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The central wedge excision to reduce the labia minora was reported in 1998. The purpose of this article is to present recent modifications and results of this technique.A central wedge or V is removed from the most protuberant portion of each labium minus. The outer portion of the V excision is usually curved lateral and anterior to excise redundant lateral labium and excess lateral clitoral hood. Postoperative examinations were performed when possible. Two separate mailings of questionnaires were sent, and follow-up phone calls were made to nonresponders.A total of 407 patients had labia reductions from January 1, 2005, to December 31, 2006. All but 14 (3 percent) were bilateral. Ages ranged from 13 to 63 years (average, 32.4 years). Almost all patients had some lateral clitoral hood excisions with the extension of the lateral hockey-stick design. Postoperative examinations at least 2 weeks after surgery were performed on 123 patients. The total number of patients undergoing reoperation was 12 of 407 (2.9 percent). Patients responding to the questionnaire (166 of 407) were pleased with the surgery by an average score of 9.2 of 10 (where 10 = most pleased). Improvement in self-esteem (93 percent), sex life (71 percent), and discomfort (95 percent) was reported with a low significant complication rate (4 percent); 163 of the respondents (98 percent) would undergo the surgery again.Central wedge reduction with lateral clitoral hood reduction is a safe, effective procedure with few complications and high patient satisfaction.