Who is a candidate?
Labiaplasty has become a much more popular procedure, due in part to greater awareness that the surgery exists, more acceptance talking about preferences in the genital region, and grooming trends towards hair-less or minimal hair styles.
It is very important to know that “normal” labia come in all different shapes, sizes, colors, and textures. While many people prefer a neat, trim look, there are also those who prefer a natural look no matter how large the labia are or what color they are.
Also, it is normal to undergo changes in the area with puberty and pregnancy. Ultimately the decision on who should undergo labiaplasty comes down to personal preference, as well as the present of certain complaints that may be improved with labiaplasty.
Common reasons for having labiaplasty include:
- Preference for neat, trim appearance
- Correcting asymmetry
- Pain with sexual intercourse
- Decreased clitoral stimulation when excess skin covering the area
- Difficulty with hygiene
- Pain or discomfort with activities such as bike riding
- Difficulty wearing certain clothing like fitted pants or exercise clothing
- Friction or pulling with exercise
There are many different techniques for labiaplasty. The main three techniques utilized are the trim (or amputation) technique, the wedge technique, and the modified or extended wedge technique (described by Dr. Gary Alter).
Dr. Patel prefers the extended wedge technique for several reasons.
In the trim technique, the labia minora is simply clamped, amputated, and the two sides are sewn up with a running baseball type of stitch.
The advantage of this technique is it is a very quick procedure.
The potential disadvantages are taking off too much (leaving very little or no labia), and having a straight line scar on the border of the labia which is reported to have greater risk of painful scar.
With the way the procedure is done, it also is a more obvious scar since it removes the normal gradual transition from the outer textured and colored skin to the inner smooth pink skin.
Also, a straight line scar has the potential to tighten or form a contracture, which would be undesirable in this location.
The wedge technique involves simply taking a wedge, or V shaped excision, from the center of the excess labia.
This is better than the trim technique because it preserves the natural transition at the border of the labia.
The disadvantage is the outer labia scar is a straight line going horizontally across the labia, and there is a risk of the border of the labia looking “scalloped” if the scar tightens or there is not a lot of subcutaneous tissue.
The modified or extended wedge is an improvement on this technique because it takes a wedge from the inner labia skin, and take a downward facing wedge on the outer labia.
This means the outer scar does not go horizontally across the labia. Instead it lays in the crease between the outer and inner labia, in a vertical orientation. Once this scar heals it is difficult to find it.
On the inner surface the scar is horizontal towards the vaginal opening, and also heals to a nearly imperceptible scar.
Clitoral Hood Reduction
Clitoral hood reduction can be done at the same time as labiaplasty, or as a stand alone procedure.
The entire area needs to be evaluated as a unit, and the relationship and proportions need to be adjusted if needed.
In some patients, there is extra skin at the clitoral hood and the labia, and if only the labia are addressed, the upper half of the region takes on an abnormal appearance.
Dr. Patel does a conservative excision of tissue in this area due the sensitive nature of the anatomy.
Can I be awake for labiaplasty?
Labiaplasty can safely be performed under local or general anesthesia, and Dr. Patel offers both options.
Labiaplasty with general anesthesia is typically preferred for patient comfort throughout the process.
Risks of labiaplasty?
Labiaplasty is a safe procedure when performed by appropriately trained surgeons in an accredited facility.
Standard risks of having includes: Pain; bleeding; infection; scarring; painful or hypertrophic scarring; hematoma; seroma; injury to vessels, nerves, any surrounding structures; prolonged swelling; change in sensation; contour irregularity; poor cosmetic result; under- or over-resection; asymmetry; separation of incision line or open holes along incision; need for further procedure; risks of anesthesia.
Postoperative follow-up visits
Visits following labiaplasty surgery typically occur the day after surgery (for dressing change and making sure there were no issues overnight), the week after surgery (to check on suture lines), 2 weeks after that, and then spread out less frequently thereafter.
The schedule is adjusted based on doctor/patient preferences and needs.
Recovery after Labiaplasty
Most patients report a mild uneventful recovery. Walking for daily activities may be started on the day of surgery.
You may shower 24 hours after surgery, with care taken to avoid rubbing or pulling on or around incision lines.
No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay.
Typically swelling and soreness is the greatest for the first 3 days.
Early swelling subsides afterwards over the next 2-3 weeks. Patients are advised to avoid sexual intercourse and strenuous activity or activity that causes friction, pulling or stretching at the labia for the first 8 weeks following surgery.
This is the best way to prevent complications such as opening of the incision or little holes along the incision line.
It is much better to allow it to heal correctly the first time than go back to activity too early and have to start over with a new recovery period. Patients are provided with syringes to fill with water and use to rinse after voiding if desired, and pat the area dry.
Dr. Patel also recommends applying Bacitracin ointment to the external incision lines for the first week or so.
For patients with a history of genital herpes, having surgery in this area can trigger an outbreak.
Therefore prophylactic antiviral is prescribed for prevention.
Arnica and Bromelain (Arnica Forte) is recommended before and after surgery, and with this patients have been noted to have minimal swelling or bruising.
You may return to work the week after surgery, depending on your pain level, stamina, and activities required in your occupation.
You may drive once you are no longer taking pain medications or muscle relaxers, and allow a 24 hour minimum window between your last pain medication or muscle relaxant dose and driving.
All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.