Our New Labiaplasty Documentary is Finally Here!

Dana Goldberg MD: Labiaplasty as a procedure and external female genitalia surgery in general has been growing dramatically over the last few years. There are some women that come in just for a small amount of trimming and other women that come in for work on both the labia majora and labia minora.

So, in California, they’ve actually shown that this procedure is now more popular than breast augmentation in the last two years, so it is definitely something that a lot of women face, and more people are just now becoming comfortable talking about. (Music and typing sounds)

One of the things that has surprised me most about labiaplasty surgery is the wide variety of patients that come to seek it. I’ve had 15-year-old girls come in who are embarrassed to go the beach with their friends because they feel their labia is visible through their bathing suit. I’ve had moms come in because they’re uncomfortable wearing yoga pants and chasing after their children, and I’ve had women come in because they’re self-conscious about the appearance of the area. So, doing this procedure has taught me that there is not typical labiaplasty patient and there’s no typical appearance to the area as well. (Typing sounds)

One of the most common areas women experience dissatisfaction with is the labia minora, or the inner lips of the labia. Many times if they protrude beyond the external lips, or the labia majora, women can feel very uncomfortable physically or very self-conscious. It can even interfere with sexual intercourse. Labiaplasty refers to changing of the labia in any aspect. This can include reduction or plumping of the labia majora, tightening or reduction of the labia minora, and pexy, meaning lifting, or reduction, meaning smaller size, of the clitoral hood. (Music and typing sounds)

Clitoral hood reduction refers to tightening of the tissue [00:02:00] above the clitoris. Many women experience looseness of this tissue over time, which makes it hard to experience clitoral stimulation, and can be a little embarrassing in appearance. Clitoral tightening, when done properly, has extremely minimal risks of complication and permanent nerve damage. (Typing sounds).

Vaginoplasty refers to any procedure performed to the vagina. Most commonly, that includes resection or removal of excess lining of the vagina, along with tightening of the muscles along the vaginal canal. Either labiaplasty or vaginal tightening can also be combined with peroneal tightening, which means tightening of the muscles right at the entrance of the vagina.

Many women, after childbirth experience grown of their vaginal canal. There is stretching of the muscle layer underneath as well as actual growth of the vaginal mucosa or lining of tissues. In a very similar way to tummy tuck where excess skin is removed and the muscle layer is tightened, vaginoplasty is performed to remove the excess lining and tighten the muscle layer underneath. (Music and typing sounds)

There are two main techniques to reduce the labia minora. One involved taking a V shaped wedge out of the center, where there’s the most hypertrophy, and this will result in the most natural shape to the edge, and minimize the number of the incisions that are on the external part that would face your underwear. Other techniques involve basically amputating the front part of the labia minora. So, the incision would be on the external surface, and that can usually allow for a bit more reduction in volume than with the wedge technique. (Typing sounds)

When I perform surgery on the vaginal or labia area, especially near the clitoris, I’m extremely slow and extremely cautious about protecting nerves, blood vessels, and other tissue in the area. Permanent sensation changes are [00:04:00] extremely rare, and sometimes hypersensitivity does occur after surgery, but most often resolves within six weeks, if not, almost always within six months. (Typing sounds)

I actually get many patients referred from gynecology offices. Most gynecologists don’t feel comfortable managing the cosmetic concerns of patients because they’re very busy taking care of their medical concerns. I do find some OBGYNs are very qualified for managing post-op changes for women, but I do find that that’s mostly confined to the labial and vaginal areas. OBGYNs who offer liposuction and tummy-tuck procedures are almost always trained at weekend course and are not really board certified to do those procedures. I don’t mean any individual can’t do a great job, but as a whole, you’re better off going with a board certified plastic surgeon. (Typing sounds)

Surgery for the labia minora can be done in the office under local anesthesia. The same is true for tissue above the clitoris and tissue on the labia majora that make it lose or deflated looking over time. Most of the time labia procedures and procedures on the perineum, or the external area between the vagina and rectum, can be done under local anesthesia in the office with very minimal risk. Internal vaginal tightening does need to be done in the operating room, and it is a very delicate procedure. But, I have a lot of experience with cancer reconstruction and other extensive procedures in the area, which make it unlikely to actually have an injury if things are done properly. (Typing sounds)

The main reason to avoid over-reduction of the labia is to avoid a look where the vaginal opening is open, even when the legs are spread. And, the other major risk with over-resection is actually removing too many of the lymph channels within the tissue, that evacuate swelling, so you can end up with chronic swelling. The final reason to avoid over-resection is to avoid nerve damage, especially near the area of the clitoris. So, [00:06:00] how small the labia can become does depend a little bit on the patient’s anatomy to begin with, and also the surgical technique. (Music and typing sounds)

For most women, it’s possible to get the labia minora at least flush with the labia majora, which is on the outside. (Typing sounds) It is always possible to lose normal sensation to any tissue when surgery is performed, but as long as a surgeon is being very careful to keep the dissection very superficial over the area where the nerves are most likely to be, it’s actually very rare to lose sexual sensation, and most disturbances in sensation that occur from numbing or from swelling resolve within the first six to eight weeks after surgery.

