Labiaplasty

The Best and Worst Techniques for Correcting Elongated Labia Minora

Dr. Loftus performs more labiplasties than any other plastic surgeon in the region. She also sees women who have had labiaplasties performed by other doctors who have not been properly trained, resulting in unfavorable results. So, she is familiar with the best and worst techniques for correcting this problem, and she shares it on this page, along with her recommendations.

Excessive Labia Minora

The labia minora (small labia) are folds of mucosal tissue which can become enlarged due to pregnancy, inflammation, or due to generic predisposition. When the labia minora become enlarged and hang below the labia majora, they can create several problems. They can cause self-consciousness during intimacy and discomfort during intercourse. They can be visible through tight clothing and swimming suits. They can be generally uncomfortable, particularly during exercise. For these reasons and more, women are seeking labiaplasty (also called labia reduction surgery) in greater numbers than ever.

The Best and the Worst of Current Labiaplasty Techniques

• Amputation: The first labiaplasty (sometimes called labioplasty) operations involved amputation of the excessive labia minora. This was basically a straight cut across the labia, which resulted in a smaller labia, but with caused an unnatural appearance, overly tight vaginal opening, irregularities, pigmentary problems, and chronic pain when performed closely to the clitoris. As a result, this operation has been largely abandoned, and other operations have been developed.
• Wedge: The wedge excision involves removal of a pie-shaped section from the center of each labia. It became popular because it addressed the problems of irregularities and color issues, but it introduced the potential problems of scar contracture (scar shortening), creating a notch and contraction along the free border of the labia minor. Worse is the propensity for this type of labiaplasty to breakdown and open up, leaving the patient with an open wound. The risk of healing problems following the Wedge technique can be as high as 20%, and if this occurs, it can take weeks to heal. After it heals, it can leave the patient with an unnatural result or deformity that requires corrective surgery to achieve a normal appearance.
• Z-plasty The z-plasty was developed to address the problem of scar-shortening that is associated with the wedge excision. And for that reason, it is superior to the Wedge. However, the z-plasty has the same risk of dehiscence (healing problems) as the wedge excision, which is why it has not become popular. Because dehiscence is such a significant problem for women when it occurs, the Z-plasty has never gained popularity. Because of the risk of dehiscence, Dr. Loftus seldom recommends wedge or z-plasty technique.
• Mucosal Resection: The mucosal resection was developed to minimize healing problems. It involves removing just the mucosa (the lining) from each side of each labia. There is no through-and-through incision, so the healing is excellent. Indeed, this surgical approach has solved the healing problem associated with the wedge and z-plasty techniques. However, because it compresses the labia vertically and horizontally, it can result in a somewhat ruffled appearance of the labia minora in some women. The women who are most likely to have this outcome are the women with the longest labia, who also happen to be the women who want/need this operation the most. Dr. Loftus typically reserves this technique for women who have minimally elongated labia minora, and it works fabulously on them.
• Trim: The Trim, sometimes called "free edge technique," involves removing the excessive portion of the labia minora along its free edge. In doing so, it removes the dark portion of the labia minora, which most women are delighted to part with. It leaves intact at least 1 cm (about a half inch) of labia minora, which is necessary to avoid deformity and to protect the vaginal opening. The resection follows the natural curve of the labia minora, so the final result looks natural. The healing is much better than a wedge or z-plasty, and almost as good as the mucosal resection. When there are healing problems with the Trim technique, they tend to be minor and resolve fairly quickly. The main disadvantage of this technique is in women who have a 3-dimensional labia, such that an extra fold of labia flows into the labia minora from the sulcus, which is the side lateral to the labia minora. This configuration is not uncommon in women with excessive labia. When these women undergo the Trim technique, the area of confluence of the 3-dimensional labia cannot be completely smoothed out without encroaching on the clitoral hood. It is unwise to encroach on the clitoral hood, as doing so will place a scar too close to the clitoris, and this could cause a painful neuroma in some woman. If this were to happen, then it would cause a much greater problem than the original elongated labia, and this is why most plastic surgeons recommend that women with this configuration of labia accept the residual redundancy of labia in this area rather than push their surgeon to remove it. Of all of the women Dr. Loftus has operated on with this configuration of labia minora, none have regretted having had the labiaplasty, and all were very accepting of the residual minor excess, which tended to shrink down over time and become very difficult to see after fully healed.
• Anterior Sulcus Resection: Dr. Loftus determined long ago that women who have the extra fold of mucosa lateral to the labia minora (the 3-dimensional labia described above in the section "Trim") often have redundancy of the clitoral hood itself. For reasons noted above, Dr. Loftus does not recommend operating on or near the clitoral hood, but she has had great success in removing excessive labia lateral to the clitoral hood. In doing so, the excessive clitoral hood is drawn lateral and results in a smaller, less redundant clitoral hood and an overall better final result. Dr. Loftus calls this the "Anterior Sulcus Resection," and she has performed it on many women as a part of the labiaplasty procedure. Including this in the labiaplasty doe not increase cost to the patient or recovery, and it provides a superior final result.

Dr. Loftus' Recommendation

Based on years of performing each type of labiaplasty (except for the amputation, which should not be performed) and based on seeing women who have had complications from procedures performed by inexperienced doctors, Dr. Loftus has found that the Trim technique works best for women who have moderately or severely excessive labia. When these women also have redundancy of the mucosa or the clitoral hood, she also recommends the anterior sulcus resection. Dr. Loftus recommends the Mucosal resection for women with minimally excessive labia.

Before	After

Labiaplasty: During and After Surgery

Anesthesia: General or sedation or nitrous
Location of operation: Office
Length of surgery: 30-60 minutes
Length of stay: Outpatient (home same day).
Discomfort: Mild. Dr Loftus uses long-lasting local anesthetic injections during the procedure so that post-operatively, there is no pain. The local anesthetic wears off over the course of 4-8 hours, and soreness begins to evolve over that time frame. Most women find that the soreness lasts 2-3 days and is well controlled by of prescription pain medication and ice packs. Women who have had an episiotomy during child birth describe the discomfort related to labiaplasty as being much less.
Swelling: peaks at 2-3 days and improves over 1-2 weeks. Within 4 weeks, at least 80 % of the swelling will have resolved, but the last little bit of swelling can sometimes take much longer to completely resolve. During the period of minor residual swelling, your labia will look natural, and it is unlikely that anyone else would or could tell that your labia were swollen.
Bruising: Occurs in most, but its extent varies significantly.
Bandages: none.
Stitches: Will be absorbable.
Back to work: 3-7 days.
Sex: Wait 6 weeks to ensure complete healing.
Exercise: May be resumed in 1-2 weeks.
Final result: Will be seen after the swelling has resolved.

A word of Advice

Labiaplasty is a great procedure and results in significant satisfaction when the best procedure is selected for each patient individually and when the procedure is performed by an experienced surgeon. Unfortunately, some surgeons remove too much labia. Dr. Loftus has seen many women who have had too much labia removed by other doctors, leaving them with a cosmetic deformity, asymmetry, pain, and the unpleasant sensation of air entering their vaginal opening when they are walking or exercising. So, if you are seeking to have this procedure, be sure to see a surgeon who has significant experience with this.

Dr. Loftus has the very highest ratings in patient satisfaction in the region, according to an independent ratings website which shows the ratings of the best and worst plastic surgeons in the country. Follow these links to see how Dr. Loftus compares to all other plastic surgeons in the Greater Cincinnati Area and All of Kentucky. Once you meet Dr. Loftus, you will understand why her ratings are so high, why patients are so happy with their care, and why they never see another plastic surgeon again.