Back to square 1 - painful frenulum, ugly scar tissue, third labia lip

Thank you for sharing your question and photographs. Although a touch-up revision could be performed to improve upon symmetry, especially of the lateral prepuce and clitoral frenulum tissue, the wrinkling you see is normal and improves with a labiaplasty but does not result in a perfectly smooth appearance once healed and swelling has resolved.

Thank you for your questionFrom your photos, none of your surgeries addressed the prepuce. There are actually two pair of inner labia. A lower pair that inserts into the clitoris via the frenulum and a second pair, called prepuce, that forms the hood and can insert into the lower pair and distort or even overwhelm the lower pair. You can see in all your photos that the prepuce has not been addressed particularly on your left(photo right) side. The video below discusses prepuce resection as part of labiaplasty

As the inventor and innovator of the wedge technique in 1994, I reconstruct many women who have had labia reductions by other surgeons, both wedge and trimming techniques​. You had a trimming labiaplasty which resulted in asymmetry, excess clitoral hood, and scalloping. The initial good appearance after your revision was due to early swelling which resolved causing your present poor appearance and discomfort. 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 eleven years ago. You will need various reconstructive techniques to give you a good appearance, but this won't be known until all the swelling is gone. You can have a much better appearance by a very skilled reconstructive labiaplasty surgery. Approximately 40% of the surgeries I perform are revisions of other surgeons' labiaplasties. I would probably use multiple wedge excisions to reduce your labia, eliminate many of your scallops, and improve symmetry. 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

Q: What did happen?
A: I respect Dr. Michael Goodman, but his answer to your questions are not quite right; quote: “There no fault here; just the way your body heals over time.” It is unbelievable that the doctor who advised you at the same time blamed your body for over-healing and protecting the surgeon who needs to be put on notice to protect other women from his/her surgery. Contrary, pictures of your both surgeries clearly indicating that in your case, the surgeon made serious mistakes that resulted in pain and unacceptable esthetic outcomes. Now, you have not only esthetic dissatisfaction from surgeries, but also have functional problem related to over-resected and everted both labia minora. To blame your body for it is not answer to your situation because your first operation did not address all cosmetic problem and wrong technique of straightforward amputation (trimming) was applied that changed the rounded natural look of the labia minora (thin labia) to the unnatural straight look. Additionally, the surgeon had a problem with proper suturing and tying surgical knots. It is well-known complication and is termed “railroad tract.” It is not a condition that your body created by healing but a surgeon’s inappropriately executed operation. When this condition is created, it cannot be treated by additional labial resection, as it was done here, since it inadvertently leads to over-resected and everted labia minora, potentially very severe complications. In both operations that you underwent the clitoral frenulum was wrongly connected to the labia minora and such is responsible for your pain. In his antiquated video, Dr. Goodman advised you and others to select a cosmetic-plastic surgeon based on the number of cases done and the photo gallery. Such a piece of advice does not work for anybody, including you. To choose a surgeon, you need to be examined by a surgeon who should take pictures and teach you from them how his/her plan can work for you and to meet your expectations. Asking and reviewing the photo galleries of surgeons is nonsensical advice because it is not your body pictures. In addition, the number of cases does not provide anybody with the correct answer since cosmetic surgery cannot be standardized because every case must be individualized and done differently. Your case is possible to correct; however, it requires a surgeon familiar with tissue expansion or flat advancement, tissue transposition, or auto-transplant of the similar tissue of the labia minora. Additionally, a surgeon must have intimate knowledge about external genitalia anatomy. Finally, a corrective surgery should give you good functional and esthetic look results.
With regards, Prof. Dr. Adam Ostrzenski USA

hello
edema occurred after revision surgery. You like the image because of my payment. After the edema was corrected, wrinkles appeared. Again, minor interventions can be made and corrected.

What happened has to do with the normal healing of your body. It appears from your initial post-op revision photos that your surgeon did proper, appropriate work. THEN... your body's propensity to "overheal" produced redundancy and the "wrinkled" outcome that you have experienced. There is no fault here; just the way your body heals over time. So... WHAT TO DO?? There are in my opinion, 2 alternatives. One is to accept your overall beauty, your normal, but not smooth labia, and get on with life. This may or may not be possible. If, after much consideration, you wish to see if there is some way to obtain an overall smoother result, I would recommend RF (radiofrequency) feathering (aka "airbrushing.") This is a technique whereby an RF needle is used to little-by-little skin off the "hills"/wrinkled areas. This will produce more of a "Barbie Doll" appearance, and should be smoother, BUT-- there has to be the disclaimer that it probably win't be totally smooth. Eliminating any suture reaction should to a great extent obviate the final "wrinkled" response. You will need to first consult wiht a specialized revieion surgeon schooled in RF feathering technique. While I cannot give you a firm fee estimmate without a consultation, our fee here in Northern CA would be approximately US$5000-$6000 including anesthesia, facility and supplies

Very best wishes, Michael P Goodman, MD, FACOG, IF, AAACS. Cosmetic Gynecologist specializing in Revisions, Davis, CA, USA