Despite the fact that no two people have the same faces, conformity of the genitals has become a national obsession. Perhaps the new technologies and the increase in all types of plastic surgery are making it easier and more affordable for everyone to fix body parts that do not suit them. If a face can be made more youthful and a waistline made smaller, then it is logical for any body part to be altered to look just right. In essence, labiaplasty makes the genitals prettier and boosts the woman's self-confidence just like breast augmentation did and does for millions of women. More importantly, function is restored when enlarged labia minora cause physical discomfort and pain during sex, from exercise, or just walking around. New technology such as laser and radio frequency makes fixing this problem easier with less pain and minimal downtime. Any woman who is healthy and from any background or culture can re-size and reshape their genitals to be more functional, natural, youthful, and aesthetically pleasing. This is why labiaplasty is becoming one of the most frequent cosmetic consultation requests that patients make to gynecologists and plastic surgeons. This procedure is also known as Labial Reduction Surgery, Labioplasty, or Vulvar Surgery.
Dr Williams talks on Vaginoplasty
The What and Why
that Leads to Labiaplasty
Labiaplasty surgery is performed by precisely excising the excess skin of the labia minora (the inner lips) so that the two sets of lips appear sculpted and even. Excess skin around the clitoris can be removed at the same time. This is called clitoral unhooding and is done if this extra flap of skin causes irritation or interferes with sexual intimacy and pleasure. Maintaining hygiene and preventing yeast infections are other important reasons for women to have their labia trimmed. Excess labial tissue can become chafed from excess heat and friction. This can lead to extra moisture, itching, pain, and burning. Pregnancy and childbirth cause weight gain and more pressure that stretches the delicate labial tissue. Lacerations or episiotomies during a vaginal delivery can heal unevenly and leave unsightly flaps of tissue. The lack of estrogen at menopause reduces the collagen of the labial tissue and causes them to droop and elongate. Other women have difficulty with their exercise routine, cannot wear bathing suits or yoga pants without feeling self conscious or experiencing pain. Simple activities such as walking, riding bikes, and having sex can be difficult for many women with enlarged labia minora. A combination of any of these conditions can be the reason for a labiaplasty surgery consultation. As more and more women become comfortable discussing once 'taboo' subjects, become more knowledgeable, search the internet for answers and pictures of 'before and after' procedures, they begin to think more seriously that labiaplasty might be the answer they are seeking.
Other types of feminine procedures or surgeries are are monsplasty, vaginoplasty, hymenoplasty, G-spot augmentation, frenuloplasty, perineoplasty, fat injections, or combinations of these procedures. Again, making the area look more symmetric and improving function are the primary goals. Labia minora reductions are more common than reductions of the labia majora.
Dr. Williams, one of the best labiaplasty surgeons in Chicago, does a detailed evaluation and spends considerable time discussing each patient's concerns and will decide whether labiaplasty is the best solution. Women with other gynecological diseases may not be good candidates for labiaplasty surgery. Overall, the risk of any complication is very low, reported at less than 1%. Smoking increases the risk of complications such as poor wound healing. Collagen disorders, autoimmune diseases, severe diabetes, severe obesity, or cardiovascular disease are conditions that make the procedure more risky and healing more difficult. To be good candidates for labiaplasty, patients should be in good health, optimal weight, completed childbearing or be at least 6 months after birth and cessation of breast feeding, and over the age of 18.
If there are any significant physical and functional concerns, labiaplasty can be individualized and done at any time, especially if a previous labial surgery had poor results or healed incorrectly. A surgical informed consent will be discussed and signed before surgery is performed. It will outline risks such as pain, swelling, scarring, infection, bleeding, and the possibility that more extensive surgery is required. Expectations of results will be discussed to help the woman understand that perfection is not attainable, but that improved look and function are the goals.
