Beautiful, natural results.
Labiaplasty (or cosmetic rejuvenation of the female genitalia) is one of the most popular procedures in my New York City plastic surgery private practice. As a female plastic surgeon, many of my patients feel comfortable discussing their most intimate concerns with me. Equally important, I am committed to giving superb surgical results to each patient in my practice. Examples of results from my actual patients are displayed at the bottom of this page.
U.S. plastic surgeons have reported a 44% increase in labiaplasty procedures over the past several years, according to the American Society for Aesthetic Plastic Surgery. This makes labiaplasty the fastest growing plastic surgical procedure in America.
WHAT IS LABIAPLASTY?
Labiaplasty is an outpatient surgical procedure designed to make the female genital area more aesthetic and comfortable. Women seek labiaplasty because they are unhappy with the way their private parts look, or because they are uncomfortable with friction caused by exercising, sexual intercourse, or wearing fitted clothes. Labiaplasty can address the inner labia (labia minora), the outer labia (labia majora), the clitoral hood, or any combination of those areas. Atrophy or sagging of the labia majora can also be addressed with filler or fat grafting.
WHAT IS THE ANATOMIC CONCERN?
The most frequent complaint related to labiaplasty is protruding or enlarged labia minora (inner labial lips). This is also the most common reason for women to seek labiaplasty in my practice. As women get older, some experience atrophy or sagging of the labia majora (external labial lips). Occasionally, women also complain of enlargement of the clitoral hood, looseness of the perineal tissues, sagging of the labial majora, or bulkiness of the mons pubis.
Labiaplasty is tailored to your individual anatomic considerations and concerns, as each woman is different. Labiaplasty does not affect sexual sensation, enjoyment, or ability to have an orgasm. The female erogenous zones, such as the clitoris and "g-spot" are not operated on and experience no changes during the operation.
WHAT IS THE SURGERY LIKE?
Labiaplasty is done under local anesthesia with or without light sedation ("twilight"), which is always supervised by my board-certified female anesthesiologist. About 70% of my patients elect to have the surgery done under local anesthesia alone. The surgery itself typically takes under 1 hour. When surgery is complete, you will have ointment and a maxi pad placed as a dressing. If you have had local anesthesia only, you will feel fine immediately after surgery. If you have had sedation, you will feel a bit tired and you will recover in one of our private recovery room suites, where you will be able to relax, sleep, watch TV, or read a magazine. Once you are feeling fully awake and alert, usually after about half an hour, you will be able to go home the same day.
What are the scars like?
Scars for labiaplasty are hidden in locations that are not visible under most circumstances. Even when scars are closely examined, as in during intimacy or mirror examination, the female genitalia generally heals extremely well. Any scars that are present will heal in a camouflaged manner, and care is taken to design your scar placement in a buried or hidden location.
EDGE OR WEDGE?
There are two well-described techniques for performing labiaplasty that addresses the labia minora: the external trimming technique (excising the "edge" of the protruding tissue-- the edge technique) and the v-shaped surgical excision (excising a "wedge" of the protruding tissue-- the wedge technique). I am well-versed and facile in both techniques and will tailor the procedure to your individual desires. Both procedures have their role in labiaplasty, however, generally speaking, I prefer the wedge technique in most women, as I consider it to provide a superior cosmetic result.
In general, the wedge technique is considered the gold standard of labiaplasty technique, and it has supplanted the edge technique in the hands of many modern and experienced surgeons. The wedge technique is more technically challenging from a surgical perspective, and for this reason, it is less common to find a plastic surgeon to perform this procedure. However, the wedge technique is considered a superior operation in most women for several reasons:
- The Edge technique creates a linear scar along the edge of the external genitalia, which can appear scallopped or irregular when the stitches heal. The Wedge technique has a buried scar that is less noticeable and leaves the external genitalia with a smooth contour.
- The Edge technique is associated with occasional complaints about dysparunia, or pain with sexual intercourse. These complaints are almost unheard of with the Wedge technique.
- The Edge technique is more traumatic to the tissues and has an increased amount of swelling, as well as an increased risk of wound breakdown. While swelling is also present with the Wedge technique, it resolves more quickly. Wound breakdown is not common with the Wedge technique.
WHAT IS THE RECOVERY LIKE?
After surgery, you will wear a maxi pad with a small amount of ointment on it, and use ice packs for comfort. All of your stitches will be dissolvable. You will use a "peri bottle" or water bottle to cleanse yourself after going to the bathroom. When you are resting at home, I advise pelvic elevation by keeping your pelvis propped up on 1-2 pillows to help the swelling come down.
