LABIAPLASTY

This surgery is safest when performed by a board-certified plastic surgeon, cosmetic gynecologist, or cosmetic urologist who has extensive training and experience operating in this sensitive, nerve-rich area.

In fact, some surgeons suggest only consulting surgeons who’ve performed at least 100 labiaplasties, since it can take that many to become truly proficient. 

A 2018 study found that many providers offering the procedure may not have sufficient experience: while nearly 11,000 labiaplasties were performed by members of The Aesthetic Society in 2017, 66% of these surgeons only performed between 1 and 10 of these procedures each year. 

Dr. Michael Goodman, an OB-GYN in Davis, California, who specializes in female genital aesthetic surgery, says that "thousands of labiaplasties are performed annually by 'general gynecologists,' for mostly functional reasons. In order to be covered by insurance, these procedures are not considered cosmetic." He cautions that because general gynecologists do not receive plastic surgery training, "mutilations may result."

Related: Botched Labiaplasty Is Common. Doctors Explain Why.

Women consider labiaplasty surgery for several different reasons.

• Excess tissue that causes the labia minora to hang down lower than the outer lips (aka labial hypertrophy) can cause physical discomfort and pain during sexual activity and exercise. They can even harbor bacteria that cause more frequent urinary tract infections.
• Enlarged labia can make it difficult to wear tight clothing, such as yoga pants and swimsuits. 
• For many, it’s also a source of self-consciousness, especially in intimate situations.
• Another common goal is for the labial edges, which often grow darker with age, to look more pink.

“Patients in my practice fall into one of three groups. Some have functional issues as a result of enlarged or asymmetrical labia,” explains Dr. Nelson Castillo, a board-certified plastic surgeon in Atlanta. “Others desire improved aesthetics and self-esteem, and some have a combination of functional and aesthetic concerns,” he explains.

Pros

• The procedure can address both functional and cosmetic concerns, and a good result can improve quality of life.
• It has a high patient satisfaction rate: labiaplasty reviewers on RealSelf give the procedure a 96% Worth It Rating. Many report increased self-confidence, especially in intimate situations or when wearing swimsuits or leggings.
• Decreased friction after excess tissue is removed can make it possible to more freely participate in previously uncomfortable sports, exercise, and other physical activity.
• It can also reduce discomfort during sex.

Cons

• You'll need up to a week of recovery time.
• You'll also have to wait three to four weeks after surgery before you can work out and six to eight weeks before having sexual intercourse.
• You may be left with skin irregularities, such as wrinkles on the skin of the labia and irregular pigmentation or discoloration on the edge of the labia.
• Like all surgical procedures, this one comes with risks, including nerve pain, infection, scarring, asymmetry, and separation of attached edges. "These complications, while not uncommon when performed by a general OB-GYN, are rare when performed by an experienced plastic surgeon or cosmetic gynecologist," says Dr. Goodman.
• Some women aren’t happy with their result. The most common concern expressed by RealSelf members who said their procedure was "Not Worth It" is the size of the clitoral area, compared to the rest of the vulva. But again, an experienced surgeon should know how to avoid this result.
• You may need revision surgery to correct a suboptimal result. If your provider removes too much tissue, you may even need reconstructive surgery.

• Average Cost:
• $5,393

• Range:
• $2,500 - $12,000

During your initial consultation, ask what’s included in the cost they quote you. It could be just the surgeon’s fee, or it might include the anesthesia, facility fees, lab work, and any follow-up appointments. Make sure that you ask about the total “out-the-door” fee.

Cosmetic surgery procedures aren’t covered by insurance. If your procedure isn’t considered medically necessary, your provider may offer payment plans or accept third-party financing options, such as CareCredit.

See our complete guide to labiaplasty costs and insurance coverage

As you're choosing your surgeon, look for labiaplasty pictures with symmetrical, natural-looking results and no visible scars. The labia should look well-balanced with the clitoral hood.

It can be difficult to see whether too much tissue has been left, or too much has been removed, so it’s still important to ask your prospective surgeon about their training and technique, to avoid a poor outcome that may require reconstructive surgery.

The labiaplasty photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Adult women who are physically uncomfortable or self-conscious due to the size or appearance of their labia minora can be good candidates. Generally speaking, most healthy nonsmokers and non-diabetics can have this surgery. 

If you want to reduce an enlarged labia, remove skin with pigmentation issues, or fix asymmetry, this procedure might be a good choice for you. 

