What You Need to Know About Labiaplasty (Ep. 9)

Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I’m your host, Dr. Jason Hall.

All right, welcome to the show. On today’s show, we’re going to talk about a really sensitive topic. Now, most of plastic surgery, most of the stuff that we discuss on the show is really out in the open. Labiaplasty surgery is not there. It is still very hush-hush, obviously, and is not one of those procedures that people talk about at parties, or that you’re going to discuss with a casual group of people like you would a breast augmentation or rhinoplasty surgery.

However, labiaplasty is really becoming more popular in the United States, largely due to social media and a more relaxed attitude towards plastic surgery enhancements. Every year, there are about 10,000 labiaplasties performed in the United States and that number is going up. So, labiaplasty is a thing, for lack of a better term, and it is one of those things that people are looking for information for. And the reason to make this show, in particular, is that there really is not a lot of good information out there. There’s a lot of social media stuff; not a lot of great information.

So, why I really wanted to record this episode is to give you good information about what a labiaplasty is, what it treats, and what else is out there because there are other non-surgical treatments that are out there that are kind of aimed at the same population, but not really. So, let’s start with what a labiaplasty actually is. Now, without going into great anatomic detail here, there are two main portions of the female external genitalia that we surgically manipulate. One is the labia majora, which are large and largely fatty tissue on the outside, and then the labia minora, which are on the inside—so medial or inside of the labia majora—and are right at the edge of the vagina and urethra. This is the very thin tissue that does have muscle in it that is highly sensitive and sort of shields the opening of the vagina and the urethra, as well as providing cover for the clitoris.

In labiaplasty surgery, what we’re primarily doing is altering the labia minora which is that thin tissue on the inside, which can get stretched out or enlarged, or some women are born with it enlarged. Now, why would we want to perform a labiaplasty and remove this tissue? Well, there are medical reasons for that, mostly chafing, pain, discomfort with activity or exercise, something called dyspareunia, which is pain with sexual intercourse, but a lot of the reason for labiaplasty is cosmetic and psychological: Women feel that their labia are too long, that they’re too protrusive, that they’re asymmetric, that they are embarrassed to wear tight clothes or swimsuits, or they’re self-conscious when they’re undressed. And all of those things can really damage a woman’s self-esteem and lead to difficulty with sexual relationships.

This has actually been studied in 2016, in a behavioral science journal, and women who demonstrate a positive genital self-image demonstrate higher levels of sexual self-esteem, which make them feel more sexually attractive. And I think that’s probably a no-brainer of a statement, but if you feel good about the way that your genitals look, you’re going to feel more sexually attractive. And this is really, I think, the driving force behind a lot of women seeking labiaplasty surgery. So, that gets to, kind of, the next point which, who gets labiaplasty? Some of my labiaplasty patients are moms who are done having children, but many if not most of them are in their early-20s, never had kids, but are embarrassed by the appearance of enlarged or asymmetric labia minora that make it difficult to wear swimsuits, tight clothes, exercise without discomfort, or they’re just embarrassed at the way they look naked.

And, like we kind of said before, this can really damage sexual relationships and sexual self-esteem. Some of my labiaplasty patients are moms who are done having kids and who have very similar complaints but feel that the changes that they see in their labia minora are largely due to childbirth changes, with hormones that come with age, but we end up treating essentially the same problems. Some women have seen their gynecologist, who have tried to dissuade them and told them not to worry about their problem, that it wasn’t a big deal, that the surgery was very dangerous. And what we see, as plastic surgeons, is that many gynecologists traditionally have a very dismissive attitude toward the surgery because, in their literature, labiaplasty surgery does carry a fairly high complication rate of about 20%. Now, you can contrast this with the quoted complication rate in the plastic surgery literature, which is one-fifth of that, which is about 4%.

And there’s probably room for jokes between the specialties there, but gynecologists, in all fairness, have no training in cosmetic surgery, where plastic surgeons, we learn how to do this operation during our training. But it’s also, from a principle standpoint, very similar to a lot of the other procedures that we do, specifically an upper lid blepharoplasty. The techniques are a little bit different, the way we approach the operation is a little bit different, plastic surgeons tend to be more liberal at using labiaplasty surgery because of its low complication rate and because of its very high patient satisfaction.

So, let’s talk surgery. How’s the surgery done? So, first thing, before we talk about the surgical details is, I want to differentiate between labiaplasty and vaginoplasty. Labiaplasty, which is what we’re talking about here, is removing excess skin on the outside of the genitalia. Vaginoplasty on the other hand, is tightening the vaginal canal.

This is often the result of childbirth or birth trauma such as an episiotomy, and can also occur naturally with menopause. Surgical vaginal canal tightening is muscle repair. It’s tightening the muscular wall of the vagina to narrow it. And when we do that, that is oftentimes combined with labiaplasty surgery but doesn’t have to be. There are also non-surgical vaginal tightening methods which are out there, there are lasers which can tighten the muscles of the vaginal canal, and these offer—compared to surgery—fairly modest results that are less predictable because we’re relying on muscle tightening as a result of heating. Some of the very same principles that we talked about in the laser show apply to that procedure as well.