Swelling after labiaplasty peaks in the first 2 weeks. During this time frame, swelling is gravity-dependent, so you will notice that spending more time doing pelvic elevation helps the swelling decrease. Even if you are up and about right after surgery, this will not effect your long term result, although it may take a bit longer for your swelling to go away. After the first 2 weeks, swelling continues to decrease on its own. You will have about 80% of the final surgical result at 1 month after surgery and 90% after 6 weeks, although it takes a full 6 months for all swelling to completely dissipate.
When can you return to work and play?
You will be able to do normal activities, such as walking around the block and running an errand, the day after surgery. Depending on the nature of your job, many women are able to return to work within 2-3 days. For more strenuous types of work, this may vary. Strenuous activity is not advised for the first four weeks after surgery, although pending Dr. Devgan's recommendations for your individual case, you may be able to resume some light exercises at 2-3 weeks. You will be able to return to sexual intercourse, strenuous exercise, swimming, and normal activities after approximately 6 weeks.
What is the next step?
Patient satsifaction with labiaplasty is extremely high. For questions about the procedure or to set up an in-person consultation, please call our office at (212) 452-2400 or email info@LaraDevganMD.com.
A Systematic Approach for Superb Labiaplasty Results
By Lara Devgan, MD, MPH
An invited EXpert article for Healio,
an online journal for doctors and surgeons
A SYSTEMATIC APPROACH FOR SUPERB LABIAPLASTY RESULTS
By Lara Devgan, MD, MPH
Labiaplasty, or cosmetic rejuvenation of the female genitalia, is the fastest growing plastic surgery procedure in America. The most recent set of statistics published by the Amercian Society of Plastic Surgeons reveals that the number of labiaplasties has nearly doubled over the past year, with a 44% increase as compared to the previous year.
What is labiaplasty?
Labiaplasty is, in short, any plastic surgery procedure designed to improve the cosmetic appearance of the female private parts. Areas of concern include the labia minora, the labia majora, the clitoral hood, the perineum, the mons pubis, or any combination of the above.
The most common complaint for women in my practice is hypertrophy or excess tissue of the labia minora. This area can hang down and create uncomfortable and unsightly bulging in the genital region. Not only does this frequently make a woman feel self-conscious about her physical appearance, but it can also make exercise, sexual intercourse, or activities of daily living uncomfortable. In severe cases, women experience chafing, skin irritation, and rashes in the affected regions. Generally speaking, labia minora hypertrophy is something that a woman is born with, though it can certainly be exacerbated by hormonal changes or the trauma of childbirth.
Another common concern is redundancy of tissue in the perineum. This is frequently related to injuries and tissue tears that occur during vaginal deliveries, including episiotomies.
As women age, they also experience atrophy of the labia majora. This creates a droopy or saggy appearance of the outer, more visible tissues of the female genitalia. Most women with atrophy of the labia majora are perimenopausal or postmenopausal, although it can also occur in women who have lost a significant amount of weight or who have poor tissue elasticity.
Mons pubis bulkiness is a less common complaint related to female genital rejuvenation. Puffiness in this an atomic region is generally associated with excess fat deposition in the area. It can also be seen in patients who have lost a significant amount of weight.
Prominence of the clitoral hood is a less common complaint related to cosmetic improvement of the female genitalia. Women who have clitoral hood hypertrophy have often been exposed to higher than typical amounts of testosterone or other male hormones, either during in utero growth, pubertal development, or later in life.
How should a plastic surgeon analyze a labiaplasty patient?
A full history and physical examination are essential in evaluating a labiaplasty patient. This includes a detailed account of menarche, puberty, pregnancies, types of delivery, and menopause. It also includes a history of any exposure to hormones or hormonally mediated medications.
Physical examination should include a systematic analysis of the labia majora, labia minora, clitoral hood, perineum, and mons pubis. It must also include an analysis of tissue type and quality. This includes assessing a patient's subcutaneous fat deposition as well as the elastic recoil of the skin and soft tissue.
Preoperative photographs are important to document the patient's anatomical concerns. These are taken with the patient in both standing and frogleg positions. A gloved hand can be used to splay the tissues apart to document particular areas of concern, as needed.
What is the surgical approach to labiaplasty?
