Labiaplasty

Labiaplasty is an aesthetic or reconstructive surgery to reduce the size of the labia minora AKA the inner flaps of skin on either side of the vagina. It is the most common vaginal rejuvenation procedure performed and can improve the appearance of the vagina while relieving symptoms related to enlarged labia minora. Labiaplasty can eliminate the pain many women feel from a twisting and tugging of the labia when exercising, riding a bike or during intercourse. Women with larger labia may also suffer from itching or irritation especially when wearing tighter fitting clothes. The procedure reduces the labia minora so they do not hang below the hair-bearing labia majora (the outer folds of skin on either side of the vagina) when standing.

Am I a Good Candidate for Labiaplasty?

A GOOD CANDIDATE for labiaplasty may include:

• Women who aesthetically want to reduce the size and shape of the labia minora
• Women who are self-conscious of their labia (sexually or when wearing a swimsuit)
• Women with asymmetric labia or one side longer than the other
• Women who have discomfort associated with the labia minora

The following patients are NOT GOOD CANDIDATES for labiaplasty:

• A woman with any serious medical condition which may increase surgical risks or impact healing
• Patients with some genital diseases
• Anyone who is ill at the time of the surgery
• Any patient who cannot go without intercourse for 6 weeks

How is Labiaplasty Performed?

Labiaplasty is an outpatient procedure usually performed under general anesthesia but it can be performed by some physicians under local anesthesia.  The procedure takes approximately 30 minutes to two hours depending on the surgeon and the surgical technique used.  Reduction of the clitoral hood is often performed at the same time if the clitoral hood is bulky, long or protruding.  Occasionally, clitoral hood reduction can increase sensation during intercourse if the head of the clitoris is buried under significant excess skin. There are many different techniques for reducing the hood depending on the anatomy and the surgeon.

While there are a few techniques available for labiaplasty, the central wedge technique creates a more natural look with less pain and scarring than other methods. During this procedure, the surgeon will remove a wedge or “pie slice” from the portion of each labium that protrudes the most. The top portion of the labium will then be sutured to the bottom portion, with dissolvable sutures, to create a smaller labium with normal anatomy.

Alternative Techniques

An alternative technique involves trimming each side of the labium along the entire edge. However, this technique leaves a long scar along the entire labium which can result in painful scarring. It can also cause scalloping and irregularity of the labial edge with a higher incidence of asymmetry.  The central wedge technique preserves the edge of the labium and maintains a more normal look.

Some patients feel their labia majora are also too big which can cause a bulge in clothing. The surgeon can reduce the size of the majora by excising excess skin and, if necessary, excess fat. This procedure is called a labia majoraplasty and can be performed separately or at the same time as a labiaplasty.   

What is the Cost of Labiaplasty?

The cost of a labiaplasty procedure ranges from $3000 to $12,000 depending on the surgeon, the technique, if general anesthesia is used and the geographic location of the procedure.  While health insurance will not cover the cost of labiaplasty for cosmetic purposes, it may cover a portion of the cost if the labia cause pain during exercise or intercourse.

Recovery and Downtime

After labiaplasty, the amount of tenderness and swelling of the genitalia during RECOVERY varies greatly depending on the technique used and the patient. The labia and surrounding area may be bruised. Pain medications will be provided and should be taken as directed. An oral antibiotic may also be prescribed as a preventative against infection. There are different post-operative protocols depending on the type of labiaplasty and the surgeon.  Ice packs on the genitaiia can be placed for a couple of days to ease discomfort and minimize swelling. Wedge labiaplasty patients usually require minimal postoperative care.

Patients may feel some mild stinging when urinating. A squirt bottle filled with water is used after urinating. Stool softeners should be used to stay regular since pain medications can cause constipation. Blood-tinged drainage, or bleeding, is common for one week after trimming labiaplasties so patients will need to wear a sanitary napkin.

In terms of DOWNTIME, patients with wedge labiaplasties can usually return to work in a few days but trimming labiaplasties are commonly more painful.  Friction from walking can cause moderate to severe discomfort (especially from a trimming technique). The wedge method has less friction issues since the incision moves inward towards the vagina. During the first week, patients should avoid much activity or carrying heavy objects. Showering is usually permitted the day after surgery and a gentle rinsing of the vagina is acceptable.  A mild soap may be used in a week in some cases. Tampons should not be used for 4 to 6 weeks. Patients should avoid strenuous exercise for 3 weeks after the procedure and avoid intercourse for at least 6 weeks.

Results

The results from labiaplasty can be obscured for the first couple of weeks due to swelling. By the sixth week, eighty percent of the swelling should have subsided and the patient will see smaller, more natural labia minora.  Residual swelling can last up to 4 or 5 months. At that time, the labia usually do not protrude past the labia majora.  Final results can be expected by 6 months post-op. The results are long lasting but pregnancy, or the natural effects of aging, can alter the results.  

Limitations of Labiaplasty

LIMITATIONS for labiaplasty can include:

• The misconception that labiaplasty will always increase sexual pleasure.
• The amount of skin removed during a labium reduction. While some women desire a large reduction, over-resection can cause additional symptoms such as chronic dryness.

Risks of Labiaplasty

The RISKS associated with labiaplasty may include:

• Adverse reaction to anesthesia
• Bleeding
• Infection
• Hematoma
• Poor wound healing
• Pain
• Temporary numbness
• Changes in pigmentation
• Asymmetry
• Under, or over, correction
• Changes, or a decrease, in sensation
• Creasing, or a puckering, of the skin
• Excess scar tissue buildup
• Sexual dysfunction
• Scarring at, or near, the vaginal opening from too much skin removal can cause pain during intercourse

Choosing a Surgeon

Many women are self-conscious about the appearance of their genitalia and specifically about the size or shape of the labia minora. However, they are often too embarrassed to seek help or do not know that labiaplasty can correct the issue. Any patient considering labiaplasty should consult with a board-certified plastic surgeon that often performs this procedure. Potential patients should ask what technique the doctor uses, how many years of experience the doctor has performing labiaplasty and should view “before and after photos” of patients treated by the surgeon. If well performed, it is an excellent operation. If not well performed, it can lead to lifelong deformities and discomfort.  It is imperative that a woman does her research to make sure she picks the correct surgeon for her. 

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview provided by Gary Alter, MD in Beverly Hills, CA.