Now, the important thing to remember with vaginoplasty surgery is the need for vaginoplasty can often be accompanied by other medical problems, problems with the—genitourinary system, pelvic floor laxity problems—and so a more extensive medical workup is really necessary before a vaginoplasty is performed to make sure that there are no other issues that need to be addressed at the same time.

Okay, so let’s talk surgery here. There are two main labiaplasty techniques. One is the wedge resection, the second is the trim technique. Now, the wedge resection is just what it sounds like. It’s essentially taking a wedge or a pie piece out of the excess labia that includes both skin and muscle, and then sewing those two edges together to shorten the labia and make them smaller.

This technique works but has a much higher rate of complications. There can be notching, there can be dehiscence, or where the suture line comes apart, and the need for revisions if any of that happens because essentially, the whole thing comes apart, falls apart completely. Because it’s a non-anatomic resection. Contrast that with the trim technique—a modification of which is what I do—is where excess tissue is removed laterally and no muscle is removed. It is essentially skin only.

And this is really where the similarities between labiaplasty and blepharoplasty are most apparent is that we’re taking off skin, hiding incisions, really in plain sight in tissue creases where they’re right there. But because of the way the skin is removed and closed with no tension and buried sutures, which are underneath the skin and dissolve and never need to be removed, that we’re able to reshape and really beautify that entire area, with incisions that are almost invisible. Trim labiaplasty is often combined with clitoral hood reduction to elevate and expose the head of the clitoris, and that can be easily done with the same hidden incision as used for a standard labiaplasty. Dehiscence, or the suture line coming apart, really is not a problem with a trim technique because we respect the natural anatomy; we put those incision lines in natural skin creases, we’re not removing muscle.

And so if a suture gaps a little bit, or God forbid, there’s a blood clot or something else goes wrong right after surgery, the entire thing doesn’t come apart and need to be redone. And, you know, whenever we talk surgery, the discussion of complications as important, and the trim technique just carries a lower chance of problems, even though the chance of problems is low already. Surgery itself, in my practice, we do this under general anesthesia. Takes about an hour; you’re asleep the whole time and go home the same day. I know there are some surgeons that do this as an outpatient procedure under a local in their office.

For my patients, I just find that it’s easier and much more comfortable to do this under an anesthetic, you’re asleep, you don’t have to worry about whether something that I’m going to do is going to hurt, and it just makes it a much more pleasant experience for everyone. In terms of recovery, you’ll be able to return to work after labiaplasty within a few days, but you will really need to avoid any exercise or any other strenuous activity for about a month.

A couple of recovery tips after labiaplasty. Number one is, wear loose cotton undergarments and avoid any clothing that’s too tight or too irritating. And you’re going to want to follow that one for about a month. You just want to make sure that nothing is too tight and constrictive. You’ve just had surgery, you don’t want to constrict that area, and goodness knows, you don’t want to disrupt the suture line. But you also—if things are tight, it’s just going to be uncomfortable, so avoid anything that is tight for at least a month.

Number two is, wear a maxi pad is covered with a lot of antibiotic ointment. You want to make sure that the suture lines stay covered in antibiotic ointment for at least the first week after surgery to really let those incisions heal. Those incisions in my practice, all of the sutures are buried, so there’s no stitches that are going to be sticking out or catch, but you don’t want anything sticking to that suture line and pulling and potentially disrupting it.

Third is that ice is going to be your friend. And this—you could probably say that about every plastic surgery procedure, but ice is going to help reduce swelling and reduce discomfort, especially during the first two or three days after surgery.

Tip number four; biggest question we get is, “When can we have sex?” And what I tell patients is you want to wait a month. Give yourself a month, no tampons, no intercourse, and avoid crossing your legs for about a month after surgery. Again, you just want to let this area heal without any unnecessary trauma. In my practice, we see our patients back for their, kind of, clearance checkup at six weeks, and the incisions after labiaplasty are really difficult to see at six weeks.

At the three-month mark, they’re practically invisible. And my patients will tell me afterwards that they’ve been to see their gynecologist for their annual checkup, their gynecologist couldn’t even find their incisions. And that to me, that tells me that I did a good job, is things look… natural, look pretty, and incisions are almost invisible. So, this is a shorter show, but really wanted to get this out there because, you know, labiaplasty is a rapidly growing procedure here in the US. It is an incredibly beneficial operation that offers not only functional improvement but improves a woman’s quality of life and self-confidence in a way that’s really difficult to describe. So, if you’re interested in learning more about labiaplasty, you can check out my website for more information, or hit me up on social media @jhallmd. Thanks, everybody.

Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at @jhallmd on Instagram and Twitter and @DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.