The procedure can be done in the hospital, an outpatient surgical center, or in the office. All are done with local anesthesia (numbing medication) to reduce the amount of bleeding, bruising, and to provide extra postoperative pain relief. Intravenous sedation or general anesthesia are additional options, but are more costly. The other advantages to local anesthesia alone are that the patient can be involved in the amount of skin removed, be able to ambulate to and from the surgical suite, and be able drive to and from the office or center. Topical anesthetics or ice packs can be applied before injection of the numbing medication. The entire labiaplasty procedure usually only lasts one hour, maybe two if another procedure is done at the same time.
Causes of Enlarged Labia Minora
The exact cause of labial hypertrophy (excessive growth) is unknown, but it is considered multi-factorial. Being born with the condition as a result of genes, hormones during adolescence or pregnancy, genital piercing, lacerations from childbirth, weight gain or weight loss, extensive bicycling or horseback riding, sexual intercourse, and any chronic mechanical stretching predispose someone to have the condition. Labial hypertrophy is not considered a disease, nor is it considered abnormal.
Classification and Types of Labiaplasty
The first published report on labiaplasty occurred in 1983. In the past, any labia minora extending 5 cm was called hypertrophy of the labia. Currently, 3-4 cm is considered excessive length which gave rise to a new classification system in 2010. Regardless of the classification system, any woman can have a labiaplasty.
Class 1- Equal or minora less than majora
Class 2- Minora extending beyond the majora
Class 3- Hypertrophy of the clitoral hood
Class 4- Hypertrophy of the minora extending to the perineum
Classes 2, 3, and 4 are excellent reasons for surgeries if desired by the woman. Another clinical system used to evaluate the degree of hypertrophy categorizes the labia minora relative to the majora. They are:
None-in that the labia minora extends no further than the majora
Mild to Moderate- the minora extends 1-4 cm beyond the majora
Severe- minora extends more than 4 cm beyond the majora
Types of Labiaplasty
'Trimming' the labia minora can be done in a straight or curved line incision along the outer edge of the labia minora by using either scalpel, laser, scissors, incising needle, or radio frequency (RF). Dr. Williams prefers using the laser or the scalpel which stops bleeding better and causes less pain. The trimming method removes excess tissue on either side of the labia minora and the edges are sutured together with buried, absorbable stitches that do not require removal. This technique results in an even appearance of the minora and removes the bulge between the labia majora.
The 'Wedge Resection' technique is done by making an incision that is ‘V’’ or cone-shaped. This results in a more natural appearance and reduces the possibility of nerve damage to the outer edges of the labia since no 'new' labial edge is created.
The central de-epithelialization excision is more complicated and involves an elliptical incision to the inner wall of the labia through to the exterior side.
Your surgeon will make a surgical recommendation based on your specific requests and desired aesthetic result. Dr. Williams uses a hybrid technique which is a combination of the 'trim' and 'wedge' technique, known as the “C' technique. In this technique, the removed, excess, stretched-out labial skin heals faster and the scar is hidden between the labia majora which makes the area more natural appearing, neat, and tidy.
It usually takes 6 weeks for the tissue to heal completely, but the area continues to improve for up to 6 months. Labiaplasty does not involve the vagina like an episiotomy which makes the healing faster. During the first day or two after the procedure, it is best to stay in bed to minimize swelling, pain, and to keep the bleeding or spotting to a minimum. Ice packs and oral anti-inflammatory medications are useful. You may be prescribed an antibiotic. Ice packs should be used intermittently for 20-30 minutes and are best if a damp, soft cloth is placed around the pack. Loose clothing should be worn for 14 days. Sexual relations and vigorous exercise should be avoided for 6 weeks or after the post operative visit.
Gynecologist vs Plastic Surgeon
When considering a physician to perform your labiaplasty or vaginal rejuvenation, you must do your homework. You want a surgeon well trained in the anatomy, physiology, and natural function of the vagina.
Dr Williams has spent extra training under a world renowned Urogynecologist learning about the pelvic floor, its function, and the proper physiologic repair of this vital organ.
Most plastic surgeons have little, if any, training in vaginal surgery. They may be fantastic at face, breast, or abdomen, but when it comes to your vagina, you want a highly trained Gynecologist who specializes in pelvic floor.
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