Labiaplasty: Reduce uncomfortability and self-consciousness
What is Labiaplasty?
I've been getting quite a few patients interested in cosmetic labiaplasty.
This is entirely an aesthetic procedure. And the vast majority of women who want labiaplasty are very concerned about the length of the labia minora or majority.
The minora is the inside hairless area of the external genitalia. This is a really interesting consult because these women who come in for this consult, they've thought about it for quite a long time, and this is something that's causing a lot of self-consciousness.
Patients may mention that they’re dating, but from an intimacy standpoint, they’re really self-conscious and it holds them back. I know situations like this are where I can really help this person.
It's really gratifying for me to help these women because this is a small pain that you don't see that can really annoy someone for a long time. Most people do not talk about their external genitalia so this is a hidden self-consciousness that others cannot see externally and can be embarrassing to talk about.
How we interact with Labiaplasty patients in our consultations
Me being a woman surgeon, I do my absolute best to try to make my patients comfortable and since I can relate to and understand them better, they are a little more open with me.
There is absolutely no judging.
When I see a labiaplasty patient, we meet in my clinic where we have a very calming atmosphere, we can look at nature outside, watch some wildlife and we just talk about their situation, allowing me to ask, “what's bothering you?”
It's really important to listen instead of assuming the type of condition someone has.
One patient may have an overhanging labia minora that extends beyond the confines of the labia majora, which is a hair-bearing part on the outside - but not always the case.
One patient may say, “it's actually the labia majora, it looks like it's a little bit deflated with age. That area is sagging.”
Another thing I have heard from patients is that they may experience pain or discomfort while running or during other activities due to the labia being pulled.
Having a long or prominent labia minora is not abnormal and this is a delicate topic. Listening is so important for patients to feel comfortable and they’ll help explain exactly what their situation is.
In many cases, we can offer an option for a surgical correction.
Things to Consider About Labiaplasty and Insurance
Patient Activity
I do ask about the history and level of activity of my patients. This is an area of the body that is very sensitive and needs a lot of rest so I need to know exactly what their situation is and their regular routines.
For example, if you like riding a bike - the patient cannot do that until they are fully healed, at least 6 weeks after the procedure. When it comes to sitting down and going back to work - only about a week of downtime is required.
Insurance
When it comes to insurance, labiaplasty is a purely cosmetic procedure and is almost never covered. There are very rare circumstances that it may be covered, but I tell patients to be under the assumption that it will not be.
Expectations of a Labiaplasty surgery
One important part is managing the patient's expectations during the whole process, especially during recovery. One thing to be very careful of is you can actually have dehiscence - which means when you put the skin tissue back together, it can fall apart if it's under too much tension.
I actually have to be a little bit conservative as a surgeon and tell the patient “We're gonna stop here. It's not about making something super tight, this is entirely about just removing any excess tissue and healing it asymmetrically as possible.”
How to perform a Labiaplasty surgery
There are several ways of performing a labia minora-plasty. In general, the labia minora has some pigment on it, but the pigment is distributed a little bit unequally on the skin. The most inferior, meaning the part that's hanging, tends to have a little bit more pigment. The more inside we go towards the vaginal opening, it tends to get pinker. So it's not a uniform color in that area.
If you do a Labia minora reduction using the “trim technique,” for example, if it's hanging too long and it's just cut up and down from the front to the back, well, it will close nicely, but there's usually a color match problem, meaning some areas will be a little pinker, some areas will be browner. I don't like that technique because it leaves a long scar over a longer length and it's more uncomfortable. A straight amputation technique is not something I recommend.
There's also another technique called the wedge technique, in which the longest part of the labia majora is cut out in a wedge and it's sewn back together up and down.
That tends to heal nicely because then the brownish more pigmented area of the labia minora can be put back together so it doesn't cause that color match issue. So that's my preferred technique to do this.
Vaginoplasty vs. Labiaplasty?
Vaginoplasty is a term I want to be careful about using in my practice. When we say vaginoplasty in a standard plastic surgeon's office, that usually means a vaginal rejuvenation, a tightening procedure.
Vaginoplasty is not something I perform.
There are some plastic surgeons who do offer it but it's more of something a gynecologist or urogynecologist may perform. There are some medspas that offer fillers in the vagina for “sexual health,” I'm not an expert in that, so I really can't comment on the efficacy or its indications.
Additionally, in transgender medicine, vaginoplasty means something entirely different in gender affirmation - if a patient who was assigned male at birth is transitioning to female, that means that a doctor would be recreating a vaginal canal for her. That’s entirely a much, much more difficult procedure that's usually performed in a hospital which I would refer to another doctor.
So just to reiterate - I do not perform vaginoplasty procedures.
I purely operate on the outside of the vagina.
What Can You Expect in Labiaplasty Aftercare And Recovery?
With post-op care, I actually encourage the patients to ice the area immediately after surgery, which does tend to help with comfort. About 20 minutes on, 20 minutes off. We don't want the ice to be causing any cold injuries either, so that's why you can't take a nap on an ice pack.
I also recommend a daily application of Bacitracin ointment, which is a topical Vaseline, a kind of petrolatum-based ointment that has bacitracin, which is an antibiotic in it.
I also prescribe patients a Diflucan which is an antifungal pill in case there's a yeast infection. We try to preemptively avoid yeast infections because that would be very uncomfortable.
I see my patients 1 day, 1 week, and 1 month after surgery just to make sure things are healing very well. So if there are any signs of infection, I don't expect the patient to be looking out for that. This is not an area that she can see, so, I can examine that.
Postsurgical Care and personal hygiene
When it comes to showering, I tell my patients to use a fragrance-free soap or body wash. We want something that is very gentle.
No harsh rubbing in that area.
When it comes to blotting and wiping down, I always ask my patients to use paper towels, not house towels that could be dirty or have bacteria on them. Instead, use paper towels to blot the area post-surgically.
Then put on a pad and supportive underwear to protect the area as much as possible.
Are there any potential risks or times when a patient should call?
The one situation that I think needs to be addressed is post-operative bleeding. It's sometimes called a hematoma, a fancy word for saying there's a blood clot underneath the sewed tissue.
This is a very vascular area, meaning it has a good strong blood supply and that's why it heals well, but the drawback is we can have some bleeding.
If there is a hematoma a patient will usually know because there's a lot of bloody drainage and also a severe swelling on one side or the other. It's also quite uncomfortable so if there is a hematoma, I expect my patients will pick up the phone and call me.
Labiaplasty before and after images
I do have before and after photos of labiaplasty procedures but I only show patients the photos in the privacy of my office from patients who have given me permission to do that. If that is something you would like to see, then please come in and we’ll be more than happy to have a consultation.
Conclusion
If you are interested in getting a labiaplasty procedure in Columbus Ohio, feel free to call our office or fill out the contact form on our website to get an appointment with Dr. Okada. We’re more than happy to chat with you to see if you’re a good candidate for the procedure.