Botched plastic surgery is always distressing, but a botched labiaplasty seems especially so. The results can be “horrifying,” as one Australian labiaplasty patient recently reported via email to Dr. Michael Goodman, a board-certified OB-GYN in Davis, California. She writes of a severed attachment to her clitoris, rips and tears in her labia, and delayed healing, and she describes her result as a “deformity.” Sadly, her experience is not unique. Bad labiaplasty outcomes abound.
In case you’re unfamiliar with it, labiaplasty is a surgical procedure that’s designed to reduce the size of the labia minora, the smaller inner vaginal lips, so they don’t hang below the labia majora, the larger outer lips. One of the main goals of labiaplasty is for the labia minora not to be visible when standing. The surgery is the most common aesthetic procedure for female genitalia.
Despite its recent rise in popularity, labiaplasty is still not a common procedure—according to the American Society for Aesthetic Plastic Surgery, an organization of plastic surgeons that offer cosmetic procedures, fewer than 14,000 labiaplasties were performed last year. That doesn’t account for the number performed by gynecologists, however, and—though no statistics are available—more and more of these providers are reportedly offering the procedure.
Though it’s sometimes performed purely for cosmetic reasons (in 80% of cases, in one study of 451 cases), labiaplasty can also help to relieve discomfort or irritation that can result from large labia minora. “Having a body that doesn’t look like everyone else’s or function the way it should affects more than a woman’s ability to be active and be able to wear certain clothing,” says Dr. Troy Robbin Hailparn, a board-certified OB-GYN in San Antonio and the author of the e-book Beneath Your Pink Perfect: Everything You Ever Wanted to Know About Labiaplasty But Didn’t Know to Ask. “It limits her relationships, inhibits sexual intimacy, and can create feelings of self-loathing that affect self-esteem and cause depression.”
When properly performed, labiaplasty has a high satisfaction rate and a low complication rate. “As soon as I woke up from surgery, I felt an immediate difference, like a weight had been lifted from my shoulders,” reports L.C., one of Dr. Hailparn’s patients. “I have more confidence in myself, my sex life isn’t suffering anymore, and I can perform my daily activities without pain.”
Unfortunately, labiaplasty isn’t always properly performed. And when it goes wrong, the surgery can cause unrelenting pain, make hygiene difficult, and often leave women feeling mutilated and self-conscious.
How common is botched labiaplasty?
It’s difficult to say how many labiaplasties go sideways, since statistics aren’t available. But providers say that it occurs too frequently and that numbers in the past few years have steadily risen. “I’m seeing a lot more women with botched labiaplasty, or with what I like to call ‘unintentional avoidable genital mutilations,’” says Dr. Goodman, who’s one of a small handful of surgeons who perform lots of labiaplasty revisions. “The doctors think they can do the procedure, so it’s really unintentional. It’s avoidable because training is definitely available.”
The term botched labiaplasty is so frequently Googled—there were 470 searches in May 2021—that one board-certified OB-GYN, Dr. Red Alinson, who performs a significant amount of revisions in his Laguna Beach, California, office, even has a website, botchedlabiaplasty.com, devoted to the issue. He reports on the website that the volume of revision surgeries sent to him has doubled in the past three years.
Inquiries about botched labiaplasty are also common on RealSelf. Dr. Adam Oppenheimer, a board-certified plastic surgeon in Orlando, Florida, who does about 100 labiaplasties a year, estimates that one in six questions about labiaplasty is about botched jobs and revisions. “It’s not an accurate sample of how happy people are from having a labiaplasty,” he says. “Instead of having the opposite effect of educating, it’s deterring women from having the procedure. Women may avoid having a labiaplasty for fear it could end up badly.”
What can go wrong?
There are many ways that labiaplasty can result in a poor outcome, but there are two that occur most commonly, according to Dr. Oppenheimer. To add insult to injury, both can occur in the same patient.
One is that too much or too little tissue is removed, he says. “Usually, too much is removed from the labia and none or too little is removed from the clitoral hood,” the fold of skin that surrounds the clitoris and protects this sensitive erectile tissue from friction or rubbing. Most women who have extra labial tissue also have excess folds of the clitoral hood, which can—and often should—be reduced at the same time as the labiaplasty is performed, in a procedure known as a clitoral hood reduction.
During the misguided surgery, the surgeon pulls the labia minora and cuts the excess with scissors. The result is that the labia are fully amputated at the midpoint, where they normally somewhat overlie the vaginal opening. “It will be prominent at the top of the labia and prominent at the bottom of the labia,” says Dr. Oppenheimer. It almost looks like someone took a bite out of the labia in the middle.
