For whom labiaplasty surgery is suitable
The shape and size of the external female organs is enormously diverse that depends on racial, hereditary, hormonal and other factors. There is also a completely different perception around the world of what is considered aesthetically acceptable or normal. There is even an exhibition since 2006 called “The great wall of Vulva” by British artist Jamie McCartney, which has basically taken casts from the vulva from 400 women and has captured them three-dimensionally, in order to highlight the diversity that this area displays anatomically. Below is a section of his work:
We observe that the basic anatomical units are the same in all women, however what differs radically are the proportions mainly of the skin of the inner lips in relation to the outer ones, the skin that covers the clitoris as well as the thickness of the outer lips. In no way are any of these different forms pathological and they are all considered normal. However, in some women the imbalances can be very intense and create aesthetic, psychological or functional problems. The procedure of labiaplasty also know as vaginoplasty is the means to treat such problems.
The most common imbalance we see is hypertrophy of the inner lips in relation to the outer lips. We expect the labia minora anatomically to take precedence over the labia majora in most women, but in some women they this is excessive, resulting in complaints of various problems. The most common concern is aesthetic, as the inner lips can be very visible with swimwear or tight clothing and many times we hear the term “camel tow” regarding how the inner lips are outlined with underwear. Hypertrophy of the inner lips can also cause dyspareunia, i.e. pain and irritation during sexual intercourse. Finally, some women report that they constantly feel humid and it is difficult to maintain hygiene of the area.
Another case is in the area of the clitoris. In some women there may be hypertrophy of both the clitoris and the skin that covers it (clitoral hood) and sometimes it may even have the image of a miniature penis. Functionally we do not see a problem here and the issue is mainly aesthetic.
With age or due to construction, we observe in some women atrophy of the outer (large) labia of the vulva. This, combined with hypertrophy of the inner lips can also lead to imbalance and require intervention on both the outer and inner lips. In other cases, especially when there are extra pounds, there may be a strong enlargement of the outer labia or pubis to the point where the entrance of the vagina may be completely covered.
Finally, in the context of vulvar plastic surgery, we will refer to problems related to the entrance of the vagina and the vagina in general. Issues such as urinary incontinence or vaginal prolapse are purely a field of other specialties such as gynecologists and urologists, however relaxation in the perineum and vagina can be treated in the context of vulvar plastic surgery and is always considered.
As mentioned above, the most common problem we face surgically is hypertrophy of the inner labia of the vulva. During the clinical examination we need to ascertain whether the problem extends higher to the clitoris or concerns only the labia minora and whether the labia majora are normal. Since the correction concerns only the labia minora, labiaplasty is always based on the preferences of each woman, after explaining the particularities of each technique. The classical techniques are two:
Labiaplasty with wedge-shaped resection
In this case, a wedge of excess is removed in the lower and middle third of the inner lips. The advantage is the operation has great precision and can correct any asymmetries very satisfactorily. Also, the scar is not visible at all after a few weeks and the result is very natural, since a part of the inner labia remains and does not disappear completely.
Labiaplasty with longitudinal excision
In cases with more intense hypertrophy of the inner lips and when women want an even clearer image where the inner lips will be barely erased, we can perform an elongated resection. That is, the entire inner lip is removed from the bottom to the clitoris, leaving 1-1 and a half centimeters residue. This operation is more radical and is chosen only in specific cases. The scar is almost completely lost, but not as well as in wedge-shaped resection.
In the area of the clitoris it is also sometimes necessary to remove excess skin that is a continuation of the inner lips and ends in the clitoral hood. For this area there is no standard intervention and each time it is adapted to our needs. The most common method is reduction with V-Y technique, which in addition to removing excess can also lift the underlying skin. In no case is the sensation and function of the clitoris affected, as the innervation comes from a much greater depth in which no intervention is made.
On the labia majora, when they are very empty, fat can be harvested from other parts of the body and transferred in the outer labia. This can sometimes be done in combination with labiaplasty for even greater aesthetic improvement. When the labia majora are very full, either liposuction or surgical removal of excess can be performed. The pubis can also be aesthetically improved by liposuction, when hyperliposis occurs.
In cases of mild vaginal relaxation, some small improvement can be made by injecting fat intravaginally, in order to narrow the entire vaginal area. In more intense intense vaginal relaxation, perineoplasty is performed, i.e. the immediate surgical tightening and restoration of the perineum and vagina.
Operations are usually performed under local anaesthesia under a comfortable and private environment. The pain is usually mild and treated with oral painkillers. In the first few days there may be a small flow of fluids or a small amount of blood that is perfectly normal. The most critical phase of recovery is the first 24 hours, when rest is needed to avoid bleeding or hematoma formation.
Sexual intercourse is interrupted for 3-4 weeks after surgery, until healing is complete. The scars disappear completely and are in such a place that they do not cause aesthetic or functional disorders.