Labiaplasty is a surgical procedure that corrects enlarged or redundant labia minora to make the external genitalia more cosmetically attractive or more comfortable. Ladies that consult for labiaplasty are often self-conscious about their labia minora feeling that it protrudes too much when standing or in intimate positions. Some ladies are concerned about asymmetry of their labias and some ladies even have discomfort during sex or when exercising. In rare cases excess labial tissue predisposes to yeast infections.
Labiaplasty should not be associated with embarrassment or shame. Women of all backgrounds, shapes, sizes and cultures seek labiaplasty. Following childbirth labial tissue can become stretched and redundant. It can also become more deeply pigmented at the leading edge. Following menopause the labia can droop with loss of collagen and elastin. Many women are born with asymmetric or excess labial tissue.
During a labiaplasty, the excess labia minora tissue is excised to create a more neat and tidy appearance to this region or to reduce bulk for those with symptoms. Labiaplasty usually addresses just the labia minora, does not usually involve the labia majora and never changes the vagina.
Who is a Good Candidate for Labiaplasty?
Labiaplasty is suitable for women looking to reduce the size of their labia minora. This may be because you experience awkwardness, pain with intercourse, or discomfort when walking or with exercise; or because you wish to improve the appearance of this part of your body. Rejuvenation of the labia area can improve a woman’s body image, self-esteem and comfort during intimacy.
Who Is It Not Suitable For?
Ladies with significant medical history, smokers and those with unrealistic expectations are not suitable for labiaplasty. Cosmetic surgery is not suitable for ladies who have been encouraged by others to change their appearance.
Different Types of Labiaplasty
For most labiaplasty I recommend a short general anaesthetic to ensure comfort and relaxation. In some cases where there is only a small amount of tissue to be excised, labiaplasty can be performed under local anaesthetic. However do bear in mind that even small cases can take up to a hour to complete and you will need to stay in position with your legs up and out for this period of time. When you have general anaesthetic, additional local anesthetic is used to prevent bleeding and bruising during surgery, and to keep the area numb for many hours afterwards.
Trim Procedure
A trim labiaplasty excises the leading edge of the inner lips of the labia (labia minora). The area to be trimmed is marked out; usually planned to bring the labia minora back to within the labia majora. The tissue is excised, bleeding stopped and then careful sutures are placed in multiple layers to close the labia with an attractive natural appearance. The stitches are all dissolving and an antibiotic cream is applied for a week. Advantages of this technique are that it removes the rim of pigmented and ruffled edges, which is important to some ladies. A disadvantage is that the scar sits on the most anterior part of the new minora.
Wedge Resection
An alternative way to reduce the bulk of the labia minora is to perform a wedge excision. The wedge technique removes a triangular wedge of tissue from the base of the labia minora. The edges are then brought together and sutured, pulling the remaining labia taut and therefore reducing anterior protrusion. Unlike the trim procedure, this technique leaves the natural anterior border of the labia intact. An advantage of this technique is that it can tighten the clitoral hood without the need for additional incisions. A disadvantage is a slightly increased risk of wound breakdown
I perform both wedge and trim procedures and the choice of which type depends on your individual anatomy and your individual priorities and desires.
Clitoral Hood Reduction
A clitoral hood reduction can be performed as part of a labiaplasty when needed. This involves careful trimming of excess skin that hangs over the clitoris. The overlying skin is then rearranged and closed without risking nerve injury or affecting sexual sensation.
Labia Majora Reduction
Occasionally, ladies are troubled by the labia majora. These can be trimmed to reduce their prominence. The procedure involves incisions in the skin of the labia majora and is associated with additional scars and post-surgical swelling during healing.
What to Expect at Initial Consultation
At your initial consultation, I spend a great deal of time getting to know you personally and taking a full medical history. The success of any cosmetic procedure relies on you being open with me at this stage. It is important for me to explore your reasons for seeking labiaplasty, what you dislike and your expectations of surgery. I also need to know about your general health, lifestyle and medications, prescribed or otherwise. I also need to know about past surgery to this area (including previous episiotomy).
