subdermal Hypertrophy (uneven thickness of the clitoral hood).

Each category of clitoral characteristics will require a different surgical intervention. The following surgical interventions for clitoral hoodoplasty have been developed by Dr. Ostrzenski based upon this classification:

  1. Hydrodissection with reverse V-plasty was applicable for the occluded clitoral prepuce,
  2. Modified hydrodissection with reverse V-plasty,
  3. Clitoral subepithelial hoodoplasty for asymmetrical subdermal hypertrophy (uneven thickness).

Therefore, it became clear that a one-fit-all procedure could not be offered to all of those women who requested clitoral hoodoplasty.

In 2010, Professor Ostrzenski described and published in the professional peer review journal a new operation of hydrodissection with reverse V-plasty technique for restorative clitoral hoodoplasty (Journal of Gynecologic Surgery 2010;26(1):41-48). The concept of this procedure was based upon both: 1. to rebuild the obliterated opening of the clitoral hood, and 2. to restore the – vanished prepuce without causing transient or permanent clitoral nerve injuries. Then, the clitoral glans (the tip of the clitoris) was excavated from partially occluded (closed) opening of the clitoral hood (phimosis) or totally occluded clitoral hood (buried clitoris). In this new technique, sterile saline was used to separate the clitoral hood from the clitoral adhesions and agglutination as well as to remove smegma and debris (hydrodissection) and the reverse V-plasty method trims and models the excessive skin and restores the desired shape, arch, and conceals the scar. Also, this technique prevents the potential complication of clitoral numbness which has been often observed postoperatively when metallic-rigid instruments were used for separation of the clitoral hood from the clitoris.

The reductive hoodoplasty is a surgical intervention designated to decrease the excessive length of the clitoral prepucial tissue or to reduce the uneven thickness of the clitoral hood. Ostrzenski’s modification of hydrodissection with reverse V-plasty is used to reduce the excessive, and overlapping clitoral hood.

The hydrodissection with reverse V-plasty surgical method was modified by Dr. Ostrzenski from his own technique and used for reductive clitoral hoodoplasty. In the modified technique, no prepucial surgical incision is needed to get access between the inner surface of the clitoral prepuce and the clitoral body; the hydrodissection process is applied directly under visual control to divide adhesions and to eradicate agglutination between the inner surface of the clitoral prepuce and the clitoris, and to remove smegma and debris. The excessive clitoral prepucial tissue is excised in reverse V-plasty mode. The suture line is hidden in the newly created clitoral prepucial opening with the clitoral glans being exposed between 3-5 millimeters. The modified hydrodissection technique is easy to learn with very natural and pleasing aesthetic outcomes.

In 2010, Dr. Ostrzenski developed a new surgical technique of clitoral subepithelial hoodoplasty (CSH). This surgical method is very useful when uneven thickness of the clitoral prepuce is present. Reductive clitoral hoodoplasty itself is not enough to accomplish satisfactory aesthetic results. The operation can be combined, and often is, with the Ostrzenski’s modified hydrodissection with reverse V-plasty for reductive clitoral hoodoplasty. Also, CSH can be performed as a single procedure when the length of the clitoral prepuce does not require reduction. The concept of a surgical intervention is to resect the subepithelial hypertrophied tissues to create symmetrical thickness of the clitoral hood bilaterally. This surgical intervention should be applied when asymmetrical thickness of the clitoral hood is identified.

Clitoral Frenuloplasty

The clitoral frenulum is an anatomical structure which is created by the extension of the upper part of the thin labia (the labia minora). It attaches to the back of the clitoral glans (the visible part of the clitoris when the overlying skin is pushed-up away).

Clitoral frenuloplasty has been developed by Ostrzenski during his comprehensive cosmetic/plastic gynecologic clinical study. A surgery for aesthetic motives is usually needed when the clitoral frenulum is enlarged, asymmetrical or over-pigmented or any combination thereof. Sometimes it also requires transposition of the frenulum to the posterior clitoral glans. This procedure is performed almost always in association with a modified reductive clitoral hoodoplasty or subepithelial clitoral hoodoplasty.  Caution must be exercised during clitoral frenuloplasty, since between and posterior to both frenula just under the epithelium lays the bulboclitoral region which is a very neurosensitive area. The bulboclitoral region incorporates the clitoral root and the commissure of the vestibular bulbs known also as the “Pars Intermedia”. It is much safer to reduce the frenulum by slicing the outside part of the clitoral frenulum.  In many instances, the clitoral frenuloplasty is mandatory to perform in order to achieve aesthetically desirable results.

*   “A New, Hydrodissection with Reverse V-Plasty Technique for the Buried Clitoris Associated with Lichen Sclerosus”
Adam Ostrzenski
Journal of Gynecologic Surgery, 2010; 26(1):41-48
(To access click on the “Hoodoplasty” page.)

* “Clitoral subdermal hoodoplasty for medical indications and aesthetic motives. A new technique”
Adam Ostrzenski
J Reprod Med. 2013 Mar-Apr;58(3-4):149-52. [ePub ahead of print]
(To access ePub click HERE) or
(To access Full Article click HERE)