Labia naturally have a lot of variation in size, shape, and pigmentation. While adult films have normalized very small, pink labia minora, keep in mind that your anatomy can look very different and still be well within the range of what’s “normal.” 

In some cases, a patient may benefit from mental health support before making a decision to have surgery. One study found that 18% of women pursuing labiaplasties met the criteria for body dysmorphic disorder (BDD), a type of obsessive-compulsive disorder in which you can’t stop thinking about one or more perceived flaws in your appearance. If your surgeon has concerns that you may be showing symptoms of BDD, they may refuse to operate on you.

The type of anesthesia you have will depend on the complexity of your procedure and the preference of you and your provider.

They may recommend:

• general anesthesia, so you're fully asleep
• local anesthesia in the genital area, with IV sedation to keep you very relaxed and sleepy
• local anesthesia, along with a mild oral anti-anxiety medication 

“The choice of local with mild sedation or general anesthesia is determined by the surgeon and patient,” says Dr. Alter. “I perform the central wedge technique, often with extensive clitoral hood surgery. This procedure can take up to two hours which can be difficult for patients with local anesthesia in stirrups, so I usually use general anesthesia or sedation.”

Dr. Goodman utilizes local anesthesia with mild sedation for all procedures up to 3.5 hours.

Whichever option you have, you should experience no pain during the procedure itself.

This outpatient procedure usually takes one to two hours, though it will take longer if it’s combined with other procedures.

There are more than a dozen variations on the two main labiaplasty techniques: the trim and wedge methods. Find a board-certified surgeon who is skilled in more than one technique, so they can recommend the most appropriate one for your situation and desired result.

Here’s how some of the primary techniques work.

The labiaplasty trim method (aka the curvilinear or linear resection technique) 

• The surgeon makes one continuous incision along the edge of the labia minora, to evenly remove excess tissue, including the outer edges. 
• This technique is “similar to pruning the tops of hedges—a segment of tissue is removed at a predetermined level,” says Dr. Castillo. It’s the simplest technique, so be wary of providers who only offer this option; they may not have sufficient training to offer others.
• “This is a particularly useful technique if complete removal of darker-pigmented tissue along the labial edge is desired,” he explains. 

The central or “V-Y” wedge method 

• The surgeon removes a V-shaped wedge of tissue from the center of each labia minora lip. 
• They then stitch the remaining tissue back together, pulling the entire length of the labia minora tighter and "tucking it in." It's a more complex procedure than the trim method, with shorter incisions across the width of the labia. 
• "With this technique, the upper portion of the 'V' may be extended upward to encompass any redundant hood tissue into a single incision line, for a contoured superficial closure," explains Dr. Goodman.  
• The results of this technique look more natural, with a less noticeable scar. “The outside scar is in or just medial to the groove between the labia minora and majora, and the inner scar goes in toward the vaginal opening,” explains Dr. George Marosan, a board-certified plastic surgeon in Bellevue, Washington. 
• While the central wedge removes the darkest portion of the labia minora, it doesn’t remove all of the dark tissue, creating “pigment transition.” “I tell patients that everything has a cost/benefit,” says Dr. Alter. “You get a lighter color with a trim, but you’re going to have some irregularities along the edge, which won’t be there with a wedge.” 

Once your procedure is complete, your surgeon will suture the incisions closed with dissolvable stitches. Scars typically blend into the labial tissue’s wrinkles and folds. 

You’re able to return home shortly after your surgery. You may be groggy from the anesthesia or sedatives, so make sure you have someone you trust there to get you home safely.

"If your surgeon uses a long-acting anesthetic, which lasts 4-5 hours, you can return to home or your hotel, have a meal, and begin taking pain medication before your anesthetic wears off," says Dr. Goodman.

The natural edge labiaplasty technique 

Unlike the trim method or the central wedge method, which removes or alters the free edge of the labia minora, the natural edge technique maintains the natural aesthetics of the tissue—the color, contour, and texture. 

There are several ways to perform a natural edge labiaplasty procedure, but Dr. Scheinberg prefers the technique known as posterior wedge delamination because it helps avoid these potential drawbacks of the trim and wedge techniques:

• the creation of horizontal scars on the labia
• over-trimming
• interference with the blood supply, which he says can lead to complications in healing

Posterior wedge delamination involves the layer-by-layer removal of the central portion of the labia. “The labia can be viewed as lamina (layers), with flat inner and outer surfaces,” explains Dr. Scheinberg. “By delaminating, instead of excising [cutting out] these enlarged surfaces, the blood supply can be preserved, leaving a solid, natural-looking, petite labia with hidden suture lines.”

