For some ones who has   big penis that the skin form penile shaft is too wide or ones who regularly strap the tip of penis to the buttock crease to hide the penile shaft during dressing as a woman that will make the penile skin wider and longer, if we use all parts of the penile skin to make the labia minors, the labias will be to wide and too thick which not be  a good  esthetic appearance of the labias.

The 16^th edition is  a reversion of the 15^th edition. For this technic, we  separate the penile  skin into  2 parts, one  to make  the labia minors and  the  outer part  to make  the  inner side of labia majors.  We  need the proper design on the penile skin to make  the proper size of the labia minors, while  the rest of penile skin can help in reducing the tension of  the labia majors ,so we can get more scrotal skin graft to make the deeper neovagina. The labia majors  are usually made by scrotal skin ,but  in the type  half of them from the penis and the other half from the scrotum.

For some patients  who  have very  small penis  or ones who have circumcised by  the technic of high level circumcision may have a  severe shortness of prepuce  skin that is not enough  to  make  a  good  shape  of  labia minors. In this  group  the  labia  will  be  short  and narrow ; most  of  the  time, they cannot cover  the  vaginal  opening. Even they  can cover the opening , because the  shortness of  tissue to make the  inner  labia , sometime  they  cause  narrowing of  the introitus and cause difficulty during  dilatation and sexual intercourse.

In order to correct that problem, in some  case  that  we do  not use  the scrotal skin such  as primary colon vaginoplasty or   in case that the  scrotal  skin is very  long or in case that the  patient decides to use skin graft  from the groin crease or lower abdomen for making  the  deeper neovagina, the scrotal  skin flap can be  designed to be the outer layer and the lower part of inner side of labia minors that we  call posterior forchette.  For this 15^th edition, the whole  outer side is totally made by the scrotal skin, while  the  inner layer  is divide  into 3 parts; the upper part by the  small remnant of prepuce, the middle by the small penile shaft ( design as turnover flap)and  the lower part by the excess tissue of the scrotum.    Because this  is  the  technic of flap for reconstruction, the  final outcome  of the  labias will be  a little bit  too thick and too wide  at  the beginning. Even they will be smaller in 2 or 3 months, in some cases,  they might need a later revision to make them smaller and flat  after 6 months.