Localized Vulvar Micro-lymphatic Imbalance Mimicking Recurrent Labia Minora Hypertrophy After Labiaplasty: Clinicopathologic Correlation and Mechanistic Insights

Persistent focal enlargement after labiaplasty is commonly attributed to aesthetic under-resection or postoperative scar remodeling; however, disruption of superficial vulvar lymphatic pathways has not been well characterized as a potential contributor to postoperative contour abnormalities. We describe a clinicopathologic case of localized lymphatic channel dilation presenting as apparent recurrent labia minora hypertrophy following primary labiaplasty and propose an anatomically grounded, hypothesis-generating framework. A 16-year-old patient developed unilateral apical enlargement 90 days after neurovascular-preserving CO2 laser labiaplasty, prompting revision surgery. Excised tissue underwent histopathologic evaluation, with findings interpreted in the context of contemporary vulvar lymphatic mapping data. Intraoperative assessment demonstrated focal subepithelial fibrosis and stromal thickening confined to the apical labial segment. Histologic analysis revealed multiple dilated, thin-walled lymphatic channels within edematous fibrotic stroma, without evidence of mesenchymal neoplasia. The topographic distribution corresponded to the superior superficial vulvar lymphatic pathway described in indocyanine green mapping studies. These findings suggest that localized micro-lymphatic imbalance may represent a rare but anatomically plausible mechanism underlying select cases of apparent recurrence after labiaplasty. Recognition of superficial vulvar drainage pathways may refine interpretation of postoperative asymmetry and inform surgical technique in anatomically concentrated regions. Prospective studies incorporating lymphatic imaging and histologic validation are warranted.