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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 stem of the Y oriented longitudinally along the prepuce midline and the two arms diverging superiorly toward the mons. The geometry allows removal of both vertical and horizontal redundancy and produces a lifting effect on the clitoral hood not achievable with a simple longitudinal strip.[1] In the founding case series of n = 63 the technique achieved 96.9% patient satisfaction at 2 months with no major complications.[1] For positioning vs other female cosmetic options see Cosmetic Genital Surgery — Female.

Society positioning

The ACOG 2020 Committee Opinion No. 795 states that female genital cosmetic procedures, including clitoral hood reduction, are not medically indicated in patients without structural or functional abnormalities and that safety and effectiveness have not been established. Evidence is largely restricted to retrospective single-surgeon case series; validated outcome instruments are rarely used.[2] The FIGO 2025 Statement echoes this position. Mandatory BDD screening belongs at the front of every consultation.

Rationale and indications​

Clitoral hood reduction is most commonly performed concurrently with labiaplasty. Performing labiaplasty alone in patients with concurrent clitoral-hood excess produces aesthetic disharmony — the hood appears disproportionately prominent or "sagging" once the labia are reduced.[1][3][4] In the Eserdağ founding cohort, 90.5% of patients requested the operation primarily for dissatisfaction with aesthetic appearance and 95.2% requested minimum residual labia, mandating concurrent hood reduction to maintain proportion.[1]

The inverted-Y plasty is well-suited to:

  • 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 — most published cases combined hoodoplasty with curvilinear (edge / trim) labiaplasty.[1]
  • Patients in whom a lifting effect is desired — the diverging arms produce a subtle elevation 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. MarkingExcess prepuce marked along the midline. The excision is designed as an inverted Y — the stem of the Y running longitudinally along the hood midline, the two arms diverging superiorly toward the mons. Width and length of the stem and arms are tailored to the morphology of redundancy.
3. ExcisionSkin and subcutaneous tissue within the marked Y are excised, with care to identify and protect the dorsal nerve of the clitoris and the underlying clitoral neurovascular bundle. Avoid over-resection — excessive removal can produce clitoral exposure or sensitivity changes.
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 combined labiaplasty: 45 min (range 35–62).
  • Single-surgeon private-practice setting; local or regional anesthesia.

Critical safety points — meticulous identification and preservation of the dorsal nerve of the clitoris; avoid over-resection, which can produce clitoral exposure or altered sensation. Both points apply to every hoodoplasty technique, not only the inverted-Y.

Outcomes​

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

  • 96.9% aesthetic satisfaction at 2-month follow-up.
  • No major complications.

Across the broader hoodoplasty literature, satisfaction generally ranges 95–99% and complication rates 1.4–7.4%, with the most common issues being minor dehiscence, perceived asymmetry, and occasional revision.[2][5][6][7][8] ACOG 2020 cautions that satisfaction data should be interpreted with care given the absence of validated outcome instruments and comparison groups in most studies.[2]

Comparison with other hoodoplasty techniques​

TechniqueDescriptionBest fitReference
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 classificationPer anatomic zone (n = 789; 95.7% satisfaction; revision 1.9%)Liu 2022[6]
Extended (hockey-stick) central wedgeWedge resection extending from labia into lateral hoodCombined labia + lateral-hood excessAlter 2008
Three-step excisionSequential lateral hood + labial wedge + junction triangleLateral hood + labial hypertrophy (n = 136; 95.5% satisfaction)Xia 2021[7]
Modified wedge for composite reductionWedge with concurrent hood reductionComposite labia + hood (n = 738; 99.2% aesthetic / 96.2% overall)Shi 2026[5]

Advantages​

  • Maximum trimming of excess hood tissue compared with simple longitudinal or V-shaped excision.[1]
  • Lifting effect — the diverging Y-arms produce subtle elevation that other geometries do not achieve.[1]
  • Easily combined with curvilinear / edge labiaplasty under the same anesthetic.[1]
  • Concealed scar within the natural prepuce folds.

Limitations​

  • Single-surgeon Level IV evidence (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. Newer classification systems (Liu 2022 Zone-C / Zone-L) suggest that the optimal hood technique depends on the anatomical pattern of excess (central vs lateral, vertical vs horizontal, composite). The inverted-Y is one option within that framework rather than a universal default.[6][3]
  • Critical safety overhead — clitoral neurovascular bundle injury risk applies across all hoodoplasty techniques and is not unique to the inverted-Y.

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. Patients should be told that transient altered sensation is possible; permanent sensory loss is rare but reportable.
  • Follow-up. 1 week (wound check), 6 weeks (clearance), 3–6 months (final outcome). Long-term follow-up is sparse in the founding series — consider obtaining 12-month PROs locally to extend the evidence base.
  • 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