Labia majora too big and saggy. (photos)

Not one to go onto forums like this but I need advise please. I'm 26 with a 5 year old. My labia majora is too big I think. And when I sit down it looks saggy and ugly. What could I get done to make it look pretty. Is it liposuction I need or reduction

Doctor Answers 13

Lipo or reduction?

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Hi, great question. Definitely not liposuction as this does not work in this area and all it would do would deflate the majora more and make the skin hang even more and become saggier. Sogginess in the majora comes from actually losing some of the fat in this area that comes along with aging and childbirth. The best results come from a reduction of the majora with our without augmentation of the fat pad with autologous fat transfer. An examination will confirm exactly what you need, however by your pictures it does appear you would benefit from Labia Majora Reduction. Occasionally, the perineal muscles (if damaged during childbirth) may need to be brought back together in the midline (this is at the opening of the vagina and right below) and doing this, along with taking any extra skin in the inferior majora and/or perineum gives even more support the majora and results in a tightening of the tissues w/ muscular support. 

Please be careful and choose your surgeon very carefully! We have published one of the first papers in the literature (my partner Dr John Miklos and myself) combining major and minora reduction in a combination procedure. We also attempt to hide the majora incision in the fold between the minora and majora, however unfortunately i have seen many surgeons put the incision right in the middle of the majora, making it very obvious and unsightly. Experience plays a huge role in these procedures, so please choose carefully and travel if necessary. These procedures are ideal to travel for if necessary. 

Best of luck to you, 

Dr Robert D Moore

Cosmetic Vaginal Surgery

Atlanta - Beverly Hills - Dubain

Atlanta Urogynecologist
5.0 out of 5 stars 11 reviews

Labia majora saggy

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Thanks for the questions.  You really need to be evaluated to make sure you and the surgeon are on the same page and that your concerns are addressed. There are three scenarios:  

1) AUTOLOGOUS FAT TRANSFER------ If it really is that the labia majora are flat then you should consider autologous fat transfer ATF --- essentially it is liposuction from one area of the body and its is transferred into the labia majora.

2)  LABIA MAJORA REDUCTION WITH AFT:  -----It has been my experience when a patient is too flat often BUT NOT ALWAYS the patient has lost a lot of weight either due to diet or after having a baby and the skin is stretched in the labia majora area.  If this is the case if one plumps the skin to capacity to get the wrinkles out sometimes the plumping is excessive because the skin has been stretched due to weight gain and loss or due to delivery and 9 months of pregnancy.   In this situation the labia majora looks might look huge after plumping.  In actuality in this situation the excess skin needs to be removed first and then plumped wit the AFT.

3) LABIA MAJORA REDUCTION ONLY --- In this situation the labia majora are flat and saggy and often manifest as hanging during standing or in a bath suit women often experience a bulge.  If all you really want is to tighten up the majora so they don't sag then just the resection of the excess skin is needed.  Please take the time and get evaluated by someone who has experience.    Many surgeon make an ugly vertical scar.... the key to cosmetic surgery is to minimize the scar.  Please choose a surgeon who is well versed in majora surgery.  If the surgeon doesn't have an area on their website which discussed majora reduction then they probably do not do enough of them.

John R Miklos MD

Cosmetic Vaginal Surgeon

Atlanta ~ Beverly Hills ~ Dubai

Labia majora

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Many women share your same concern after childbirth of feeling like the labia start to droop and sag. If you feel bothered by the enlarged labia than a labiaplasty of the majora to reduce  and remove the excess skin there sounds like it would best address your concern. Best wishes!

Labia majora reduction

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The three main options for addressing the labia majora are 1. Surgical reduction, 2. Fillers (or fat transfer), or 3. Laser tightening. 

Surgical reduction is effective, but it leaves a scar, and it may distort the normal crevice between the labia majora and the labia minora. 

Filler is good for addressing a small amount of sagging and wrinkling, but it will make the area larger and it may take 1-2 syringes every 6-9 months to maintain the look (cost is around $600 per syringe). Fat transfer is generally more permanent, but some of the injected fat may reabsorb over time, and initial costs are higher due to liposuction being performed at the same time to obtain the fat. 

Laser is an option, and the downtime is only a few days. This has the added benefit of removing unwanted dark discoloration from the area, but it usually needs to be done at least 2-3 times for full correction. 

I would see a board certified plastic surgeon who specializes in labia surgery to review the pros and cons as well as the cost of each approach to decide what will best help address your concerns. 

Dana Goldberg, MD
Jupiter Plastic Surgeon
4.9 out of 5 stars 41 reviews

Labia majora too big and saggy.

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Thank you for sharing your question and photographs.  There is a wide variation in the size and appearance of a women's anatomy, and your vagina falls well within normal. Some women may have, or develop, enlarged or asymmetrical labia that can make exercise, sexual intercourse, or wearing certain types of clothing difficult.  Though nothing replaces an in-person examination, it appears that you may have some excess skin to your majora that is leaving you with a saggy skin appearance.  This can be improved upon with a reduction or by placement of fat grafts or fillers.  As you feel your labia majora is already too big, I would recommend the former and not the latter.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

Labia majora?

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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: Asymmetric Labia

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Thank you for your question and sharing your photographs. Labiaplasty is a cosmetic procedure that may improve one's confidence and resolve physical issues that one may have with enlarged labia minora.  Clitoral hood reduction may also be indicated depending on the findings on physical examination. Labiaplasty with and without clitoral hood reduction is a personal decision after being well educated on the benefits and risks.  There are several techniques, which should be discussed with you by the surgeon.   In my practice, I discuss this with my patients in order to educate them on their cosmetic issue, the surgical options and possible outcomes so that they can make an educated decision. I would recommend finding an experienced genital surgeon, which include Cosmetic Urologists, even if it involves traveling.  

Best of luck.

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

Labia majora too big and saggy.

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Thank you for sharing your photos and concerns with the community. Based on your photos you appear to be an excellent candidate for labia majora reduction. Surgical removal of the excess tissue in this area reduces the size and sagging that you are bothered by. I would recommend evaluation by a board certified surgeon who specializes in labia majora reduction to discuss the options available to you. Further information regarding this procedure can be found below. the cost of this procedure will vary by location, but the most important aspect to look for when moving forward with intervention, is finding a surgeon who is well practiced in performing these pocedures. Most of the time these procedures can be performed in an office or outpatient surgical setting with a 1-2 week initial recovery time. 

Several options for fixing saggy labia majora

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Your labia majora aren't that large or saggy. You could improve this with fat injections to add fullness, with skin excision to add tightness, or with a perineoplasty, a mons pubis lift or tummy tuck (if needed) to give additional tightening indirectly. On the nonsurgical side, you could do fractional laser skin resurfacing.

Treatment for "too big" of labia majora (and/or majora)

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Keep in mind that a physical exam is first always necessary before recommending any surgery. 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.  In a multi-center peer reviewed study I was involved in back in 2009, 98% of labiaplasty patients were satisfied with their results and had an improved sexual experience post-operatively.  

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.  To achieve these three most important elements, I have found that the "Trim Method" satisfies best.  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.

Ryan A. Stanton, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 128 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.