A procedure that alters the female genitalia, known as labiaplasty, is one of the fastest-growing plastic surgery procedures in the United States. The American Society for Aesthetic Plastic Surgery revealed recently that the number of labiaplasties performed increased by 44% in 2013. In some cases, the availability of images and a more frank discussion of those images on the internet is cited as a cause of the spike in procedures, as women become more aware of the surgery options available.
There are several reasons women choose to undergo this type of procedure: (1) They are unhappy with the appearance of their private parts or they worry others are unhappy (2) They are unhappy with the fit and look of swimsuits or athleisure clothing, e.g., yoga pants (3) Friction caused by athletic activity causes irritation, and in severe cases, rash (4) They are simply not confident about their body, and are looking for positive change. Here, Dr. Melissa Doft, a Plastic Surgeon who regularly performs labiaplasty, gives an overall explanation of the procedure.
What Is Labiaplasty?
Labiaplasty is a cosmetic procedure focused on improving 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. The procedure is tailored to your individual anatomic concerns as each woman’s body is different. Many patients who come to my office often 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.
Who Is A Potential Patient?
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 following the trauma of childbirth. Women state that they are uncomfortable in clothes, have difficulty performing exercise, and feel anxious in intimate situations. Most women say 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, resulting in the avoidance of all revealing clothing. Often athletes come to my office complaining of rubbing and irritation when running, swimming, or cycling. In severe cases, women experience skin irritation and rashes.
The Approach: Edge Vs. Wedge
There are two approaches to this issue, the edge labiaplasty or the wedge labiaplasty. In the edge technique, the skin on the edge of the labia minora is trimmed.
In a wedge labiaplasty, a pie-shaped wedge is excised from the labia minora leaving behind a small vertical scar. The benefits? It removes hyperpigmentation and excess skin. For some women, the labia majora is hypertrophied, or large. This area can be reduced by elliptically excising a section of tissue so that the scar is hidden between the two folds of the genitalia.
My favored approach is the wedge technique, which has emerged as the superior choice 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.
In the case of women with excess skin along the top of the clitoris, this redundant skin—the clitoral hood—can also be trimmed to decrease bulkiness in this area.
What If My Concern Is Sagging?
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.
What If I Want To Have Children?
Having a labiaplasty does not affect your ability to become pregnant or to have a vaginal delivery. Many women come to my office because of physical discomfort or unhappiness with their appearance—many of these women have never had children.
Will Labiaplasty Affect Sensation?
Labiaplasty does not affect sexual sensation, enjoyment or the ability to have an organism. 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.
What Is Surgery Like?
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.
How Long Does Recuperation Take?
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.
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