Everything You Need to Know About Labiaplasty

Dr. Kuruvilla (00:11):
So what is a labiaplasty? When I define a labiaplasty, I am referring to excising extra tissue of an enlarged or hypertrophic labia minora. A lot of people use the terms vaginoplasty or vaginal rejuvenation kind of interchangeably and not really knowing I think what anatomic parse they're wanting to be corrected in that setting. Usually a labiaplasty is included in your vaginal rejuvenation type procedures, but just to be very specific, when I talk about a labiaplasty, it is removing extra tissue from your labia minora. So there is multiple different techniques for a labiaplasty. Probably the two main ones that you have heard of or will read about on the internet is a wedge excision or wedge labiaplasty and a trim labiaplasty. I prefer to do the trim labiaplasty. It is a procedure that involves marking the excess kind of more pigmented, more full tissue and excising along the natural curve of the labia minora.

(01:19):
A lot of patients that want a labiaplasty are more bothered by that more pigmented tissue, that darker tissue that is along the edge of it. So a trim will address that. A wedge labiaplasty refers to essentially excising a triangular piece of tissue and closing it in perpendicular to what the trim would be. In patients who prefer to keep their natural edge of their labia or they want to keep that darker pigmented skin, then they might be more well-suited for a wedge labiaplasty sort of the most common complaints that you hear about for patients seeking labiaplasty surgery is cosmetic. They don't like how it looks. It affects their self-esteem, but also functional so it causes chafing with running. It can twist upon itself and cause discomfort cycling, horseback riding, and then in today's day and age of yoga pants and tighter fitting clothing, it might show a little bit more bulk there and can be embarrassing for patients.

(02:16):
I think that a lot of these differences people have noticed about their own anatomy have also come in the age of people being more likely to have hair removal in that area, and so that has brought a lot of differences to light of how women might vary in their vulva area. The labia minora do enlarge with puberty and then they can darken with hormonal changes as well as darken with chafing and irritation. But yes, the tissues can enlarge and lose their elasticity with age. The fluctuation in the hormones and just the changes that happen with both pregnancy and childbirth can cause elongation of the labia minora. But a lot of patients that seek this out are self-conscious about their tissues or have are symptomatic from it or have never had children before. The average kind of age range that's quoted in the literature to be the most common for women seeking this procedure is between the ages of 25 to 35.

(03:13):
So I know that historically the literature in the gynecologist world has stated that there isn't really a role for labiaplasty. And while I agree that this is all a range of normal, there is no perfect labia that everybody should be seeking. The surgical approach is very much tailored to each patient's anatomy. Now I know there are cosmetic gynecologists that do perform the surgery and have much success with it, but I think historically gynecologists have been less supportive of the procedure and feel like patients should manage whatever their symptoms are non operatively. I have to be very specific with them and what surgery I'm offering them. So I'm offering a labiaplasty, which is addressing labia minora. I think a lot of patients, understandably, when they hear labiaplasty or vaginoplasty, they're thinking, oh, tightening the vaginal opening after childbirth. That is not something that I perform. And we have non-operative adjuncts to help treat that like the ThermiVa, but for operatively repairing that I would refer them to a specialist.

(04:17):
When we do a labiaplasty consultation, we first will just kind of chat about what made you come see me about this and then I would like to hear what your goals are. I will then have you hold a mirror and we will look together and you'll show me what parts are causing you distress or discomfort and I will clarify what I can address surgically. I'll also stress that there is a range of normal in the appearance of labias. There is no perfect labia. I'll also stress kind of what my limitations are for correction just in terms of safety and mitigating those risks. Is anyone present during these consultations other than myself and the patient? The answer is yes. So my patient care coordinator is there, she's very professional, she is taking notes. However, I'm the only one that sees and performs the exam. Patients do very well with it under local anesthesia.

(05:11):
However, I can understand why it would be a very anxiety provoking procedure to have, so we do offer it under general anesthesia. When patients do have it under local anesthesia, it's all first done with topical numbing medicine and once we have confirmed that you are nice and numb, I will inject stronger local numbing medicine. Patients can take an anxiolytic medication if they want before the procedure. I think a big pro of not doing that is if patients want to be very private about this procedure that they're having, they can drive themselves there and they can drive themselves home and they don't have to worry about involving somebody to take them, just because I think some patients are a little bit self-conscious about having this procedure. So we like to give them that option. Obviously if you're having it done under general anesthesia, you need somebody to drive you to and from and you don't have to disclose what procedure you're having, but I think it makes it a little bit easier if you don't have to. From the time of being induced with anesthesia, having the local numbing medicine to walking out, it's about an hour and a half to two hours that you've spent with us.

