Labiaplasty is a surgical procedure used to reduce excessive length and bulk in a woman's inner vaginal lips. This sometimes happens after childbirth or may be the way a woman's inner vaginal lips are naturally. Sometimes it becomes a cosmetic concern. The surgery is tailored to the patient's specific desires, which are expressed at her consultation. The excessive tissue is removed and the vaginal lips are reconstructed using very delicate surgical techniques.

The Procedure

There are several successful surgical techniques used for labiaplasty. The proper method for each patient is decided at the consultation, and usually depends on the patient's anatomy. The traditional method simply involves trimming off the excess tissue in a curved or straight line and suturing the edges together vertically. This is not the preferred method for all women since it may give more post-operative scarring and a small amount of sensation is lost. What this method can do however, is eliminate the dark edges of the labia and give better symmetry.

Our preferred method is using a Z-Plasty technique. Specialized flaps are made in the labia and sutured together using very delicate sutures. The upper and lower edges are then brought together horizontally. This provides for a more natural look that preserves the original color of the labia while drastically reducing the extra tissue. Absolutely perfect symmetry is usually not possible to achieve with this procedure. The near-perfect asymmetry however, is seldom noticed by patients and their partners.

After the procedure, the operated area will appear swollen. This will resolve slowly over several weeks. Bruising usually resolves over a few weeks in the typical case. The swelling is greatest about 2-3 days after the surgery. You will be given instructions on wound care and pain management.

Possible Complications

In any surgical procedure, no matter how simple, there is the possibility for complications. The complication risk for this procedure however, is very low.

Bleeding: Blood clots can collect beneath the skin and must be removed through a small opening or via the use of a needle. Bleeding can be made less likely by avoiding aspirin and aspirin-like compounds (like ibuprofen and motrin) for 7-10 days prior to surgery. This will be explained to you before the surgery.

Infection: The infection rate in patients following labiaplasty is very low. Infection can cause poor wound healing and increase scarring. Infections may require drainage through a small opening. Antibiotics are given in most cases to reduce the possibility of infection.

Skin Loss: Very rarely a portion of skin will not survive and will be replaced by scar tissue. This is usually due to loss of the blood supply to the flap or infection.

Asymmetry or Undesirable Shape: The labial lips are never completely symmetrical. Patients start out with varying degrees of asymmetry. During the procedure we make every effort to make each side match closely, but there is usually still some difference in the appearance and shape between the two sides after surgery. This is almost always a normal outcome of the procedure, but is sometimes due to improper healing or weak labial skin. The overall goal which is improvement in appearance and a decrease in the lip size, however, is almost always achieved. Each patient's surgery is designed specifically for her needs and desires; however, the ultimate result is mostly dependent on healing. Your healing capability can not be predicted 100%. We make all reasonable efforts to deliver a result which is cosmetically pleasing to the patient, and in accordance with the patient's wishes, however we cannot guarantee that the outcome will exactly as expected.

Loss of Sensation: On a rare occasion, numbness in the operated area is permanent, but most of the time it improves over weeks to months. It is possible that sensation in the operated area could become unusual or annoying. The more complete removal operations may be more likely to cause this effect. The more tissue there is that is removed, the greater the chance of numbness or loss of sensation in the area.

Scar Overgrowth: The scars following this surgery usually disappear after a few months. Sometimes it can take up to a year. Some women may continue to have scar growth for even longer. Revision may be helpful in improving scar tissue.

Anesthesia: General anesthesia is required for the longer, more extensive surgeries. Simpler cases can be performed under local anesthesia or with oral sedation. Most patients desire a dramatic change, which requires more extensive surgery, and general anesthesia. General anesthesia also allows for the use of less local anesthesia which can distort the suture line, leaving creases in the skin.

Post-Operative Care

Following the procedure, the wounds will be dressed with an ointment. The sutures will dissolve over a few weeks. You should have light activity in the early post-operative period to minimize the potential to damage the healing wound or cause bleeding. Intercourse should be avoided for at least six weeks. In some cases you can receive oral sex in as little as 3 weeks. Exercise may be resumed in 2-4 weeks.

Avoiding trauma to the area allows for the best possible would healing. Patience during the post-operative period will pay off dramatically in the long run.

Labiaplasty Recovery: Recovery varies from person to person, and your recovery time and amount of pain will be different from other patients. After your surgery, you will be sent home with a bandage and sometimes ice on the area, which should be applied constantly for 24 hours or more. You will have none or very minimal pain that day. This is due to the injections that we place at the conclusion of the surgery. You will be drowsy when you arrive home due to the anesthesia. We recommend a method of ice therapy of 20 minutes "on" and 40 minutes "off". Don't put a cold compress directly on the skin. Place a paper towel or thin, soft cloth on the swollen area to protect it, with ice on top of the cloth. You can use specialized cold therapy compresses, frozen peas or blueberries in a ziplock bag, or gauze pads soaked in water and ice. For the next few days, you will take a prescribed pain medication. We will give you these prescriptions prior to your surgery for your convenience. After urinating, you must apply Bacitracin or a similar ointment to the area. Before using the ointment, use a spritz bottle to spray the area with water to clean it off. You may shower on the second day and rinse the area, but soap is not allowed until the third day. You will be bruised, and probably swollen. This is all normal.

The stitches used are almost always dissolvable and so will not need to be removed. It can take up to six weeks for them to dissolve completely. You will experience mild to severe discomfort with the sutures. You may experience itching during the healing process.

You should not exercise for at least four weeks, and again, no sex for at least six weeks. You should not wear fitted clothing for several weeks, and may not be able to wear anything on the area at first because of discomfort.

Most people are able to go back to sedentary jobs after just 48 hours. In some cases, women may take a couple of weeks to sufficiently recover, so be prepared just in case you need to spend your time resting.

This surgical procedure requires expertise. Although the recovery may be painful, it may help women with body image problems, or discomfort. We will make every effort to reduce your pain after the surgery. You should know your expectations ahead of time. This surgery is not reversible, so it is important for you to be confident with your surgeon.

What if I am unhappy with the results? Will I be charged for a revision?
Though no surgeon can make a guarantee of 100% satisfaction, we will do everything possible to give you your desired results. We have a very low revision rate. Most patients just need a little nip/tuck on one side or the other. Many times the revision can be performed under local anesthesia. If a patient needs to go back to surgery, we do not charge a new surgeon's fee for the surgery. The patient will be required to pay for the use of the operating room and anesthesiologist if the procedure needs to be performed in the hospital.
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