The surgical approach to labiaplasty is uniquely tailored to each individual patient depending on her anatomic concerns.
Labia minora hypertrophy is addressed with labia minora reduction. Widely accepted techniques for labia minora reduction include wedge excision, straight-line edge excision, lazy S edge excision, and opposing W-plasties.
The best technique for a given patient will depend on how prominent her labia minora tissues are, her degree of asymmetry, the pigmentary changes along her mucosal to skin border, and the desires of the patient and surgeon. In my practice, I frequently perform all of the above maneuvers, depending on the situation. It is important to seek a plastic surgeon with a high comfort level in each of these surgical approaches to ensure that you get the best technique for your concerns.
Excess tissue of the perineum as well as clitoral hood hypertrophy can both be addressed with conservative excision of redundant tissues. For clitoral hood hypertrophy, and excision of prominent tissue in the lateral clitoral hood region is planned. For perineal hypertrophy, excision of redundant tissue between the vagina and anus is planned, with care taken to avoid the muscle fibers that power the anal sphincter.
Atrophy of the labia majora is best addressed with fat grafting or filler. A hyaluronic acid-based filler such as Juvederm, Restylane, or Voluma can be used to augment the labia majora in a minimally invasive manner. While filler has the advantage of no surgery and minimal downtime, it has the disadvantage of being a semipermanent solution that needs to be repeated every 4 to 6 months.
Fat grafting is far more durable and is a preferred technique in the majority of patients. When fat grafting the labia majora, I harvest liposuctioned fat from the lower abdomen, spin it in a centrifuge to obtain the highest quality fat particles, and reinject it in a precise and controlled manner.
The mons pubis can be addressed with either liposuction to debulk excess fatty tissue or a pexy procedure to resuspend a drooping mons pubis. The procedure of choice here is dependent on the plastic surgeon's analysis of the patient's anatomic issue.
Cosmetic surgery for female genital rejuvenation should only be performed by an experienced plastic surgeon who is comfortable with the anatomical areas in question.
In my practice, I find that accurate preoperative marking is essential. The should be done before injection of any local anesthetic agent, as local anesthesia will distort the patient's tissues and alter the planned incisions.
Many of these procedures can be done with the patient wide-awake under local anesthesia only. However, I frequently use IV sedation performed by a board-certified anesthesiologist to increase patient peace of mind. The use of a pudendal nerve block is helpful ensuring the patient's intraoperative and postoperative comfort.
I routinely use a dose of preoperative antibiotics and frogleg positioning for these cases. Traction sutures, Colorado tip Bovie electrocautery, and meticulous hemostasis are also mainstays of my surgical approach for labiaplasty procedures.
For alterations of the genital mucosal tissue, I prefer to close in layers with 4-0 Vicryl and 5-0 chromic sutures. A gentle compressive dressing such as mesh panties with padding and an ice pack will limit postoperative inflammation and hasten recovery.
Pitfalls and complications
When done properly, the complication rate for labiaplasty procedures is extremely low.
A plastic surgeon must be mindful of pigmentary changes so as not to distort the "pink-white" or "pink-brown" junction between mucosa and skin. One must also take care to avoid vertically shortening the clitoral hood, as this can cause too much exposure of the clitoris and make sexual intercourse uncomfortable.
Complications of labiaplasty include wound dehiscence, hematoma, discomfort with sexual intercourse or other activities, clitoral exposure, and scar tenderness. A patient who experiences any of these complications should be seen frequently in the postoperative period and referred to a more experienced plastic surgeon as needed.
Postoperative care and recovery
Many patients feel comfortable enough to return to work within 1 to 3 days after labiaplasty surgery. That being said, I recommend that all of my patients take one full week off of work commitments in the event that they are uncomfortable.
Postoperative care includes pelvic elevation, frequent icing to minimize inflammation, use of bacitracin ointment and maxipads as needed, and avoidance of strenuous exercise or physical activity for 2 to 4 weeks.
Patients are permitted to shower the day following surgery, however the are advised not to soak in a bathtub or pool for at least 2 to 4 weeks. I also ask patients to refrain from sexual intercourse and use of tampons for one month.
Labiaplasty is expected to continue to rise in popularity as misconceptions about the procedure are cleared up and public awareness of the procedure grows. In the past several decades, there were certainly taboos associated with women thinking about or talking about rejuvenation of their private parts. However, as society becomes more progressive, feminism becomes more entrenched, and social standards become more accepting, increasing focus will be paid to this important area.