Is this level of labiaplasty amputation considered below the standard of care? (Photo)

Question

Not looking for a revision. Pic is from 1.5 years post op. Did not consent to full removal/Barbie. Full amputation of labia and most of clitoral hood, clitoris is exposed. A lot of scarring. Loss of sexual function, no ability to become aroused, no pleasure, can't have vulva stimulated due to pain following (have done pelvic physio since post op). Is this considered below the standard of care? This result comes from an experienced Labiaplasty surgeon.

Mark N. Scheinberg, MD · Answer

Thank you for your question. There are no standards for quality of care. There are multiple methods for labial reduction and each have their pros and cons. Labial amputation or "trimming" is one of these. There are variations of which "Barbie" appearance is one. It is a riskier procedure and has higher incidence of problems. I advise patients against this variation because of these problems but surgeons still perform this method. "Experienced labiaplasty surgeon" does not mean well trained or competent, it only means does a lot of cases. It is why we tell patients to look at reviews and see the before and after photos before choosing a surgeon.

Adam Ostrzenski, MD, PhD · Answer

There are two separate questions:

Q1. 
Are labia minora and clitoral hood amputation (2 pictures presented here) considered below the standard of care?

A1.
 If you are looking for an expert to help you in litigation, your attorney should establish contact with a prospective expert and send your complete and pertinent medical records. I need to review your medical and surgical records before giving my opinion. Also, I need to see you in my office to obtain your pertinent medical history and document your symptoms, as well as to do a target physical external genitalia examination. Furthermore, I need to take photos of your current status of genitalia. After these initial processes, I can and will issue my opinion to your attorney.

Q2. 
Is it possible to reverse ruin intimate life by the "Barbie Look" labioreduction?

A2.
 Neither conservative medical nor surgical therapy can successfully reverse symptoms in such a case. Both attached pictures show total amputation of the labia minora and over-resected of the opening wall of the hood. This surgery damaged nerve endings through over-resections, and the presented narrative report leads to neurological symptoms. In my corrective cosmetic gynecological practice, I have not seen an improvement in neurological sexual dysfunction by conservative medical management, although there is some success in controlling pain.

I know you are not looking for a surgical revision, but I would like to brief RealSelf readers about the surgical options. This surgery will require an extraordinary and skillful surgeon who thinks outside the box. In such cases, I surgically correct a) the clitoral prepuce by lowering it and reconstructing the upper part of the clitoral hood and the anterior commissure (the connection between the left and right upper thick labia; b) removing scars; c) the fragment of the labia minora must be freed from fusion with adjacent of the skin of the intralabial crease and thick labia (the labia majora); d) the labia minora tissue must be expended (this is the first stage of surgery); e) reconstruction of the labia minora (the second stage of the corrective surgery).

In summary, patients should never accept a trimming procedure, particularly the "Barbie Look" procedure, since it represents the most extreme example of labial trimming (over-resection).  Corrective surgery can decompress nerve endings and ease symptoms. There is no clinical study to verify the effectiveness and safety of corrective surgery or medical treatments for this iatrogenic condition. The presented case here illustrates how the Barbie Look procedure without a patient's consent devastates the patient life.

To those selecting a surgeon, please listen to your prospective surgeon and discuss what she or he does in a similar case and what outcomes can be expected. Trimming should be used with caution or not due to potentially damaging function esthetic outcomes.

With regards,
Prof. Dr. Adam Ostrzenski 
USA

Ozgur Kartal, MD · Answer

we do not perform labiaplasty surgery in this way. We do not recommend removing the labia completely with the clitoral hood. In this way, we do not perform the surgeries of our patients who want surgery. We say that you can have surgery in other centers.

Michael P. Goodman, MD, FACOG · Answer

I perform a lot of medical-legal genital plastic review for both Plaintiff's and Defense attorneys (more Plaintiff than Defense...) and uaually have 3-4 active cases on board at any one time. It is impossible to give you an opinion without much more information including your surgeon's records, op report, and a "statement" from you regarding what you were told at your consultations. Also copies of your "Informed Consent" documents and other information. Officially, while I give general advice in this area to patients, I would need to work with your attorney to give any "official" determination.

That said, whether your procedure would qualify as "...below SOC" would depand on the training of your surgeon, what you "negotiated" re: your aesthetic desires pre-op, how (s)he performed surgery (exact technique, sutures used, post-op instructions given, etc.

I commiserate with oyour present (post-op) concerns and situation. As a female genital plastic/cosmetic surgeon and sexual medicine practitioner specializing in "LP gone wrong" (both treatment of neurogenic pain and sexual issues, and surgical reconstruction if appropriate), I see many patients in your situation. I suggest that you seek out a Cosmetic Gynecologist or P.S. who can prove to you their experinece in revisional work and who is a trained sexual medicine practitioner. While in-person consultatiopns are always best, many practitioners (myself omong them) are comfortable with phone, FaceTime and Zoom consultations. You mention "Loss of sexual function, no ability to become aroused, no pleasure, can't have vulva stimulated due to pain..." There definitely is a lot of hope for resolution of these issues with both sexuality counselling, topically-applied neuroleptic medications, massage and visualization, and other sexual medicine techniques. Important is to work with a savvy practioner who had adequate TIME FOR YOU to work out these issues. This will most likely require you to see a private practitioner, as this type of work cannot be successfully done with 15-20 minute visits "...under insurance..."

Best wishes,

Michael P Goodman, MD, FACOG, IF (Fellow, ISSWSH), AAACS
Davis, CA, USA

Is this level of labiaplasty amputation considered below the standard of care? (Photo)

Answers (4)

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