What can be done to improve the aesthetic appearance of my vagina?

Please keep in mind that an in person consultation with physical exam is first necessary before any final surgery recommendations are made. Nonetheless your story and concerns are in good company with almost ever other patient that undergoes labiaplasty and/or clitoral hood reduction (aka hoodectomy). Based upon your photos, your anatomy is very typical of someone who seriously considers having these procedures and experiences a major boost in (sexual) self-confidence and pleasure thereafter. Labiaplasty, which most commonly involves surgical reduction of the labia minora (inner/thinner lips) but not infrequently trimming or tucking of the labia majora (outer/thicker lips), has become a relatively common procedure over the last ten and even more so last five years. Most commonly it is done under light sedation (aka twighlight sleep) with local anesthesia, in which case the patient should feel no pain during the operation. Whether the surgery is done using a laser, scalpel, or scissors does not really matter but what does matter is "symmetry". Symmetry is the most important aspect to the final aesthetic result. Most women, just like yourself, prefer to have as much of the darker pigmented edges removed as possible. Also, it's not how much tissue is removed but how much is left remaining because a certain amount is necessary to maintain proper form and function - typically ~10 mm or so of the dry part of the labia. Finally, I have found the scar along the edge of the labia after "Trim Method" to be much more imperceptible compared to the scar running perpendicular through the entire labia minora after "Wedge Method". Thus to achieve these four most important elements, I have found that the Trim Method satisfies best.  One unique potential complication after Wedge Method is that the clitoris gets pulled downward which sometimes is annoying and sensory changing to women.  Thus it is extremely important to consult with a board certified plastic surgeon that specializes in this operation (does at least 1 - 2 per week). It may cost you a bit more but it is this type of result you will want to live with for the rest of your life. Typical (all inclusive) fee at my office/surgery center is $4500. Although there is no guarantee, women frequently do seek clitoral hood reduction (Hoodectomy) to improve exposure of the clitoris and hence better stimulation during sexual activity. By removing some of the excess &/or redundant skin concealing the clitoris, it becomes more readily exposed to sexual stimulation and hence a heightened sexual experience/orgasm is possible. Sometimes I recommend adding hoodectomy to labiaplasty to better harmonize the aesthetic outcome. Again, the key is seek consultation with a board certified plastic surgeon or gynecologist who performs this procedure regularly (>2-3 x/month) so that just the right amount of tissue is removed and just the right amount remains such that the clitoris is not constantly exposed and rubbing on clothing, etc... Typical fee for a hoodectomy is ~$3000 but reduced to about half that price if done along with a labiaplasty. Now for recovery, because the labia tissue is so robust with blood supply it has an amazing ability to heal relatively quickly. Most patients are sore for 4-5 days before things start to get a lot better from there. Some patients can resume work before this time depending upon their occupation. No exercise for two weeks, no baths/jacuzzi or swimming for 3 weeks, and no sexual activity for typically 4 weeks. My patients are given an oral pain medication such as Vicodin or Percocet but icing the area for the first 48 hours and applying some custom made take-home topical local anesthetic cream seems to work the best. Glad to help.

There is a trend to have less prominent labia, but this is a matter of choice and there are no medical reasons to do so other than improving your appearance down there. Candidates for a Labiaplasty procedure are women who are concerned about the appearance of their labia or experience discomfort due to exceptionally large or long labia of either the inner our outer lips. Labia unevenness can result in discomfort with intimate contact, chronic rubbing, as well as psychological discomfort, which leads to the inability to wear certain types of tight clothing. Most women live with these symptoms, and actually are not even aware that a certain surgical procedure exists to help to correct this problem and restore their femininity.
#labiaplasty #labia

Thank you for sharing your question and photograph.  Based on your narrative, there are a couple of options available to you.  Your labia minora shows some skin excess which can be either fat/filler grafted to increased tissue bulk and fullness, or any loose skin can be removed surgically to leave a smoother appearance.  Though your labia minora are not excessively protuberant, a trim labiaplasty with clitoral hood reduction would help minimize the hyper pigmentation along the tissue edges and reduce the bulk of the hood.  Hope this helps.

