A 45 year old woman had problems with unsightly appearance of the labia hanging down and wanted that corrected cosmetically. She also wanted a correction of problems associated with the elongated labia minora, such as chafing, itching, and swelling. The alter wedge technique was performed for maximum patient comfort and easy post-operative care. All sutures were placed internally with no external sutures. Exparel anesthetic injection was used for post-operative pain control lasting 72 hours. Topical anesthesia was prescribed for maximal patient comfort and pain control. The patient did well, with no post-operative pain and gave Dr. Fernau a 10/10 satisfaction rating. She was thrilled with the results.