Peter Castillo, MD, FACOG

Thank you for your question, Clitoral hood elongation and redundancy is quite common and often is done at the time of a labiaplasty when indicated. In some occasions, the problem isn't just the hood but is due to a larger clitoris. This may create a limitation in how much hood reduction can be performed unless modifications to the technique are performed to allow an appropriate reduction without over exposure. For this reason many plastic surgeons and gynecologists don't offer clitoral hood reduction because of insufficient training. I recommend seeking a specialist trained in clitoral hood reductions for optimal results. Best of luck. Peter Castillo, MD, FACOG, URPS Vaginal Aesthetic and Reconstructive Surgery

Hi optimistic893925, Although PRP and other regenerative therapies for hair restoration can be very effective in properly selected patients, hair shedding is a normal function of hair. Daily the average person may shed 100-150 hairs per day. The is the Telogen phase and allows for generalized shedding throughout the scalp without significant volume loss. There is a condition that is quite common that increased the amount of hair shedding called Telogen Efluvium. Because hair cells are highly metaobolicaly active thus highly sensitive to change, a variety of stressors can cause hair to prematurely move into the Telogen (shed) phase thereby increasing the amount of generalized shedding to 200-300 hairs per day. Telogen effluvium often occurs in patients immediately after childbirth. Many moms will remember the post-baby shed that fills the shower drain or the brush. For people that are prone to this, it can happen after a major illness, or stressful event, or hormone shifts like pregnancy, menopause or hormone replacement. Because hair phases vary and can last as long as 3 months, Telogen effluvium can take up to 6 months to normalize and go out of phase again. Although there is no harm in using PRP to support or restore hair that is being lost, haisr shedding isn't lost it's just in the shed phase and will come back. Hope this helped. Peter Castillo, MD FPMRS

Hi dawn92, Thank you for your question. Labial tissue that was removed will not come back however there are techniques to create more labial tissue using surrounding skin. Alternatively, if assymetry is the concern, reducing the opposite side to match is another option. Depending on your age, hormonal influence may promote further development of the labial tissue but in general this will not be the case. Labial "puffing" is meant for restoring volume not regrowing tissue so would not likely produce the desired outcome. Please provide photos for more accurate guidance. Best regards, Peter Castillo, MD FPMRS Aesthetic and reconstructive Vaginal Surgery

Thank you for your question. As others have mentioned, Labia come in different sizes and shapes and are all considered normal. However, each person has an ideal image of them selves and how she may wish to appear. The most common reason patients have a Labiaplasty procedure is because of being self-conscious of the appearance in or out of clothes. It is important to have a consultation to review your anatomy because it’s not only what is removed/reduced, it’s also what is left behind that becomes the new focus. From your photos, a Clitoral hood reduction with pexy combined with a Labiaplasty will give you a balanced look. I recommend searching in this site for surgeons experienced in vaginal surgery and is able to provide more than just a Labiaplasty. Best of luck in your search. Peter Castillo MD FACOG FPMRS Aesthetic and Reconstructive Vaginal Surgery Los Gatos, CA

Thank you fir your question. The short answer is yes, a Clitoral hood reduction would balance your results and can still be performed. This is an area of special interest to me because I see many patients that have a Labiaplasty performed by surgeons that are untrained and afraid of treating the Clitoral hood. In my opinion, it is the responsibility of the surgeon to not only perform what is asked but to also point out and address what is left behind. “The eyes don’t see what the mind doesn’t know” is the easiest explanation for why Labiaplasty surgery is often incomplete by the inexperienced surgeon. In your case a Clitoral hood reduction would provide a balanced, fully tucked in appearance. Best of luck, Peter Castillo MD FACOG FPMRS

Thank you for your question and photos. I can appreciate your concerns regarding asymmetry and incomplete work. This unfortunately is not an uncommon outcome when labiaplasty is performed by inexperienced surgeons performing Labiaplasty through insurance. Although as one of the other surgeons have stated that there is quite a variety of “normal” amount of redundancy, your decision to have a procedure to achieve an ideal is valid and should not be dismissed. On the positive side, your ideal results can still be achieved as the surgeon who performed your Labiaplasty left sufficient tissue to work with. A revision Labiaplasty to balance the asymmetry in the Labia minora combined with a prepuce and Clitoral hood reduction with pexy will give you a balanced and youthful result. Search for providers on this website (not your insurance directory) for experience in vaginal cosmetic surgery, revision surgery and Clitoral hood reductions for optimal results. Best of luck, Peter Castillo MD FACOG FPRMS Aesthetic and reconstructive vaginal surgery Los Gatos, CA

Thank you for your question and for sharing your photos. Although difficult to see the full results of your Labiaplasty from the photos that you’ve submitted, your concerns are apparent. Very commonly surgeons unfamiliar with vulvar anatomy, perform a Labiaplasty in the simplest form. That is give the patient what they asked for…smaller Labia. However, it is also the responsibility of the surgeon to take into account not only what is taken away but what is left behind. When the labia minora are elongated, asymmetrical or darker than the surrounding structures, they become the focal point. However, once the labia are addressed, the eye goes to a new focal point if left unbalanced. From your photos it appears that your surgeon did not address the redundant prepuce or perform a Clitoral hood reduction. By only addressing the labia, your results are nice however top-heavy. I see this frequently when labiaplasties are performed by surgeons that are not specially trained in vaginal cosmetic surgery. A prepuce and Clitoral hood reduction with pexy would likely complete the appearance that you are looking for. I recommend waiting a minimum of 3-6 months before performing the next step and research surgeons on this website for level of experience in performing Clitoral hood reductions. Best of luck, Peter Castillo, MD FACOG FPMRS Aesthetic and reconstructive vaginal surgery Los Gatos, CA

Thank you fir your question. Although vagina estrogen is more often recommended for peri or post menopausal women, it is a great adjunct to improve and speed up healing following vago al surgery at any age. Because estrogen doses for the vagina is for local absorption, it does not increase or add to systemic estrogen blood levels. So you can rest assured that this is safe to do and will speed your recovery. Peter Castillo, MD FPMRS Vaginal Aesthetic and reconstructive surgery Los Gatos, CA

Thank you for your question. Although women with prolapse may have slightly increased risk of UTIs, most women with UTIs don’t have prolapse. From your photo you have perfectly normal anatomy. However it’s a great photo fir teaching anatomy. Notice the urethra is the first thing you see. It is also the first thing that gets irritated during intercourse. The majority of UTI happen because bacteria that live near the area namely from the anus are introduced through the urethra. I recommend seeking a Urogynecologist or Urologist for simple recommendations for managing recurrent UTIs. Peter Castillo, MD FACOG FPMRS Intimate Wellness Center Los Gatos, CA

Thank you for your question. 8 days post Labiaplasty is probably the peak of swelling and distorted appearance. The labia are delicate and will undergo remarkable transformation over the 6-8 week period. Being patient is important and follow your restrictions. You’ll begin to appreciate your final appearance between 6-8 weeks. Send photos around that time for input if you have any concerns. Best of luck in your recovery, Peter Castillo, MD Intimate Wellness Center Los Gatos, CA