Your labia minora are only mildly enlarged, but your clitoral hood is protuberant and more enlarged.. A labiaplasty with a clitoral hood reduction can reduce your size. However, it must be performed by a surgeon with experience. One of the two most common labiaplasty techniques is the central wedge technique, which I invented in 1995 and published in the plastic surgery textbooks. It is also known as the "V" or wedge technique. Gynecologists and most plastic surgeons perform a labioplasty very differently. They essentially trim the labia minora (inner vaginal lips) and leave a long suture line instead of the normal labial edge. Their technique is the same whether a scalpel or a laser is used. In contrast, the central wedge removes triangles of tissue and bring the normal edges together. Thus, the normal labial edges, normal color, and normal anatomy are preserved, but the darkest labial tissue is usually removed. If you have extra tissue on your clitoral hood, it can be reduced it at the same time. Your clitoral hood is thick, wide, and protuberant. It can be decreased somewhat by reducing the sides. I pioneered a clitoropexy with clitoral hood reduction in which the clitoris is pushed closer to the pubic bone and the width, thickness, length, and protuberance of the clitoral hood can be decreased.  I have performed this procedure over 250 times with excellent results. I have not published this technique yet so mo one does it similar to me. Your labia majora have stretched which resulted in excess skin. In addition, they probably have lost some fullness.  I suggest reducing the excess skin and maybe increasing the fullness with fat injections if there is a fat deficiency. A surgical reduction places a scar on the inside of the majora in the fold between the majora and the minor and clitoral hood.  Alternatively, I can tighten the skin modestly with a laser. No matter the technique, an inexperienced or unskilled surgeon can lead to a high rate of complications, chronic scar discomfort, labial deformities, and further surgery
Gary J. Alter, M.D.Beverly Hills, CA - Manhattan, NY
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Hello Jenna,Thank you for your photo and question which leads me to conclude that you're unhappy with your dark and thick labia minora, large and saggy clitoral hood and loss of volume and darker color of your labia majora. What I'm describing are common vulvar changes that occur with aging.Your options for the majora include non-surgical options such as fractional CO2 for lightening effect with injection of PRP or autologous fat for additional volume. Alternatively, there is surgical labia majora reduction. Following an exam at the time of consultation I would be able to give you what I think would give you the results that you are looking for.Your labia minora could be reduced, but you would need a clitoral hood reduction with clitoropexy for the best optimal, youthful appearance.Please see link below for tips in finding that best surgeon for you.Best of luck,Oscar A. Aguirre, MDAguirre Specialty Care - Pelvic Surgery & Intimate Aesthetics®

as there is truly nothing wrong with your appearances and you don't have the marked excesses of labia that plague many other women.  If you're trying for the smoothest look possible, I appreciate atrophy of your majora and fillers or fat grafting could be done for that.  If you're wanting even less bulk, your hood can be reduced or the labia majora reduced. Costs are even less the more North you go on I-5 as this can be done for less than $3000 'out the door' but you would have to spend a night in town.  And if there are any concerns, revisions (not involving fat grafting) are only $142 as we want our patients very happy... but its a long way from LA.

Hello "Jenna,"  

Thank you for your good-quality photo and succinct query. While of course a personal consultation either in-person or "virtually" speaking with you on the phone with a full photo-file of your labia up in front of me is best, I can give you an idea of my recommendations. 

While you could have RF or laser tightening of the vulva, this would require 3 sessions and would only last 2 years (laser) or 1 year (RF.) Better for the outer lips (majora) would be a skillfully performed labia majoraplasty, which would also lighten the color of the area and is "permanent." You could have additional fractional CO2 laser resurfacing at a later date as desired.  if after all is healed you wish the color lighter. As for the minora, a careful "skinning curvilinear labiaplasty + reduction or robust clitoral hood skin would both minimize size and modestly lighten color. Your own anatomy and reasonable expectations negotiated between yourself and an experienced gential plastic/cosmetic specialist are of paramount importance. Price-wise, our office in Davis (near Sacramento) performs labiaplasty + hood for an average "out-the-door" price of $5500 (includes fcility & local anesthesia), and we give a 50% discount for the second (labi majoraplasty) procedure so, with your RealSelf discount, total price for all would be ~ $7700. Additionally, we cover up to 2 nights at a nearby quality hotel for our out-of-area guests. 

Michael P Goodman, MD

Davis, CA (near Sacramento), USA
 

Thank you for your question and photograph.  Everyone has a different opinion regarding their genitalia.  It is challenging to answer your question without additional photographs and a description of your specific concerns.  A consultation with a cosmetic genital surgeon, including a Cosmetic Urologist, would also allow you the ability to address your concerns.  Best of luck.    

Jeffrey S. Palmer, MD, FACS, FAAP (Cosmetic and Reconstructive Urologist
-- Cleveland, Ohio)