So, patients are not allowed to drive themselves home from labiaplasty if any type of sedation is used. In our office, we use pill sedation, and in the operating room, there’s obviously IV or full anesthesia. So, patients do need to have a ride a home from surgery. If patients are only taking Tylenol the next day, some may feel comfortable driving, but most patients can’t count on being able to drive a car for at least three to five days. (Typing sounds)

It’s not a good idea to do a whole lot of walking the first day or two after the procedure because that can definitely increase swelling. So, for most patients, the walk is a little bit funny for the first days, just as the area is swollen and sore, but within three to five days, most people find they can resume most of their normal activities, including work. (Typing sounds)

Labiaplasty is very commonly tolerated under local anesthesia alone, with, or without some pill sedation. Internal vaginal surgery does require general anesthesia because it’s a bit more extensive and it does involve internal procedures. But, external tightening can happen very easily in the office without the need for anesthesia, which definitely decreases the recovery period and decreases the cost of the procedure. (Typing sounds) [00:08:00]

Many patients will have a little discomfort through the procedure but the numbing cream and local anesthesia we use is generally enough that most patients feel very, very little actually. During the recovery period, there’s a dramatic difference between patients as far as how well this procedure is tolerated. I’ve had just as many patients come in the day after the procedure taking Tylenol alone as I have patients a week afterwards, still feeling like they need narcotics to sleep. What I can say is that ice and elevation of the area do help a lot during the first forty-eight hours to decrease the discomfort, and we will give patients enough pain medication and anti-anxiety medication to get them through the post-op period, no matter what it brings. (Typing sounds)

Most patients will need to take at least two to three days off work after this procedure. Typically we do them in the office on a Wednesday, so most patients are really adequately ready to go back to work by the following Monday. If jobs involve a lot of activity or heavy lifting then some patients may find they want to take a little more time off, up to two weeks.(Typing sounds)

(Music) So, the day of the procedure, patients come to our office. They will take their premedication, meaning an anti-anxiety pill and a pain pill, out in the lobby, and when they start to feel the effects of the medication, we bring them back to the room and apply a numbing cream to the area. After about thirty to forty-five minutes, the area is numb enough with the creams and the premedication that we begin injecting the local anesthesia.

From there, the procedure will only take about an hour, and most patients will leave the office fully able to walk and feeling very, very comfortable. During the procedure, we set up in the rooms to have Netflix, or Pandora or anything else that will [00:10:00] help the patient relax and just focus on something other than the procedure and that usually works pretty well. After the procedure, we fit patients with a non-stick dressing against the incisions, followed by a, a pad filled with a lot of ice, and this will provide the most comfort for the patient right after the procedure and help decrease swelling. (Typing sounds)

Fort the first two to three days after the procedures patients need to take it very easy. This is a time to mostly be laying around, and keeping your pelvis propped up on a few pillows. Walking around when necessary is definitely okay, but you don’t want to walk at a brisk pace those first few days. Um, it’s also very painful for most patients to urinate the first few days because the incisions are fresh. For that reason we recommend patients use a squeeze bottle or a cup of water to pour over the area during urination to help clean the area and to help minimize any stinging sensation.

After five to seven days, most patients can increase their cardiovascular activity and begin working out again, but that’s going to depend on the amount of soreness. Tampon and exercise activity is generally restricted for the first two to four weeks after surgery, but that will depend on how each person is healing and it will be a little different for every patient. (Music and typing sounds)

Depending on the technique used, some patients would potentially feel comfortable reintroducing sexual intercourse as early as the first week or two after surgery. Some patients may find they’re not comfortable with intercourse until six to eight weeks after surgery; a little bit of that depends on the extent of resection, and where the scars are placed. With more extensive resections, using the wedge technique, some of those incisions can become close to the vaginal canal and increase discomfort during intercourse. For those that get the anterior wedge or anterior resection technique, intercourse is potentially comfortable a little bit sooner. (Typing sounds and music) [00:12:00]

Some women have hypertrophy of the labia far before they have children. Many women do notice a slight change after childbearing or certainly at menopause, with the ceasing of hormones, but there’s really no right time to have labiaplasty and a future pregnancy won’t necessarily undo any type of surgery. So, women who are considering this before childbirth shouldn’t necessarily wait till after because it could be a good time even before children. (Typing sounds)

We see patients back in the office within a day to two after surgery, just to check on things, and then we follow up at seven to ten days after the procedure, again to be sure that the stitches are dissolving as they are supposed to and that everything looks free from infection, and like it’s healing well. And, after that, we usually follow up with patients at four to six weeks after the procedure. If everything has gone well most patients don’t need to follow up after that time. (Typing sounds)

With tightening of the external structures, including the labia majora and minora, some women do get an indirect affect on the tightening of the tightening of the vaginal canal just at the very entry. So, a few patients have said that they do actually notice a difference themselves or with their spouse, as far as sexual intercourse but the only procedure that truly does tighten the vagina is internal vaginal tightening, not external labiaplasty. (Typing sounds)

So, the sutures will dissolve within about seven to ten days after the procedure, although for individual patients, sometimes there are a few knots and other bits of suture that can linger for a few weeks after the procedure. This isn’t harmful and doesn’t increase the risk of visibility of those scars in the long run. Most patients will also find that they have some puckering or pleating along the incision lines, and even some potential separation at the incision line. These areas usually disappear completely within four to six weeks after surgery [00:14:00], and in the long run it’s very difficult to tell where an incision was made.