Reconstruction from trauma. Had a lot of scars, rips, and half my cervix removed. Options? (photos)

Question

I am a 31 year old, with good health. I had a rough childhood and endured sexual abuse. I had alot of scars, rips, and half my cervix removed. I started seeing a obgyn at a young age due to a hpv diagnosis. He told me he could fix it, big mistake. I now have holes, worse scarring, and extreme embarrassment. It is so hard to clean, and is always sore. I would like to find someone who can just give me a normal appearance and fix the holes. Biggest concern is my hood as holes and scars are painful.

Gary J. Alter, MD · Answer

There are many ways that your clitoral hood and labia minora can be improved. 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 ten years ago. You will need various reconstructive techniques to give you a good appearance. Approximately 40% of the surgeries I perform are revisions of other surgeons' labiaplasties. That experience of reconstructing botched labiaplasties translate to your labia and clitoral hood defomities. I would use multiple wedge excisions to reduce your labia, eliminate many of your scallops, close holes, and improve symmetry. I may also be able to use some of the skin on the sides of your hood to recreate some labia 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

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY

Burcak Tok, MD · Answer

Hello ,It looks like you have a sad story and the procedure was not successful. Holes and folds can be corrected with a second revision surgery. However, while doing this, the labia minora will become much smaller. I think that the operation we call Barbie aesthetics will be the most suitable procedure for you.

Mark N. Scheinberg, MD · Answer

Thank you for your questionf\From your photos,I believe that there is high probability that your issues can be fixed. First is to under stand the anatomy. There are actually two pair of inner labia. A lower pair that inserts into the clitoris and an upper pair, called prepuce , that forms the hood and often extends into the lower pair. It appears from your photo that the scarring and holes are predominantly in the excess tissue of the prepuce and so can be removed, eliminating the abnormal skin, then connecting normal tissue to normal tissue giving a nice "bridge of the nose " appearance . The lower pair of labia need not be treated , but can if you prefer, to give a smoother appearance .

Christine Rodgers, MD · Answer

Hi pocahontas,

I think that you could get a nicer result if you visit with a plastic surgeon who specializes in labial surgery . No guarantees, but he/she would be able to use a different technique for excision and closure of the areas that are concerning to you.

Please visit with specialists in your area who can give you good options for a revision of your previous surgery.

Good Luck and Best Wishes,

Dr. Christine Rodgers

Oscar A. Aguirre, MD, FPMRS · Answer

Hello Pocahontas27,
I'm sorry to hear about your prior trauma and the results from your corrective surgery. You will need to find an experienced cosmetic vaginal surgeon to achieve the best possible results. For this you will likey need to travel.
Go to the link below to see hundreds of before and after photos where you will find many examples of my work. From that link you can schedule a virtual consultation via phone or zoom, at which time we can discuss in depth your anatomy, expectations and concerns. Women from all over the world travel to my Center for their Intimate Makeover.
Best of luck,

Adam Ostrzenski, MD, PhD · Answer

Q: Is it possible to revise the “railroad tracks marks on the labia minora” complications in this case?

A: Yes, it is possible. "The railroad track marks" on the skin are the most common surgical complications and are very difficult to treat on the human labia minora because of the limited size, and an additional resection can create nerve injury or damage with severe and chronic pain at the incision sites (labia minora neuropathy) or neuralgia of the perineal nerve with severe pain located in many areas remotely from the incision. Therefore, Dr. Michael P. Goodman’s advice for performing, quote: “a tight linear trim” does not only make medical sense, but also it will lead to over-resection of the labia minora that significantly increases the potential for severe damage of multiple nerves. Additionally, Dr. Goodman advises applying radiofrequency (RF) to “airbrushing.” Airbrushing does not describe what exactly Dr. Goodman wants to accomplish by utilizing a radiofrequency device in which safety and efficacy have never been established of RF. Why will Dr. Goodman suggest using  “a mini-wedge for tunnels” since this woman requests to restore a normal appearance and eliminate holes? The small wedge resection of tunnels is unnecessary since no such tunnels are present. Why does Dr. Goodman call the tiny holes created by scars “fistulae” or “tunnels” since no fistula or tunnels present will meet their clinical definition? Both pictures illustrate de novo small lobules created by applying too many, too close, and too tight sutures. Contrary to Dr. Goodman’s suggestion that “the wrong sutures” were used, it is impossible to verify this notion because not the type or size of the suture plays any role in railroad track marks complications. 
	These complex complications require a good understanding of the patient's requests and whether these requests can be fulfilled.
		A corrective surgeon, in this case, should take into consideration the following: 
1.	 Appropriate knowledge of labium minus surgical anatomy to dissect the labia minora from the clitoral prepuce and establish the integrity and appropriate location of those structures. The main upper trunk of labia minora on both sites was brought to the clitoral prepuce.