As horrible as that sounds, the saving grace of the pull-and-cut technique is that it often can be successfully corrected. Because the clitoral hood has been under-resected, the surgeon can rotate it around from above and use it to create labia minora. “The clitoral hood becomes your lifeboat for doing the reconstruction,” says Dr. Oppenheimer. “It’s a very elegant solution for that very specific problem.”
The second mishap is suture-related scarring from using the incorrect suture technique and/or material. In this scenario, surgeons use a running “over-and-over” suture—picture the stitching on a baseball—to close the incision, once the redundant tissue is removed. Not only does this type of stitching create a series of piercings through the labia, but the material used to suture the area often is a type that causes inflammation. “Doctors often use a running over-and-over stitch to stop bleeding, but it will create channels that swell, creating bulges and track marks,” Dr. Oppenheimer explains.
This is not typical scarring—it’s more like shape distortions and nodules. One RealSelf member who was “desperate for help” described it as “hard lumps, holes, and clumps in a zigzag pattern that are just miserable to deal with and make me look like I’ve been butchered.” The good news is that if enough tissue has been left, this type of botched labiaplasty can also be revised and made to look much better.
How to avoid catastrophe
“It breaks my heart when people come in and I have to fix things,” says Dr. Mark Scheinberg, a board-certified OB-GYN in Deerfield Beach, Florida. He tells of a patient who had her inner labia so far removed that her hymnal ring, a thin membrane that encircles the inside of the vagina, was showing. “It’s so much easier to do it right, from the beginning.”
The key to having a labiaplasty done right in the first place is to do your homework. Nothing is more important than choosing a surgeon who’s experienced in performing the procedure. Despite their intimate acquaintance with your labia, that caveat probably excludes your general OB-GYN: “100% of botched patients who come to see me or send me photos asking for reconstructive surgeon recommendations were [worked on] by general gynecologists,” says Dr. Goodman, who frequently serves as an expert legal witness in botched-surgery cases.
The issue is a lack of training. “These are good docs, good people. But general gynecologists, no matter how well thought of, are not usually trained in labiaplasty,” Dr. Goodman says. As he explains, their idea of labiaplasty comes from their training in residency, which involves tumors. The procedure they learn is labial amputation, or as Dr. Goodman defines it, “just cut it all off. They think, ‘The labia is my area. I’ve been trained to do cancer surgery there, so how hard can labiaplasty be?’ That’s the mindset.”
In addition to asking about their training (more on that later), there are a couple of tips that can help you determine if a surgeon is up to snuff.
1. Know your anatomy
If you’re considering a labiaplasty, you’re no stranger to your labia. But here’s the thing: successful surgery often isn’t about just the labia minora, reports Dr. Gary Alter, a double board-certified plastic surgeon in Beverly Hills, California, and New York City. There are other anatomical parts that also have to be considered. Key among them are the clitoral hood (or prepuce), which houses the clitoris, and the frenulum, a ridge of tissue that attaches the clitoris to the upper inner lips. (Shockingly, many surgeons cut this support tissue while trimming the labia. “This causes the clitoris to rise up, and all of a sudden you lose feeling,” says Dr. Scheinberg. “That’s not rare—it’s common.”)
All of this anatomy needs to be considered when planning your procedure. “Women come to see me, and their labia may be big but their hood may be big, or their labia can be small and they have a big hood,” says Dr. Alter. “You have to look at the whole genital area.”
The more knowledgeable you are about your anatomy and the more able you are to discuss its finer points, the better. “If you have long labia, you probably have excess hood tissue, or what’s called labia reduplication, and most likely need a clitoral hood reduction,” Dr. Oppenheimer explains. “Ladies who have just a labiaplasty often complain that it almost looks like they have a bulge at the top,” one that they sometimes say looks like a small penis.
If a surgeon doesn’t recognize this about your anatomy and doesn’t seem to realize that you need a clitoral hood reduction, consider it a red flag. “If your surgeon is nervous about doing a hood reduction, you should be nervous about going to them!” Dr. Oppenheimer warns.
2. Research the procedure
There are around a dozen techniques for performing a labiaplasty, but most are versions of the two main procedures: the trim (aka the curvilinear, linear, or edge) and the wedge (aka the central wedge, the W-plasty, the Z-plasty, and the inferior and posterior wedge, to name a few).
As the name suggests, a trim labiaplasty involves “trimming” the surplus labia minora along the entire length. It makes them shorter and pulls them inside the outer lips so they don’t stick out. With a wedge technique, a wedge of tissue is removed from the central, bulkier part of the labia minora. The remaining tissue is then rejoined, which pulls the entire length of the tissue tighter.
Each technique has its pros and cons: For instance, the trim technique removes the darker, thicker border tissue, which many women dislike, in its entirety, while the wedge technique removes only the central, darkest portion. On the upside, the wedge preserves the natural edge of the labia and delivers a more natural result. The trim is an easier technique to master and is easier to recover from; wedges are more technically challenging, have a higher complication rate than the trim method, and have a somewhat longer recovery.
