The rejuvenation of the female genitalia or labioplasty is one of the fastest growing plastic surgery procedures in the United States. Due to the internet and popular culture, women have become more aware of procedures which can improve the appearance of their genital area. The American Society of Plastic Surgeons revealed recently that the number of labiaplasties performed increased by 48% compared to the previous year. Women often choose to undergo a labiaplasty because they are unhappy with the appearance of their private parts, uncomfortable due to the friction caused by sexual intercourse, exercising or wearing fitted clothing, and most importantly not confident about their body.
Labioplasty is a cosmetic procedure to improve the appearance of the female genitalia. A labiaplasty often focuses on the labia minora (inner labia), labia majora (outer labia), the clitoral hood, or a combination of areas (add anatomy diagram). The procedure will be tailored to your individual anatomic concerns as each woman’s body is different. Many patients who present to my office complain of a large labia minora (the inner fold of the genitalia). The labia minora may be elongated causing it to hang beneath the labia majora (outer fold of the genitalia) leading to irritation from underwear and bathing suits and anxiety in intimate situations. Patients also often do not like the darker color. To reduce the labia minora, I will perform a wedge or edge labioplasty in which the excess tissue or darkened edge is removed. For some women, the labia majora is hypertrophied or too large. This area can be reduced by elliptically removing a section of tissue so that the scar is hidden between the two folds of the genitalia. Thirdly, women present with excess skin along the top of the clitoris. The redundant skin or clitoral hood can also be trimmed to decrease bulkiness in this area.
Many women explain to me that the size or shape of their labia is something that has bothered them for many years, often starting in puberty or after the trauma of childbirth. Women state that they are uncomfortable in clothes, have difficulty performing exercise, and feel anxious in intimate situations. Most women presents because they do not like the appearance of a hanging labia minora beyond the labia majora or the outer lips of the genitalia. Some women find that there is an excessive bulkiness when they wear bathing suits or fitted clothing; leading to them avoid all revealing clothing. Often athletes present to the office who complain of rubbing and irritation when running, swimming, or cycling. In severe cases, women experience skin irritation and rashes.
Edge or Wedge
The two commonly discussed procedures for reducing the labia minora are the edge technique in which the skin on the edge of the labia minora is trimmed and the wedge technique in which a pie-shaped excision is made incorporating prominent tissue. Both techniques have benefits when the anatomy is appropriate. The edge technique is excellent for patients who are trying to remove hyperpigmentation or darkening along the edge of the labia minora. My favored approach for removing excess tissue is the wedge technique for three main reasons:
- The edge technique is more traumatic to the neighboring tissues and can lead to an extended recovery time due to increased swelling. The incision is longer and less concealed from the environment, leading to increased wound breakdown.
- Because the scar of the edge technique is along the “edge” of the labia minora, it can become irritated from the friction of sexual intercourse and heavy exercise.
- The wedge technique is considered to have a superior cosmetic outcome by producing a smaller, smoother, more conspicuous scar buried along the lining of the labia minora. The linear scar of the edge technique can often become scalloped and irregular.
EDGE TECHNIQUE vs WEDGE TECHNIQUE
Loss of Volume
As women age, they lose fat from not only their faces and breasts but also there is an atrophy of the labia majora. This creates a droopy and saggy appearance of the labia majora or outer, more visible lip of the female genitalia. Many of these women are postmenopausal but some have lost a significant amount of weight or have poor tissue elasticity. Sex may become more uncomfortable due to the loss of natural padding along the pubic bones. As more and more women shave or wax their pubic hair, the new wrinkling is obvious. Some women opt to fill this area with temporary injectable hyaluronic acid-based fillers like juvaderm or restylane and some by fat grafting. Fat grafting involves removing fat from one area of the body and re-injecting it to areas that need plumping. The fat will lead to a fuller, more rejuvenated appearance and the results will be permanent unlike dermal fillers.
Having a labiaplasty does not affect your ability to become pregnant or to have a vaginal delivery. Many women present to my office because of physical discomfort or unhappiness with their appearance. Many of these women have never had children.
Labiaplasty does not affect sexual sensation, enjoyment or the ability to have an orgasm. Most women derive sexual enjoyment from clitoral stimulation. The clitoris is not operated on and there should be no changes to enjoyment from this procedure.
The surgery may be performed under local anesthesia or with the addition of light sedation. The procedure takes one hour to complete. After the surgery, your incision will be covered by bacitracin and a maxi-pad will be used as a dressing. For patients who opt to have the procedure performed in the office under local anesthetic, you will be fine to travel home immediately afterwards. For those who choose to have the surgery in a surgical suite, it will take you about one to two hours to feel fully awake.
Most women relax at home for four to five days. You will wear a maxi-pad with ointment on it for several days and can use cold packs for comfort. Due to the acidic nature of urine, most women use a peri-bottle or water bottle to cleanse themselves while and after using the bathroom. Most swelling occurs in the first two weeks after surgery. Because swelling is gravity dependent, you should consider propping your pelvis up on a pillow while resting. Your sutures will be dissolvable. You can return to the gym in two to three weeks. You can return to having sex in six weeks.
A Picture is Worth a Million Words
A picture may be worth a million words but in the age of the internet, online photos can be viewed by billions of eyes. In respect of patient privacy, a before and after section was not created on our website. Several patients have agreed to allow their photos to be viewed by prospective patients in the office. You may request to view photos during your consultation. Some patients have also agreed to speak with prospective patients if you would like to learn more about the procedure from a patient’s perspective.
What is the first step?
If you are considering a labiaplasty, please call our office at 212.600.4109 to arrange for a consultation. Our New York City practice accommodates out of town and international patients who need to travel in for surgery as well as those who are local to Manhattan.