During the posterior wedge delamination procedure:

• A wedge of inner and outer skin surfaces is removed layer by layer from the central portion of the labia minora, leaving the blood supply intact. “You just take off the top and bottom surfaces,” Dr. Scheinberg explains. “The blood supply is between those two surfaces.” Besides minimizing the inner lips, the procedure can lighten the skin tone along the edges. 
• Once those layers are removed, the raw edges are sewn together, leaving the natural edge intact. “The labia minora that are projecting out don’t have a scar; the scar is covered by the labia majora,” says Dr. Scheinberg. 

Posterior wedge delamination is a more technically challenging technique than other labia reduction options, so it’s not yet widely offered. “It’s not just cut and sew,” says Dr. Scheinberg. “It takes a better surgeon to do it.” 

When consulting with providers about this technique, be sure to see plenty of before and after photos of their patients to get a good sense of their aesthetic sensibility and what they consider an ideal post-op outcome.

This aggressive trim labiaplasty procedure involves cutting away the entire labia minora, leaving minimal to no tissue at its base and allowing the labia majora to completely close. It replicates the smooth look of a Barbie doll, hence the name. 

Providers on RealSelf caution women about the dangers of removing too much tissue. A certain amount—typically 10 millimeters, around .4 inches—is necessary to maintain proper form, function, and comfort. 

A fully removed inner labia creates a compromised vaginal opening, which means that bacteria and fluids can enter and leave the vagina freely—setting up the patient for yeast infections, UTIs, difficulty with lubrication, and painful scarring, says Dr. Oppenheimer. 

“There’s a thin line between safely performing the Barbie method and removing entirely too much and ending up with an awful appearance, sexual pain, and ‘nothing there,’” Dr. Goodman cautions. 

If the goal is to have no visible inner labia, labiaplasty with clitoral hood reduction surgery can be combined with outer labia augmentation (labia puffing), using dermal fillers or fat grafting.

Everyone heals differently, but this is a typical recovery timeline, according to the doctors we consulted.

1 week post-op

Plan for a week of initial recovery time—possibly longer, depending on which technique was used (the wedge requires a longer recovery) and if you had multiple procedures done at one time.

During this week, you can expect:

• Significant swelling and bruising
• Discomfort and pain, managed through medication—often extra-strength Tylenol or ibuprofen, but sometimes stronger anti-inflammatories or narcotic pain medication, like hydrocodone
• Occasional spot bleeding

Your surgeon should provide specific instructions about what to do during recovery and healing. It’s important to follow their recommendations. “In my experience, the women who have less swelling and have everything stay intact, are those who—especially in the first week to 10 days—take it easy and don’t overdo it,” says Dr. Goodman.

That said, it's important to not be too sedentary after the first day. For a smooth recovery:

• Move. “I encourage all of my patients to mobilize after 24 hours with short, 5–10-minute walks," says Dr. Angelica Kavouni, a board-certified plastic surgeon in London. “It’s uncomfortable, so take your painkillers half an hour before. Afterward, rest for a couple of hours with your feet up.”
• Soothe. Urinating and sitting during this period may be uncomfortable. “Sitz baths can be soothing, and using a perineal squirt bottle during urination washes the acid away and reduces burning, as well as helps with keeping clean,” advises Dr. Troy Robbin Hailparn, an OB-GYN in San Antonio. 
• Keep cool. Applying ice packs for up to 30 minutes at a time can help reduce pain, itching, and swelling.

Dr. Castillo also stresses the importance of elevating your pelvis, cold compresses, pain relievers, and anti-inflammatories, including arnica and bromelain. 

2–3 weeks post-op

Pain and discomfort should resolve within 3 weeks. If you experience discomfort for longer than a month, reach out to your provider.

6–8 weeks post-op

Most patients are fully healed within 6 weeks.

Sutures should fully dissolve within 8 weeks. "Some surgeons use slowly dissolving sutures hidden underneath the skin, using rapid-dissolving sutures for the skin edges only," says Dr. Goodman.

At this point, you can resume sexual intercourse and inserting tampons.

3 months post-op

Most of the swelling should have resolved at this point, so you can see your final results.

You’ll see your final labiaplasty results within three to four months, once all the swelling has resolved.

“It generally takes three months for the majority of the swelling to go down,” says Dr. Mathew Plant, a board-certified plastic surgeon in Toronto. “There may be some continued improvement in the appearance for up to one year.”

