Q: What went wrong with labioreduction? A: 1. The surgeon chose the incorrect technique (linear labia minora resection—partial amputation), which is known to carry a higher risk of complications, and the presented picture demonstrates such surgical anomalies: a) The operation did not achieve a natural appearance in adult women, altering the rounded natural shape to a straight one (as illustrated in the picture). Please refer to the recent scientific-clinical publication by Ostrzenski A. "Severe cosmetic surgical complications of the labia minora." Eur J Obstet Gynecol Reprod Biol. 2023 Dec;291:39-48. doi: 10.1016/j.ejogrb.2023.08.010. Epub 2023 Sep 22. PMID: 37820513 (Please Google the PubMed website and search using Ostrzenski A). This study showed that the current surgical techniques cause severe physical and neurological complications due to their flawed concept, and this case is an additional example. A natural labia minora appearance can be restored using labial tissue expansion. b) The surgery did not achieve labial symmetry. c) The upper part of the labia minora was not properly addressed and has become symptomatic. It needs revision as per a patient's request. d) Both labia minora are fused with the labia majora and infralabial crease. This can be corrected using a labiolysis surgical technique, described by Ostrzenski A., "Labiolysis: Corrective Surgery for Iatrogenic Labium Minus Fusion." Ann Plast Surg. 2019 Nov;83(5):558-567. doi: 10.1097/SAP.0000000000001920. PMID: 31232812. (Please Google the PubMed website and search using Ostrzenski A). e) Reducing the clitoral prepuce will enhance overall aesthetic satisfaction (please consult publication: Ostrzenski A. Clitoral prepucioplasty with anterior commissure transposition: a case report and description of a new, minimally invasive surgical technique. J Reprod Med. 2015 Mar-Apr;60(3-4):178-82. PMID: 25898485). All the best, Prof. Dr. Adam Ostrzenski USA
Q: Will vaginal reconstruction (vaginoplasty) correct cystocele? A: "Vaginoplasty" is a term commonly used in cosmetic gynecology, but it is medically defined as the creation of a vagina de-novo when it is absent. This is a complex issue that requires further explanation. The urinary bladder is supported not only by the anterior-distal vaginal wall but also by its own suspensory and supportive structures; therefore, vaginal reconstruction (vaginoplasty) alone will not resolve bladder prolapse. Clinical assessment and imaging must confirm the site-specific defects within these supportive structures before surgery. These defects can be corrected using native tissue to reposition the urinary bladder. Surgical mesh is unnecessary as native tissue can be effectively utilized. Several anatomical regions need the restoration of the bladder's supportive and suspending structures. Vaginal Reconstruction This procedure must follow the principles of site-specific defects reconstruction instead of using a generic repair for the vaginal wall. Under no circumstances should vaginal tightening be offered, as it involves resecting the posterior vaginal wall and partially removing the posterior perineum (crotch). Such procedures can result in urinary and fecal incontinence due to unintentional damage to the perianal body. All the best, Prof. Dr. Adam Ostrzenski Florida, USA
Q: Will corrective surgery improve the external genitalia look? A: Yes, it will significantly improve the external genitalia's look. The revision surgery must address the following structures: 1. Reduction of the clitoral hood (the clitoral prepuce) and clitoral prepuce orifice, 2. Clitoral frenulopasty, 3. Labia minora reconstruction (not repeating labium minus amputation) with neurovascular bundle preservation (a new surgical technique developed by Ostrzenski), 4. Restoration of the labia minora frenulum. 5. It isn't easy to decide on pictures, and clinical evaluation will be very helpful. Labia majora restoration: 1. Identify clinically site-specific defect (most likely, the surgeon opened an adipose sac, creating herniation since it is getting larger in standing position). (This technique was also developed and published in medical literature by Ostrzenski), 2. Restoration of the adipose sac will eliminate the appearance of "third labium minus appearance) All my research and new surgical techniques can be found on the PubMed website using my name (ostrzenski a). Kind regards, Prof. Dr. Adam Ostrzenski Florida, USA
Q: Can cosmetic surgery treat dyspareunia and acquired healing skin deformities? In dual conditions, the functional disorder of dyspareunia (pain during vaginal intercourse) must be treated first and not a cosmetic anomaly. An esthetic surgery that was suggested by a doctor, even by a skin smoothing around the Fourchette (the midline posterior fusion of both labium minus, it is not a vaginal opening) and fossa navicularis (natural depression between the hymen and fourchette). It is not an acceptable medical approach. Therefore, you need an experienced medical practitioner in the diagnosis and therapy of dysmenorrhea. Reviewing the submitted two pictures, there is no vaginal gapping present, and why the surgeon presented a video of how he executes this procedure is unclear to me since the vaginal gapping is not related to this case; the presented technique is also called into question due to not addressing all the anatomical structures responsible for vaginal closing mechanism. However, the picture from December 2024 indicates that there is gapping anal orifice with the corrugator cutis ani (the anal orifice gapping) defects. In summary: 1. Find a doctor who specializes in the diagnosis and treatment of dyspareunia, 2. Rospond cosmetic surgical therapy until such time that your functional problem (dyspareunia) will be under control, 3. Select carefully a doctor to care for dyspareunia and an eventual cosmetic surgeon if you decide to go ahead with your cosmetic surgery, With regards, Prof. Dr. Adam Ostrzenski Gynecologic Surgeon USA 2.
Q: What could be done to make it look better? A: Yes, revision of this batched cosmetic surgery is possible. Pictures show the following postoperative functional and cosmetic anomalies: 1. The clitoral hood is tightened, the clitoral gland is hidden, and the clitoral frenula are not completely visible, 2. Surgery left a lot of redundant tissue, 3. The labia minora are asymmetrical, the right labium minus is inverted, and both present with deep wrinkles. The red arrow on picture # 1 indicates an over-resection of the left infralabial crease and the fragment of the labia majora. Both labia are fused with the skin of labia majora and crease. This post-operative fusion can cause functional problems (pain at the beginning of penetration, dryness, and loss of labial protection). It requires surgical treatment by applying a labiolysis technique I developed and published. Black and wrinkled tissues are depicted in both pictures in the lower part. If you are having symptoms, the surgery can help. Your esthetic problems can be also corrected. An experienced surgeon would be the best choice for your subsequent surgery, and you should ask a prospective surgeon questions like the ones I have created above. Please feel free to contact me through the RealSelf company.” Adam Ostrzenski, M.D., Ph.D. Professor of Gynecology
