Recently women have become more aware of differences in female genital appearance due to increased media exposure (more explicit photographs, movies or articles relating to this), widely accepted hair removal (Brazilian waxing or laser hair removal) in the genital area with more exposure of the anatomic variations. Labial reduction surgery is not a taboo anymore. Most consider a normal female external genitalia (vulva) to consist of the labia majora (outer lips) covering the labia minora (inner lips) completely or almost completely with the legs in the neutral position. If the labia minora protrude out significantly, a woman might consider this deformed and aesthetically unacceptable. This can cause diminished self esteem and avoidance of sexual activity. Besides the psychological effect, women also complain about irritation, cleansing issues, inability to wear certain clothes, difficulty with exercise, biking and irritation during sexual activity.
The most common cause of labial enlargement is congenital. This begins to manifest during puberty under hormonal influences. Other causes reported are the results of infection, chronic irritation, dermatitis from urinary incontinence, vulvar lymphedema, and labial growth during pregnancy, use of androgen type hormones and age.
The traditional and most commonly performed technique involves a straight amputation of the excess labial tissue and over sewing the edges (obviously under anesthesia). This is very easy and reproducible technique. The drawbacks are that it creates an unnatural labial edge, discoloration from the scar, scar contracture with potential painful sexual intercourse and overly narrowing the vaginal opening due to the scar pulling. This technique can cause the clitoris to be unnaturally exposed and lead to irritation.
I do not perform this surgery; I believe that it should be abandoned or reserved for certain limited circumstances and anatomical presentations. My labiaplasty technique involves a wedge resection (centrally or superiorly based, depending on anatomy) of the excess labial tissue and the outer suture line closure falls into the fold between the labia majora and minora and the inner suture line is toward the vaginal opening. This preserves the normal labial edge and color, does not affect the vaginal opening or distort the clitoral hood. If a woman has excess skin over the clitoris, this can be removed at the same time. All the sutures I use are self dissolving. I perform all my surgeries in our AAAASF certified office surgical suite which provides full privacy unlike a hospital. This operation can be done under local anesthesia with minimal oral sedation.
Most common condition that female patients complain about is the labia minora (non hair bearing lips).Some patients are not satisfied with the outer lips either. The loss of volume over time, loose skin is partially responsible for overexposure of the inner lips. I correct these with either excess skin excision and/or fat grafts to the outer lips to make them more plump and able to give protective cover for the inner lips. The scar for the skin excision is placed in the fold between the outer and inner lips.
Over time and also with excess weight this anatomic area gets fuller as well. Many patients complain that it feels like they have an extra roll in their jeans or workout clothes. They feel embarrassed to wear more revealing clothing or swimwear. If there's good skin elasticity, I prefer to treat this are with liposuction only. In older patients or who have loose skin and sagging of this area, I do a pubic lift alone or many times in conjunction with an abdominoplasty. One has to be careful not to elevate the hair bearing skin too high, often skin excision is necessary.
I have my patients wear underwear to support the tissues and minimize swelling, do not wipe, but rinse with water after using the restroom and abstain from sexual intercourse for 4-6 weeks. Although labiaplasty is the most common procedure requested, sometimes women request narrowing of the vaginal canal, stretched out from giving birth, or enhancement of the G-spot.