(06:07):
The surgery itself is about an hour long. I describe recovery as very similar to childbirth for any patients that have had childbirth. So it's a lot of bedrest those first 48 to 72 hours. This area is very, very prone to swelling and so we recommend bedrest taking it easy or staying home for the first 48 to 72 hours. After that, you can ease into being more and more ambulatory, trying to elevate your hip or your pelvis as much as you can. Patients usually feel up to going back to a desk job around seven to 10 days. And then you're not doing any strenuous activity, heavy lifting sexual activity for about four to six weeks depending on how your swelling is progressing. There are stitches, they're all dissolvable. The stitches that you will see that are the final layer of closure, those will take about a week to dissolve, and then there's deeper sutures underneath that that will take a little bit more time to dissolve.

(07:04):
We offer the same peri bottle that moms are offered to help wash after going to the restroom and just help dilute urine so it doesn't sting the incision line. It's similar that if you're up and about too much, you might feel the swelling similar to after childbirth, same thing, those, that incision line or that laceration in the case of childbirth is a fresh incision that we really don't want any undue tension on from swelling. The actual procedure, you don't feel anything, that's the goal, if you're having it under local afterwards, the pain, you really notice the pain if you're swelling too much, if you're doing too much. So I think that your body can really be a guide for that. I think the most uncomfortable part is probably in the first three to five days as your swelling peaks as that incision line can be a little bit irritated when going to the restroom. But after a week or so, patients say that it's very manageable. You can take Tylenol and I'll prescribe you a narcotic just to take as needed. But also we'll make sure that you're doing ice packs frequently. Some dermoplast spray that connect as like a topical numbing medicine to spray. So very similar goody bag as after childbirth.

(08:10):
So other than your general surgical risks that you hear all the time, pain, bleeding is the biggest one here. So very much want to avoid a hematoma and that is a blood collection that frequently will require another surgery to drain that, dehiscence of that suture line, if the labia minora is overly resected, if you cut too much, then that can lead to vaginal dryness because obviously now you have this opening to the vagina without that mucosal barrier that can help lubricate things and that can also lead to pain. And then I will not perform this surgery in patients that are actively smoking, that is higher risk for necrosis and wound healing complications. There's very many cadaveric and anatomic studies mapping out the nerves, and I think the biggest one people worry about is in what's called a clitoral hood reduction. That's kind an adjunct procedure to your labiaplasty.

(08:58):
The nerves of the clitoris, they're deeper to the plane of dissection and very well studied in terms of location to avoid. So you talk about this harmonious appearance to the area. So if you take down the labia minora and the patient already has a prominent clitoral hood, then you'd want to perform or I would want to perform a clitoral hood reduction as well. All these decisions are made with my patient and I just kind of guide them in terms of similar to facelift, like if you do a lower facelift and you have a very aged appearance to your eyes, you might notice that after your facelift. So oftentimes I will perform the labiaplasty in conjunction with the clitoral hood reduction if there's excess tissue there just because it's all about balance. If you wanted to combine a labiaplasty with another procedure, it's very simple to do that, especially if you're anxious about having it done under local anesthesia.

(09:53):
If you're going to sleep for something else already, it is not complicated to add that on. So it's very much an option for patients to add on to a tummy tuck, any breast procedure, any body contouring procedure, it's always an option. I think they're very grateful. I think they're very validated and also just comforted that somebody validated these concerns that maybe other doctors have told them is just kind of who they are or to treat it. It really can boost, I think in the literature there's quoted 95% of patients who report an improved self-esteem with it, and it has around 90% satisfaction rate as well. So you can submit labiaplasty to insurance. We do not accept insurance at our practice, but I've read that the cutoff for insurance is that the labia minora is greater than four or five centimeters long, or protruberant, which usually when we're repairing or reducing a labia, the goal is to leave, labia minora, the goal is to leave around a centimeter behind, so you have to somehow be four centimeters greater than that to qualify for insurance. And I think that patients experience symptoms with hypertrophy much less than that, and I think that insurance companies do know that it's technically considered a cosmetic procedure, so it is hard to get reimbursement. So all of our prices are published on the website, and if you need more detail on pricing or how it might apply to you, you can give us a call and we can give you a more specific price for you. If you would like to schedule consultation with me, you can either DM us on Instagram or you can call our office, and I would love to meet with you.

Announcer (11:33):
Basu Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. To learn more about the practice or ask a question, go to basuplasticsurgery.com/podcast. On Instagram follow Dr. Basu and the team @BasuPlasticSurgery. That's BASU Plastic Surgery. Behind the Double Doors is a production of The Axis, theaxis.io.