Although there is a wide normal variation in size and shape of the inner labia, some women find it cosmetically unacceptable if the (inner) labia minora protrude past the (outer) labia majora. Enlarged or protruding labia minora can occasionally be an embarrassing problem, particularly in sexual situations where physical discomfort may be experienced, when wearing tight clothing or swimwear. Patients may also seek help for hygiene reasons.
Previously, the surgical treatment was simple excision of the protuberant tissue, which results in a scar along the free edge of the labia. In addition, the natural contour and colour of the labial edge is removed using this procedure. This technique of labial reduction is still widely practiced today.
In 1998, Dr Gary Alter, an American board certified plastic surgeon & urologist occasionally seen on the TV program “Dr 90210”, devised a more elegant operation to deal with this problem, and it is his technique, and subsequent modifications thereof, that I now use. In 2006, a team from Brasil published a modification of Dr Alter’s technique which has proven to be very effective in selected patients and which I now tend to favour. The demand for labiaplasty has grown signifcantly over the past several years. Sadly, it is too often viewed as a very simple operation and as such, carried out by many doctors who are inexperienced and inadequately trained to perform such surgeries – the results of which can be devastating. I am pleased to advise that I have done over 300 of these surgeries and can therefore reassure patients of this experience.
The operation is usually done under local anaesthetic with light, oral sedation in my office procedure room. Should you want deeper sedation, an anaesthetist can be arranged for the procedure, but this is rarely necessary, and is then done in the main operating rooms in the hospital. It is generally very well tolerated under local anaesthetic, and the discomfort only minimal.
The surgery takes about 1-1.5 hours, and all patients are discharged on the same day. The surgery, broadly speaking, involves removing a wedge of tissue from each labium, thus largely preserving the natural free border, and leaving an almost imperceptible short oblique scar on each inner labium. The surgery is done using loupe magnification, to ensure very precise repair of the labial edges.
All the stitches are dissolving, and aside from some antibiotic gel that needs to be applied for a few days, no special post op care, other than perhaps bed rest for a few days, is needed. Abstinence from sexual activity for 6 weeks post op is advised, to allow the tissues adequate time to heal completely.
Smoking is a potent cause of poor wound healing, especially in labiaplasty, and you are strongly advised to quit for a month pre- and post op, if you are a smoker and considering this surgery.
Of note is that the erotic sensory nerves to this region are well away from the operative site, and therefore no disturbance in erotic sensation will result from this operation, if done correctly. I think it is also important to realise that not all “labiaplasties” are done this way. Still today, the most commonly performed technique involves some sort of amputation of the protuberant tissue along the free edge, whether by laser (“designer laser labiaplasty”), scalpel or scissors. I almost never do simple labial “edge” reductions, but instead have been using the techniques described above since 2003, and I am pleased to report that patient satisfaction has been very high indeed.