Is it worth having a CHR revision? (Photo)

Question

I had a labiaplasty and CHR in September. On the whole, I’m happy with the results but I can’t help feeling as though my clitoral hood still looks prominent / top heavy. This is very much down to the ideal I had in my head, rather than the surgeon. I think they did a fantastic job but I wonder whether it’s worth going ahead with a CHR revision. I have discussed the prospect of this with them and have agreed to go back to the clinic in a few months having thought about it further. Opinions?

Mark N. Scheinberg, MD · Answer

Thank you for your question Whatever makes you happy is the ultimate answer to your question. From your photo there is still a considerable amount of redundant (excess) tissue and the appearance can be much less prominent both with prepuce (clitoral hood and surrounding area) and labia. Research a surgeon well experienced in prepuce reduction

Gary J. Alter, MD · Answer

Your clitoral hood is long and protuberant, but most clitoral hood reductions do not deal with the thick tissue and protuberant clitoris. Your hood can be decreased somewhat by reducing the sides. However, 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. 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 400 times with outstanding results. I have not published this technique, so no one does it like me.

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. Approximately 40% of the female genital surgeries that I perform are reconstructions of other women's botched labiaplasties and hood reductions.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NYC

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.​​ Approximately 40% of the female genital surgeries that I perform are reconstructions of other women's botched labiaplasties and hood reductions.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NYC

Michelle Jones Singer, MD · Answer

I think it would be worth having a clitoral hood revision. Remember it is not unusual after a labiaplasty to consider additional procedures to your vulva. If the appearance bothers you then have the clitoral hood addressed. You should as you eluded to, wait at least 6 months before considering the procedure to allow for complete healing.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  I do think you would benefit from a revision CHR to substantially reduce the tissue in order to achieve a smaller, more proportional result comparable to your labia minora.  Hope this helps.

Oscar A. Aguirre, MD, FPMRS · Answer

You are definitely top-heavy. I would recommend returning to your surgeon for further reduction. It is not unusual to return for additional work in order obtain that optimal result. I see this with my own patients who start off with very large labia and hood. You are better off being in this situation than in one where too much was removed and you are left with few to no options.
Best of luck and keep us posted!

Ozgur Kartal, MD · Answer

hi, clitoral hood resection should be done and some fat can be transferred to the labium majors.
What you should pay attention to is this. While performing the clitoral hood resection, the connection between the tissues around the clitoris and the labium minor should not be disturbed.

Michael P. Goodman, MD, FACOG · Answer

"...If it ain't broke, don't fix it..." It all depends on "...bother." Does it bother you?? If so, of course your superior labia and hood can be reduced by a specialist in revision LP surgery, which requires a skillset including, but even beyond skills for primary labiaplasty. While final choice in design pends a pre-operative evaluation, from your photographs I would probably choose bilateral "straight-shot" curvilinear "longboat-shaped" incisions, adding in "feathering/airbrushing" RF techniques to even edges, if required... Best wishes,  Michael P Goodman, MD, FACOG, IF, AAACS. Davis, CA, USA