LABIAPLASTY SURGERY TECHNIQUES
There are a variety of methodologies for performing Labiaplasty. However, the most common procedures are the wedge resection and the curvilinear resection.
The wedge resection is a safe and effective method of reducing the labia minora. Done correctly, the wedge resection spares critical nerves and preserves arterial supply to the labia minora. Some physicians approach the wedge resection with a scalpel or surgical scissors. However, probably the best approach is using low-temperature radiofrequency cautery. This helps in the healing and early recovery of such a procedure. Complications of such a procedure can be hematoma formation and/or dehiscence of the incision. The patient should be aware that with this procedure the edges of the labia minora remain pigmented and irregular.
Who are the patients that desire a wedge resection of the labia minora?
These are usually patients who want to maintain the natural edging and architecture of their labia minora and who want a shorter scar, as well as less scar sensitivity. Smokers, unfortunately have a far greater incidence of scar dehiscence secondary to poor vascularization. Other causes of incision dehiscence are if the surgeon too aggressively creates the wedge resection impacting the external pudendal artery which can result in ischemia. There must be adequate length of the labia minora in order to perform a successful wedge resection. Inadequate length would be a contraindication for this procedure. It is imperative that the surgeon have a great amount of experience performing wedge resections. This procedure requires precise closure of the incision as well as a clear understanding of the anatomy in this area of the vulva.
Patient evaluation is important in understanding the goals and expectation of the patient and it is a critical part of assessing the patient’s desires for successful results. A brief sexual and gynecologic history must be taken of the patient with a discussion of basic anatomy. It is important for any surgeon to review all risks and potential complications with the patient. The labia minora must be assessed for any redundancy, asymmetry and pigmentation. Some asymmetry may remain postoperatively and this must be discussed with the patient preoperatively.
Combined procedures such as clitoral hood reduction and labia majora reduction should also be discussed prior to surgery. It is important for photos to be taken both front and back showing the degree of extension of the labia minora so that there is a good record of before and after results. Labiaplasty of the labia minora can be performed either with local anesthetic or with general anesthesia. The postoperative care of the labia minor reduction surgery involves sometimes the application of estrogen cream for patients over 35, spray bottles and pre-op antibiotics. Labiaplasty.com brings together all of the bestgynecologic and cosmetic gynecologic surgeons, as well as plastic surgeons who are qualified and experienced in the area of labiaplasty minora reduction.
This procedure is the most common of the labiaplasty performed. It can be performed using a diode laser or a radiofrequency device, as well as cold knife approach. The radiofrequency thermal energy approach is probably the most satisfying in terms of healing as is the diode laser. This procedure is for a patient who wishes to have a marked reduction in the size of their labia minora and do not want to maintain the pigmentation of the edges of the labia minora nor do they want to maintain the natural jagged appearance of the labia minora. The curvilinear resection procedure leaves a long horizontal scar versus a small midline scar with a wedge resection. Most scars soften in six months and there is rarely any scar or pain involved in the healing process. The curvilinear approach allows for a more aggressive reduction of the labia minora, as well as more flexibility in the patient choosing of reduction. The linear reduction seems to be most effectively carried out using a radiofrequency low thermal energy device such as a Surgitron or Diode Laser. Area of dehiscence, as seen with the wedge resection technique simply does not occur with a curvilinear incision. Healing is faster compared to the wedge resection, which is 4 to 6 weeks and bleeding and hypersensitivity is reported last with curvilinear resection. However, it is possible that scar contracture and pain with intercourse can result. Fortunately this is a rare occurrence especially in the hands of a skilled surgeon. It is important that the surgeon discuss the lack of preservation of the pigmented perimeter of the labia minora, as well as the so-called natural notched appearance of the labia minora. Some patients even want a more aggressive reduction so that they can attain the so-called “Barbie” look. This is easily accomplished with the use of a radiofrequency thermal generator.
Labia Majora Reduction
For many women aging includes the beginning of the sagging of the vulvar structures. The labia majora tend to go through relaxation after childbirth and post childbearing years. This sagging of the labia majora causes a great deal of consternation for women who wish to wear tight filling clothing. The infamous so-called “camel toe” appearance occurs when there is this hypertrophy and sagging of the labia majora. Aside from the aging and relaxation, the labia majora can also have an excessive amount of fat content. This gives the woman an appearance of almost testicular proportion. Many women want to see a reduction in their labia majora so that they have this flat appearance when they are standing and this allows them to wear yoga pants and bathing suits more comfortably. Conversely, some women like the “poofy” appearance. This is something that they see in magazines such as Penthouse and Playboy. This is accomplished with the transport of fat from one part of the body and then it is processed and reinjected into the labia majora with a successful implantation rate greater than 70%. Reduction of the labia majora involves a linear incision in the folds between the labia minora and labia majora and then extending out laterally to the apex of the labia majora extension once this is accomplished and the vulvar skin is removed, the surgeon can decide how much fat, if any, should be removed following the reduction of the fat content the margins are closed without tension and the scar is hidden in the labial fold. It is imperative that the labia are hemostatic before closing the skin as hematoma is a common complication along with infection, but once again still rare in light of the numerous surgeries performed. Once again, it is imperative for the surgeon to obtain accurate phots of the labia majora from all different angles of perspective, so that an adequate comparison can be made between pre-op and post-op photos.
It is important to explain to the patients that even though there is little tension upon closure of the vulvar incision there can be a slight lateral tension on the opening to the vaginal introitus this may give a bit of a gaping appearance. Patient should be aware of this other contraindication to this procedure is an active HPV or herpes infection. If the patient is anticipating bariatric surgery or a great amount of weight loss in the immediate future, it is advisable to hold off on the labia majora reduction, as more tissue may later need to be removed. All in all the satisfaction rate among patients undergoing this surgery is 95%. Once again, success depends a great deal in part of the experience and skill of the cosmetic surgeon.