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Labiaplasty

For women that experience discomfort when wearing tight pants or feel embarassement about the size of their labia, labiaplasty surgery is the right procedure.As with every paired structure of the human body, the labia minora are not perfectly symmetrical , and although the size discrepancy usually is subtle, women often present one minor lip considerably greater than its pair

Hoodectomy, also known as “clitoral unhooding” is the right procedure for women that have difficulty acheiving orgasm due to extra skin surrounding their clitoris.
Not to confuse you more, but there is also a fourth, less common procedure Hymenoplasty .Also known as “hymen reconstruction”, hymenoplasty is a popular procedure primarily for cultural or religious reasons.
Of all four procedures, the most popular and common is labiaplasty, the main topic of this website.

Surgical procedures

Pudendum femininum: The external anatomy of the vulvo-vaginal complex, indicating the clitoris, the clitoral prepuce, the labia majora, and the labia minora.
Labiaplasty with clitoral unhooding: the pre-operative aspect of hypertrophied labia minora and a hypertrophied clitoral prepuce ; the post-operative aspect of the reduced labia minora and the reduced clitoral prepuce .

Only the over-sized lip undergoes tissue resection (cutting and removal). In the woman who presents greatly over-sized labia minora, wherein one labium is considerably larger than its pair, only the over-sized lip is resected for symmetry with the smaller lip. In the case of the woman who also presents redundant folding between the labia majora and the labia minora, said condition of excess tissues can also be resolved by means of labioplasty.
The labial reduction can be performed upon a patient under local anaesthesia, conscious sedation, or general anaesthesia, either as a discrete, single surgery, or in conjunction with a gynecologic surgery procedure, or with a cosmetic surgery procedure. The resection proper is facilitated with the administration of an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the labia minora in order to achieve the tumescence (swelling) of the tissues and the constriction of the pertinent labial circulatory system, the hemostasis that limits bleeding.

 

Techniques for labial reduction

Edge resection labiaplasty

The original labiaplasty technique was simple resection of the excess tissues at the free edge of the labia minora. One resection-technique variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostatis (stopped blood-flow), and the surgeon resects the excess tissues, and then sutures the cut labium minus or labia minora. The technical disadvantages of the labial-edge resection technique are the loss of the natural rugosity (wrinkles) of the labia minora free edges, thus, aesthetically, it produces an unnaturally “perfect appearance” to the vulva, and also presents a greater risk of damaging the pertinent nerve endings. Moreover, there also exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. The advantages of edge-resection include the precise control of all of the hyper-pigmented (darkened) irregular labial edges (which the woman reported as either functionally or aesthetically undesirable) with a linear scar that can also be used to contour the redundant tissues of the clitoral hood, when present.

 Central wedge resection labiaplasty

Labial reduction by means of a central wedge-resection involves cutting and removing a full-thickness wedge of tissue from the thickest portion of the labium minus. Unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural rugosity (wrinkled free-edge) of the labia minora. Yet, because it is a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness . The central wedge-resection technique is a demanding surgical procedure, and the difficulty can arise with judging the correct amount of labial skin to resect, which might result in either the under-correction (persistent tissue-redundancy), or the over-correction (excessive tension to the surgical wound), and an increased probability of surgical-wound separation. Moreover, as appropriate, a separate incision is required to treat a prominent clitoral hood.

De-epithelialization labiaplasty

Labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minor (small lip), either with a scalpel or with a medical laser. This labiaplasty technique reduces the vertical excess tissue, whilst preserving the natural rugosity (corrugated free-edge) of the labia minora, and thus preserves the sensory and erectile characteristics of the labia. Yet, the technical disadvantage of de-epithelialization is that the width of the individual labium might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction.

 Labiaplasty with clitoral unhooding

A labial reduction procedure occasionally includes the resection (cutting and removing) of the clitoral prepuce (clitoral hood) when the thickness of its skin interferes with the woman’s sexual response. The surgical unhooding of the clitoris involves a V–to–Y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves); thus, uncovering the clitoris further tightens the labia minora.

Laser labiaplasty technique

Labial reduction by means of laser-ray resection of the hypertrophied labia minora involves the de-epithelialization of the labia. The technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts.

