Labiaplasty is a plastic surgery of the external (outer) female genitalia. The predominate reason women seek this operation is increased size of the labia minora (or inner lips). As fashions become more form fitting, hair patterns more revealing and mean of comparison more common, more women are seeking this operation for cosmetic reasons. Problems with pain, on sitting or in thigh clothes, toilet habits and sexual discomfort are functional reasons patients seek a surgical solution to elongated labia.
The problem may be exacerbated by age or activity (horse or bike riding) and atrophy of the labia majora (outer lips). Current grading suggests any length more than 5 cm is abnormal by comparison in size with what is considered anatomically normal. The goals of labiaplasty are a minimally invasive way to reduce the enlarged lips while maintaining the sensation, color, texture and adequate opening of the lips. The edges of the labia have a very unique pigmented, corrugated mucosa skin junction that cannot be replicated.
Different techniques exist from amputation of the excess lip, simple wedge excisions and more complex wedge excisions tailored to remove the excess tissue while preserving the edge. The technique that works the best is one that is tailored to the patient’s own anatomy, yet wedge technique which I use leaves more normal color, appearance and sensation.
The surgery takes about an hour and can be performed under local, sedation or general anesthetic based on patient comfort. Recovery is about a week of surgical healing with avoiding heavy exercise and sexual activity for two weeks. Care is minimal involving sitz baths and antibiotic ointment only. I utilize layers of absorbable sutures which avoid the need for removal and minimize the risk of dehiscence or the wound falling apart which is the most common of this procedure and is a rare complication.
This is one of plastic surgery’s offerings with which patients are undeniably delighted. Large series report 95-98% of patients if happy or would undergo the operation again, a solid testimonial.
The operation is not difficult, yet requires appreciation of genital esthetics, tissue handling and plastic surgery techniques. Seek help from a surgeon with understanding and experience. Ask about techniques they use to preserve mucosa to skin border to maintain texture, color and sensation especially if you have pigmented skin. The surgeon needs to leave at least 1 cm of labial length to avoid retraction and scarring. I have seen this type of problem once when serving as an expert witness for another surgeon and it is hard to fix without complex further surgery.
Price is important in all choices but make sure you are comparing the true expenses. Is this being offered in an office or operating room, is anesthesia included or is it going to require a number of sensitive injections.
In conclusion, this surgery can be combined with other minor procedures to plump up the outer lips or clitoral hooding to remove excess skin from around the clitoris.
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Dr. Steven Davison
