Clitoral hood reduction post op, advice needed please. Is this normal?

Question

I had a labiaplasty, clitoral hood reduction and a perineoplasty (advised by the surgeon) 9 months ago. I am not very happy with the hood reduction results as the surgeon advised the outer lips would be closed after surgery (hiding the clitoral are) though I think it looks wide/saggy still. Is there anything that can be done for this? Also, on my pictures, where the perineoplasty was preformed the skin at the opening of my vagina, behind this is hollow and hurts quite a lot. Is this normal?

Gary J. Alter, MD · Answer

Your clitoral hood can be reduced further.  The sides of the clitoral hood can be reduced, which may be adequate. However, you may require a procedure called a clitoropexy with a clitoral hood reduction, which I invented over a decade ago.  With this procedure, I lift up the clitoral hood skin, move the clitoris closer to the pubic bone, thin the tissues under the clitoral hood skin, and then remove a large amount of excess skin. This results in a dramatic decrease in the length, thickness, and protuberance of the clitoral hood, so that the hood is now within the labia majora when the woman stands. I have performed this procedure over 300 times with outstanding results. I have not published this technique so no one does it like me.You had a trimming labiaplasty. If you wish it improved, this can be done by doing multiple wedge excisions.  The reconstruction is much more difficult than a primary labiaplasty and should be done by a plastic surgeon with extensive experience in labia reconstruction. I published the first and most extensive paper on labia reconstruction in the prestigious journal "Plastic and Reconstructive Surgery" about eight years ago. Approximately 40% of the surgeries I perform are revisions of other surgeons’ labiaplasties. You may need various reconstructive techniques to give you a good appearances. You only get one good chance to reconstruct you, so be patient and ask a lot of questions.
Gary J. Alter, M.D.Beverly Hills, CA - Manhattan, NY - Dubai, UAE

Falguni Patel, MD, FACOG · Answer

The labia look fine for the most part as does the hood. But you have room to reduce it further if that is what you are looking for. That can be done with a surgical revision or possibly even with laser ablation. But the perineum does look like it’s a bit scarred to the one side. That is most likely what is causing you pain. I would start with massages and dilators. It may be easier to incorporate it with foreplay...otherwise who’s sitting around with a dilator in the vagina and massaging left to rights and back again!  If this isn’t working Or the pain is so severe that’s you wont even consider  sex then you may need to go back under knife. ☹️

George Shashoua, MD · Answer

Thank you for sharing. Based on your photo's it appears everything has healed well however there is still the presence of hypetrophic tissue at the level of the clitoral hood. Reduction of this area of tissue should reduce the bulge that is still present and help reduce the hood under the majora. There is a possibility that the majora may not completely hide the hood even after the reduction based on your anatomy. I recommend evaluation with a board certified surgeon who specializes in revisions of these areas to help you ultimately achieve the look you are going for.In regards to the vaginal skin at the posterior opening of the vagina, there are a few options depending on the degree of severity. The issue you are having is what we call banding. This occurs due to the closure at the time of the procedure. If the banding is mild, simple treatments with dilators can help to stretch the tissue and therefore decrease the discomfort in the area. If the banding is more severe, you may end up needing a revision of the area to release the tightened tissue. A surgeon who specializes in these types of procedures is your best option for evaluation and treatment. I hope this helps and hope you're able to get some relief!

Michael P. Goodman, MD, FACOG · Answer

Your photos show reasonable results after LP/P_. The "hollow area" and a "band" and resultant discomfort are not rare following an over-vigorous perineoplasty, and  I have treated many such situation with a combination of compounded estradiol + DHEA or testosterone, couples with a regular local massage regimen. Additionally, I have used PRP and sometimes fractional CO2 laser for recalcitrant situations. Occasionally, a small "reverse perineoplasty" is necessary to adjudicate the situation. I suggest you make an appointment with a seasoned genital plastic expert to discuss your situation.Re your labia, the edges can be "airbrushed," or a couple on mini V-wedges can be performed on each side to minimize the "opening." A thorough consultation is where to start!Best wishes,Michael P Goodman, MDDavis, Northern CA, USA

Clitoral hood reduction post op, advice needed please. Is this normal?

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