2.	The labia minora must be dissected from the fusions between the intralabial crease and the labia majora. I researched this subject and published the scientific-clinical article on " Labiolysis " surgical interventions (you will find it under my name in the Ann. Plastic Surg 2019).
3.	The labia minora tissue expansion will produce additional tissues to allow removing entire labial abnormalities and allow appropriate esthetic restoration.

Thank you for your attention,
Prof. Dr. Adam Ostrzenski
USA

Ozgur Kartal, MD · Answer

get well soon. I'm sorry for you. The more tissue left behind in revision labiaplasty surgeries, the easier it is for us to correct. You seem to have enough tissue. It's very difficult, but we can fix your image. microsurgical procedures for each tear need to be put together and redesigned and your anatomy needs to be redesigned. It would be better if you could send more detailed photos.

Michael P. Goodman, MD, FACOG · Answer

Wow, yes, your situation is challanging, and shows the severe consequences of going to a "general Ob/Gyn" for cosmetic/plastic work on the vulva (labia, vaginal opening.) Yes-- I have seen and worked on similar "catastrophies" in my 25 years practicing female genital plastic/cosmetic surgery, and my 10 years specializing in revisional work. You have a combination of "train tracks" and fistulae secondary to the wrong sutures, applied in the wrong way, and left in far too long. Whomever you see, make sure you know that he or she is a bone fide expert in revisions/reconstructions, and ask to see at least 10 B&A photos of their revisional work, plus at least 25+ photos of their primary work to get an idea of the techniques they utilize. Neither I, or any other revision expert can say with certainty the exact method they would use for your revision, as regardless of the quaity of photos provided (and yours are of excelent quality), things are always different "in-person" with a hands-on 3-dimensional evaluation. That said, and understanding that, with the damage done by your original surgeon, you never will have the idealized results possible with a primary procedure, a skilled revision surgeon can certainly make things much more aesthetic. This would most likely be done with a combined approach of a tight linear trim + RF "airbrushing" and perhaps combined with a mini-wedge for the "tunnels," and will resuly in a flattened, "Barbi-Style" look. Whichever, make sure that you see a revision surgeon who is savvy with ALL 3 of these techniques. I suggest that you do your "due diligence" and look at revision surgeons around the US and Europe, arrange virtual consultations, see their work, ask for their fees, etc. Unfortunately, "Insurance" will never cover this work (if the surgeon says (s)he will do it under Insurance, run the other way, as only non- genital plastic surgeons will accepth the super-low fee "insurance" pays...) This will cost you more than if a skilled genital plastic surgeon had done the work in the first place, and some surgeons charge rather obscene prices. Ask for specific "out-the-door" prices from the "experts" and see who is most cost-effective. Despite the complexity, this is work that can be performed under local anesthesia and in-office. RealSelf's web reference below will give you additional information. Docs than can help include Stefan Gress in Germany, Gary Alter in Beverly Hills, Red Alinsod in La Mesa CA, perhaps John Hunter or Marco Pelosi III in NYC, and of course myself. I'm sure there are a few others up to this complex revision, but this gives you starting ideas. Regards,  Michael P Goodman MD, FACOG, IF, AAACS. Revision Labiaplasty Specialist. Davis, CA, USA

Reconstruction from trauma. Had a lot of scars, rips, and half my cervix removed. Options? (photos)

Answers (8)

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