Don’t be surprised if you have an “OMG moment” in the first week after your surgery, says Dr. Goodman. “The first week or two is the ‘Frankenstein phase,’ where you look down and it looks positively awful—irregular, bumpy, and swollen.”

Labiaplasty results are considered permanent, though your body will continue to change as you age. For example, many women lose volume in the labia majora. If this bothers you, labia puffing can restore it.

You can have a baby after labia reduction, though childbirth can stretch the labial tissues or change their appearance. There is no evidence of increased labial tears, nor is there evidence that one technique withstands childbirth better than another.

You’ll need to heal for up to 6 months after labia surgery, to allow time for all the swelling to go down and blood flow to return to the tissues, before considering labiaplasty revision or reconstruction, sometimes called “corrective labiaplasty.” 

After you’ve completely healed, your plastic surgeon will set up a plan to reconstruct any parts of the clitoral hood or labial tissue that were excessively removed or deformed.

Skilled surgeons can often correct gaps, create new labia tissue out of a remaining clitoral hood, correct scars or scalloped cuts, inject fat to restore volume, or reattach hanging skin. 

However, labia reconstruction or revision surgery is more complex and delicate, so it's even more essential to find a skilled surgeon you can trust. "You only get one good chance for reconstruction, so be patient and ask a lot of questions,” says Dr. Alter.

Labiaplasties are considered safe when performed by an experienced surgeon, but it’s still important to be aware of the risks. 

An inexperienced or unskilled provider can create a poor result that leads to complications, including:

• Painful scar tissue (especially from the trim technique)
• Nerve pain
• Deformities that require labia minora reconstructive surgery. “About 40% percent of my labiaplasty cases are reconstructions of other surgeons’ labiaplasties,” notes Dr. Alter. 

Infection, excessive bleeding, hematoma, and extreme swelling are also possible during the recovery period. Post-operative care may include a round of antibiotics to prevent infections, including both oral medication and ointments.

The risk of incision separation is greater with the wedge technique than the trim technique, if it’s not performed exactly right and if post-op instructions aren’t followed.

Temporary numbness of the labia (and sometimes the surrounding tissue) is common after this surgery. The nerves that provide sensation take several days—sometimes weeks—to return to normal. 

As sensation returns, it’s common to experience the type of “pins and needles” you may feel after your foot falls asleep and starts to “wake up.”

Long-term sensory changes after a routine procedure are said to be very rare, but this complication may happen more often than is widely known. According to Dr. Alter, he and other physicians frequently see women with significant sexual and orgasmic dysfunctions after labial reduction. 

“These women presenting for labial reconstruction are usually devastated from poor appearance, but often have discomfort and orgasmic and sexual disorders from pain, lack of stimulation, loss of self-esteem, or damage to sexual structures,” Dr. Alter wrote in an Aesthetic Surgery Journal article.

A recent study of the nerves of the clitoris, which are large and near the surface of the skin, may help explain sensory loss or chronic pain. The long body of the clitoris lies under the clitoral hood and mons pubis, two areas that can be affected by labiaplasties and related surgeries. “Knowledge of this anatomy is critical prior to performing surgery near the clitoris,” the study’s authors concluded.

The labia minora are also nerve-rich and play a role in arousal. 

“It’s critical that women do their homework and investigate their surgeon well,” says Dr. Scheinberg. "An experienced surgeon with a good reputation should avoid any problems."

Goodman, MP; Placik, OJ; Matlock DL; et al “Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery” Aesthetic Surgery Journal, Feb. 2016.

Veale, D, et al. “Psychological Characteristics and Motivation of Women Seeking Labiaplasty.” Psychological Medicine, U.S. National Library of Medicine, Feb. 2014.

Trichot, Caroline, et al. “Surgical Reduction of Hypertrophy of the Labia Minora.” International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, U.S. National Library of Medicine, Oct. 2011.

Goodman, MP; Placik OJ; Benson, RH; Jason, RA; et al, “A Large Multicenter Outcome Study of Female Genital Plastic Surgery,” Journal of Sexual Medicine, 2009.

Alter, Gary. “Aesthetic labia minora and clitoral hood reduction using extended central wedge resection.” Plastic and Reconstructive Surgery Surg, U.S. National Library of Medicine, December 2008.

Miklos, John R, and Robert D Moore. “Labiaplasty of the Labia Minora: Patients' Indications for Pursuing Surgery.” The Journal of Sexual Medicine, U.S. National Library of Medicine, June 2008.