I will examine your genital area and assess what components are problematic and what can be done to address your concerns. At the end of that consultation I will describe the surgical options to address your problems and devise your personalised surgical plan. I will also explain the risks and limitations of surgery to you at this stage. I always have a second consultation to answer any questions before we book surgery.
As a female Plastic Surgeon I have an intimate understanding of how a ladies’ feelings about her body, particularly her private areas, can affect self-image and femininity. I want to work with you to achieve your desired outcome.
Preparing for Labiaplasty
You should be physically fit prior to embarking on labiaplasty. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery. It is ideal to time surgery so that you are not menstruating on the day or immediately afterwards.
What to Expect on the Day of Surgery
You will need to come to hospital starved and ready for a general anaesthetic. Surgery generally takes one and a half to two hours depending on the procedure details.
You will return to the ward around an hour after surgery and be encouraged to mobilise and eat and drink. You will feel swollen and bruised and you will be given appropriate painkillers. You will have a post-op pad in your underwear. You should be able to go home later the same day and will need someone to collect you.
What to Expect After Surgery
You will go home with some antibiotic ointment to be applied four times a day. For the first two weeks you can shower in warm but not excessively hot water and should only use simple soap. You should not have a bath until you are fully healed (you will be advised when this is the case). Some moderate discomfort is expected for a few days and you will be given oral pain medication for a week or two postoperatively. Swelling and bruising are common and usually peak at 3-5 days post-surgery before starting to settle. At this time you will want to wear relatively loose clothing.
You should not use tampons for the first 4 weeks and should refrain from sexual intercourse during this time too. Even after this time the scar may be too tender for either for a few more weeks.
You can return to light exercise at two weeks but should not do anything that involves sitting on the area such as cycling or spinning. You should not swim until you have fully healed. Strenuous exercise should be delayed for 4 weeks. You should arrange to take up to a week off work, depending on your job.
You will be seen in the dressing clinic at one week following surgery and then weekly until you are healed. Bruising and swelling will start to settle over the first few weeks and you may find that one side settles more quickly than the other leaving you asymmetric (lopsided) whilst the other side catches up. This is perfectly normal and we will not start to see the final results for at least six weeks, sometimes longer. It can take several months for all surgical swelling to subside and for the very final results to be evident.
Is a Labiaplasty Part of a Mummy Makeover?
Labiaplasty can be part of a Mummy Makeover if this is one of the areas that you wish to rejuvenate when you have finished you family. After repeated pregnancies and/or vaginal deliveries, the labia minora become elongated and hang lower than the outer labias. This can be addressed as part of your mummy makeover if you wish.
Can Labiaplasty Be Done Before Pregnancy?
A labiaplasty can certainly be performed at any time in a woman’s life. Having surgery will in no way influence future pregnancies or childbirth delivery options however having children can change the appearance of your genitalia and therefore may affect your results in the long-term.
Potential Risks and Complications of Labiaplasty Surgery
When you are considering any type of surgery, you should be fully educated about potential risks and complications. Swelling is common in the immediate post-op phase and will get worse before it gets better. This will be associated with discomfort but this should be controllable with analgesia that is provided. Other potential complications are bleeding or haematoma that could require further surgery to control, wound infection and delayed healing. There is often asymmetry initially as one side either swells more or settles sooner but there is also a small risk of persistent asymmetry. Sensation usually changes following a labiaplasty but this should settle as the swelling reduces, although it can take a number of months. Permanent numbness is rare. The scars can become tender but it is rare to have abnormally thickened scars in this anatomical area. There is also a small risk that you are unhappy with the result either because you feel not enough or too much has been taken away. Complications of any general anaesthetic include potential cardiac or respiratory problems and blood clots in the leg (DVT or in the lung (PE).