Barbie Deformity after Edge Labiaplasty: Classification and Repair Algorithm.

Background: Influenced by the popularity of the "Barbie" labia minora shape, edge labiaplasty has become the preferred option among patients and surgeons alike. However, excessive or inappropriate resection of labial free edges may lead to morphologic deformities and dysfunctional symptoms, termed the "Barbie deformity." This study aimed to classify the Barbie deformity and provide a repair algorithm to help surgeons select appropriate surgical methods.

Methods: A total of 216 patients with Barbie deformity were classified into 3 groups. Among these, 119 patients underwent repair operations using different methods based on the degree of deformity. The surgical outcomes of 87 patients were assessed by means of follow-up questionnaires. Preoperative and postoperative levels of general psychological distress and self-esteem were compared for 46 patients using standard scales.

Results: Barbie deformity was identified on 338 sides: 158 were grade I, 106 were grade II, 74 were grade III, and 187 had vestibular mucosa exposure. Repair operations were performed on 189 sides: 53 by means of edge trimming, 99 by means of wedge excision, 32 with an island clitoral hood flap, and 5 with the Gress composite method. The complication rate was 4.8%. Genital appearance was improved in 96.6%, preoperative discomfort was resolved or significantly reduced in 74.2%, and overall satisfaction was 86.2%. The general psychological distress and self-esteem scores also improved significantly after surgery.

Conclusions: The goals of repairing the Barbie deformity are to improve the appearance of the genitals and restore the position and function of the mucosa. Preventing Barbie deformity is much more important than repairing it.

Clinical question/level of evidence: Therapeutic, IV.