Do I need a perineoplasty on my "open" vagina following labiaplasty? (photos)

labia and clitoral hood area were intervened. The inner lips and clitoral hood area should be left a little longer than the main one. It does not seem possible to perform revision labiaplasty because it is taken in excess in these two areas.
You can only make the vaginal entrance slightly closed by performing perinoplasty.

You unfortunately are a "poster girl" for the reason that surgeons who only perform linear/trim technique get poor results so often. The "take home" is: do not have your labiaplasty performed by a surgeon who tells you they "...only do trims..." WHY?? Well, look at yourself! For women who have multiple hood folds (central hood, lateral hood, frenular fold, prepucial fold) or patients who have a "droopy" vaginal opening appearing in the perineal area, a "V" or "V-Y" wedge is best, as a wedge can both incorporate all the folds, and/or "pull up" the sag around the opening, and not lead to "opening droop" after an agressive "Barbie Doll" (ugh!!) amputative technique. Personally, in my training courses I teach obth linear and wedge techniques, so if your surgeon was "...trained by Dr. Goodman," this guarantees that they know both techniques. Look at surgeons' "Before and After" photos. Do all patients "...look the same..." with a near-amputative appearance. A surgeon who is well trained will be able to make the best choice based on YOUR anatomy rather than based on the only procedure they know how to do (trims are easier to do than wedges...) Additionally, a savvy surgeon will be able to identify those patients who may have "gaping" (opening) of the vagina attendant with labiaplasty, and perform an inexpensive mini-perineoplasty at the same time as your LP, so you only need one recovery. So... for you?? No, you do not "need" a perineoplasty, but a mini-perienoplasty will serve to alter the opening and close the "gap." I suggest that you "live with" your results for a while and see if there is much "bother." If so, then a well-performed perineoplasty will obviate the problem. RealSelf's web reference below shows many B&A pictures of both linear and wedge; you can see how wedge procedures (V or V-Y) "pull up" the bottom, serving to "lift" and attenuate the appearance of the opening.

Best wishes!

Michael P Goodman, MD, FACOG, IF, AAAACS
Davis, Northern CA, USA