When I assess my Toronto cosmetic plastic surgery patients requesting labiaplasty, I first ask them about why they’re considering the procedure. Most of my patients realize that their labia are actually what would be considered normal aesthetically, but they still want a change. They want a smaller or fuller result, or they want the hyperpigmented area removed, among other reasons.
As discussed in my previous blog on ‘aesthetic procedures for the female genitalia,’ the demand for labiaplasty has been steadily increasing over the last 10 years, and feminine rejuvenation only continues to gain popularity.
As I explain to my Toronto patients, feminine rejuvenation can include any of these 7 common areas within the same region, which cosmetic surgery can address:
- Pubic area
- Labia Majora
- Labia minora – labiaplasty
- Clitoris hood reduction
- Vagina – vaginoplasty
- Hymen reconstruction – hymenoplasty or hymenorrhaphy
- Perineum – perineoplasty
1. Pubic area
Common complaints are a fatty mons pubis (the triangular hair-bearing area above the clitoris), a saggy pubic area, or the inability to be able to see one’s genitals. Treatment options include liposuction of the mons pubis, mons pubis reduction, and/or a pubic lift procedure. I should mention that we commonly add these options for our Toronto patients who undergo a tummy tuck (abdominoplasty) procedure.
2. Labia Majora
The larger and outer labia can be augmented or reduced. The labia majora commonly loses volume over time with age and with hormonal changes after menopause, resulting in a more wrinkled or deflated anatomical region.
Volume enhancement via fillers is a common procedure. Fillers such as JUVÉDERM® and Restylane® offer only a temporary results, but there is no downtime. The newest JUVÉDERM products — VOLBELLA®, VOLIFT®, and VOLUMA® — offer a longer-lasting result, up to 18 months.
A more permanent volume replacement is fat grafting. I perform the Coleman’s technique of fat grafting, which consists of the more gentle hand-harvesting of fat, quick centrifugation, and meticulous transfer of fat cells using very fine cannulas in multiple layers. Fat transfer is delicate, but it does also bring in the stem cells. Because the fat does not survive 100%, a second procedure is sometimes indicated 6 months later if an insufficient amount of fat assimilates to the new placement.
Another complaint with the labia majora is the excess of mucosal, or skin within the labia majora itself. A simple longitudinal skin/mucosal excision can be done, i.e., the removal of a crescent of tissue.
In such a case, the final scar is on the inner edge of the labia majora, and it is common to proceed with a skin/mucosal excision and a concomitant volume replacement, such as fat transfer (fat grafting).
3. Labia minora – labiaplasty
Of all the requests for feminine rejuvenation, the labia minora labiaplasty is the most common request in my practice.
The most common complaint these women are looking to resolve is excessive labial show when naked or excessive bulging when wearing a bathing suit and underwear. Other complaints are hyperpigmented dark labial areas, excessive friction while running and jogging, or discomfort and tissue folding inward during sexual intercourse.
Many labiaplasty techniques exist, but the two main ones are the ‘trim’ (trimming technique) and ‘wedge’ (or V) excision labiaplasty. When the clitoris hooding is also reduced along with the trimming technique, it is called the ‘horseshoe technique’ (aka extended wedge excision). The horseshoe technique is indicated when trimming alone will lead to excessive bulking round the clitoris. The de-epithelization labiaplasty technique is a third option, which makes an elliptical incision to the inner wall of labia.
See part 2 for a continued anatomical discussion.
By Dr. Marc DuPere