There’s much debate about which technique is best; some surgeons exclusively perform one procedure or the other, while others switch back and forth, depending on a woman’s anatomy.
The major issue with both techniques is that they have to be done correctly, says Dr. Goodman. If a wedge separates (meaning the edges of the incision no longer meet), as it did in the case of the Australian woman who had a botched labiaplasty, “even though it can be a bit of a disaster, it’s fixable,” he says. “The problem with the linear is that it’s so, so, so easy to remove too much—to amputate.” Indeed, most of the botched labiaplasties on RealSelf are trims. “When you’ve amputated, your options for making it right are very limited,” says Dr. Goodman.
On the subject of amputation, most experts advise against the so-called Barbie technique, which is when the labia minora are entirely removed via the trim method. “There are women who have large labia that are chronically irritated, and they just say, ‘Please take them off,’” Dr. Hailparn explains. “You have to counsel women that if you take off too much tissue, you can expose a nerve and [cause] chronic pain.” It’s also an especially risky procedure when performed by an untrained or novice surgeon—one that easily results in a mutilated, “amputated” look, according to Dr. Goodman.
There are functional issues to consider as well. Women have labial tissue for a reason: these skin folds protect the opening of the vagina as well as the urethra, the tube that carries urine out of the body. Completely removing it can lead to problems down the road. “The procedure results in an incompetent vaginal opening, which means that bacteria and fluids can enter and leave the vagina freely, setting the patient up for potential issues with yeast infections, UTIs, difficulty with lubrication, and painful scarring,” Dr. Oppenheimer explains.
The goal should be to minimize, not completely remove, the labia minora so the tissue protrudes less. “I strongly suggest leaving half an inch of tissue,” says Dr. Scheinberg. “When you go to the base, the potential for disaster is high.”
3. Search out an experienced surgeon
To perform either labiaplasty technique well requires training and experience. “There are at least 500 doctors in the U.S. who’ve been properly trained,” says Dr. Goodman, who’s trained at least 50 of them himself.
Here’s how to tell an expert from a novice.
- Look for a surgeon who specializes in labiaplasty. “That’s number one,” says Dr. Goodman. Go onto their website and see if they have a special page on labiaplasty. Look at their education, not only residency training but any advanced training they’ve had. Your best bets are going to be plastic surgeons, aesthetic surgeons, cosmetic gynecologists, and cosmetic urologists—the word cosmetic means they’ve trained in this area. Heed this warning about general OB-GYNs from Dr. Alter, who’s the inventor of the modern central wedge technique: “Most women trust the gynecologist who delivered their baby—[but] just because someone can deliver a baby doesn’t mean they can do a good labiaplasty.”
- Read patient reviews and check out their before and after photos. “You need to see good close-up before and after photos,” says Dr. Alter. “I’ve seen websites where the photos were taken from three feet away, and you can’t tell anything.” Look for patients whose before labia look like yours and see if you like their result.
- Have consultations with several surgeons. This is your opportunity to discuss your aesthetic preferences in detail and to hear what’s possible, based on your anatomy. During the visit, ask lots of questions: How many labiaplasties have you done? (100 is a good number, according to Dr. Goodman, who’s done more than 850.) How many complications have you had, and how did you address them? What happens if this happens to me? Are you accessible? “A doctor who’s willing to go above and beyond for their patients will stand out,” says Dr. Hailparn. Ask if you can speak to a patient who’s had the procedure you’re after. “Many women who’ve had the surgery are happy to share, because they couldn’t find information when they were investigating the surgery,” says Dr. Oppenheimer. “These ladies want to pay this forward.”
A tip-off that your surgeon may not be experienced: to drum up business, they offer to do it through insurance, which would reduce the cost to under $1,000. (The average cost of a labiaplasty, per RealSelf members, is $4,200.) The reality is that because insurance providers define reconstructive surgery as a procedure to correct abnormal structures—and most all shapes, sizes, and colors of labia are considered normal—the procedure is usually classified as cosmetic and not “medically necessary,” which means it’s not covered by insurance. (The definition of “large labia,” for insurance providers, is four centimeters—or 1.6 inches—in length.)
Even if the surgery is covered by insurance, the fee that’s paid is so low that well-trained surgeons won’t accept it. “If a provider is doing aesthetic procedures with any frequency, they’re not generally taking insurance,” says Dr. Oppenheimer. “You need to go to someone who’s doing lots and lots of labiaplasties, and those are not the people who are doing these through insurance.”
What about surgeons who offer to tack on a labiaplasty to another procedure, often a breast augmentation, at a reduced cost? Best to heed the advice of Dr. Goodman, who says that “in labia surgery, as in other things in life, you get what you pay for.”