Surgical technique

Labiaplasty by de-epithelialization

Labial reduction by de-epithelialization cuts and removes the excess tissues and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and so preserves the capabilities for tumescence and sensation. Yet, when the patient presents much excess labial tissue, a combination procedure of de-epithelialization and clamp-resection usually is more effective for achieving the aesthetic outcome established by the patient and her plastic surgeon. In the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de-epithelialization labiaplasty includes an additional resection technique — such as the five-flap Z-plasty (“jumping man plasty”) — to establish a regular and symmetric shape for the reduced labia minora.
Pre-operative matters
• Consultation — To understand the aesthetic goals of the patient, the plastic surgeon evaluates the labial hypertrophy that the woman presents when standing. Afterwards, in the operating room, with the patient in the lithotomy position (as if for a urinary-bladder stone-removal surgery), the surgeon then delineates the resection-pattern markings (incision plan) to each side of each labium to facilitate the de-epithelialization required for reducing its size (length and width). Afterwards an anaesthetic solution is infiltrated to the labial tissues to numb and swell them for easy resection of the excess tissues. As required by the patient’s health, the physician–surgeon might instruct the woman to take oral antibiotic and anti-inflammatory medications before the operation; if not, they are intravenously administered to the patient at the start of the labiaplasty operation.

Operative technique
For the optimal exposure of the vulvo-vaginal complex, the patient is positioned upon the operating table in the lithotomy position. After confirming regional anaesthesia and labial tumescence, the surgeon then cuts and removes the excess tissues of the labia minora. After the resection step, the suturing of the surgical wound is the procedural step that most influences the aesthetic outcome of the labial reduction , suturing the tissues of the labia minora with a running absorbable-suture occasionally produces a scallop-edged surgical scar-line, whereas suturing the tissues with a running buried-suture usually produces a wound closure of natural appearance.

Post-operative matters
Post-operative pain and surgical-wound care are minimal, which conditions permit the woman to leave hospital and return home the same day she underwent the labial reduction procedure; usually, no vaginal packing is required, although she might choose to wear a sanitary pad for comfort. The physician informs the woman that the reduced labia often are very swollen during the early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues. She also is instructed on the proper cleansing of the surgical-wound site, and the application of a topical antibiotic ointment to the reduced labia; a wound-care regimen observed 3-times daily for 2-days post-operative.

The woman’s initial, post-labiaplasty consultation with the plastic surgeon is recommended at 1-week post-operative. She is advised to return to the surgeon’s consultation room should she develop hematoma, an accumulation of blood outside the pertinent vascular system. In accordance with her wound-healing progress, the woman can resume physically undemanding work at 3–4 days post-operative. Moreover, to allow the full and proper healing of the labiaplasty surgical wounds, the woman is instructed to not use tampons, to not wear tight clothes (e.g. thong underwear), and to abstain from sexual intercourse for 4-weeks post-operative.

Complications
Medical complications to a labiaplasty procedure are uncommon; yet the occasional complications like bleeding, infection, labial asymmetry, poor wound-healing, under-correction, over-correction do occur, and might require a revision surgery. An over-aggressive resection might damage the nerves, which condition subsequently causes painful neuromas. Furthermore, performing a flap-technique labiaplasty occasionally presents a greater risk for necrosis of the labia minora tissues.

 

FAQ :

How do I know if I need cosmetic genital surgery?

Although most women who undergo these procedures don’t physically require surgery, labiaplasty and vaginal rejuvenation can vastly improve a woman’s enjoyment of her body and her life. Generally speaking, good candidates for cosmetic genital surgery are women who experience physical discomfort due to elongated or misshapen labia. Excessive skin around the clitoris that diminishes sexual well-being or any appearance that causes embarrassment or psychological discomfort can usually be alleviated by surgery. At our practice, we emphasize that patients should undergo cosmetic surgery for their own personal fulfillment, not because they feel pressured to do so by someone else.

Should I see a plastic surgeon or an OB/GYN for Labiaplasty ?

Many OB/GYNs now perform cosmetic genital surgery in addition to their other services. Although we believe that a board-certified plastic surgeon is usually the best option for plastic surgery, either specialist may be a good option.

When choosing a surgeon, it’s important to do plenty of research. Ask the doctor if you can see before-and-after photos of his or her previous patients. Examine his or her credentials closely, and ask plenty of questions during your consultation. Don’t be afraid to shop around until you find the best match for you.

What are the potential risks of Labiaplasty?

Labiaplasty and vaginal rejuvenation are generally safe procedures that are no more or less risky than other types of plastic surgery. Complications related to anesthesia, as well as bleeding, infection, and nerve damage are possible but unlikely. The surgeon takes careful steps before, during, and after surgery to reduce the risk of complications as much as possible and ensure effective, long-lasting results.

How else can I improve the look of this part of my body?

Some other options for improving the appearance of the genitals include liposuction of the mons pubis or labia majora to reduce the amount of fat under the skin and reduce the appearance of a prominent “bulge” in swimwear or undergarments. Conversely, the same area can be enhanced with autologous fat grafts for a plump, youthful appearance. Dr. Maamari help you decide which of these options, if any, are appropriate for you.