Labiaplasty, vaginoplasty, hood reduction - are my expectations unrealistic? (Photo)

30 year old & have decided that I want a vagina makeover- basically anything to rejuvenate the look and tightness that I had pre kids! Can labia minora be tucked away & bring back tone in the majora (the skin doesn't bounce back at all). Also tighten up everything inside. I've added a few pics so u get an idea of what work might need doing and then a 'goal' pic to what I really would like- basically a nice tidy vagina! Is this achievable and what procedures would you recommend?

Doctor Answers 9

Very Realistic Expectations

Dear Happy:

Thanks for sharing your questions and photos.  I think your request is very reasonable if you choose a surgeon with the right experience and expertise.  Let us discuss each of your issues separately:

1) Labia minora reduction - the two most common techniques are linear resection and a wedge resection. based upon your photos and you desires I would recommend a linear resection. Each surgeon has their own technique and their technique coupled with artistic talent is what gives a woman their results.  In a study I performed in 2010 a review of 550 of my patients requesting labiaplasty over a 3 . 5 year period  were interview ed about their postoperative expectations.  99% of  the caucasian woman ( of which I assume you are based upon your photos--  though i might be wrong) wanted their labia reduced so they no longer protruded beyond the majora and 99% preferred a lighter skin color i.e. pink versus dark.  Of  course I would ask you personally on what you hope to achieve as you might not be in agreement to 99% of caucasian women

2) Clitoral hood reduction or in your case (lateral redundant prepuce reduction) - this is the skin lateral to the clitoral hood. In your photos you can not even see the clitoral hood due to this redundant lateral prepuce ( prepuce is another name for clitoral hood). This lateral redundant prepuce is overriding your true clitoral hood.  Many surgeons will not touch this are for fear of damaging the clitoral nerves ( nerves - note its plural because the nerves are bilateral i.e. one from each side of the clitoris).  70% of my patients have the prepuce or lateral prepuce reduced and I have never had a clitoral nerve damage.

3) Labia Majora tone- this can be done in a number of ways depending upon your exam and what you hope to achieve ( Here are 4 different approaches):

q) AUTOLOGOUS FAT TRANSFER (AFT)------ If it really is that the labia majora are flat due to fat loss in this area--- then you should consider autologous fat transfer AFT --- essentially it is liposuction from one area of the body and its is transferred into the labia majora.  Plumping up the majora gives the skin a look of having more tone or a gently taut look.   Think about a face of a person who has lost a ton of weight --- the skin can sag...if the sagging is not to severe putting fat under the skin will stretch the skin giving it bounce..... 

b)  LABIA MAJORA REDUCTION WITH AFT:  -----It has been my experience when a patient is too flat often BUT NOT ALWAYS the patient has lost a lot of weight either due to diet or after having a baby and the skin is stretched in the labia majora area.  If this is the case if one plumps the skin to capacity to get the wrinkles out sometimes the plumping is excessive because the skin has been stretched due to weight gain and loss or due to delivery and 9 months of pregnancy.   In this situation the labia majora looks might look huge after plumping.  In actuality in this situation the excess skin needs to be removed first and then plumped wit the AFT.

c) LABIA MAJORA REDUCTION ONLY ( MOST COMMONLY PERFORMED) --- In this situation the labia majora are flat and saggy and often manifest as hanging during standing or in a bath suit women often experience a bulge.  If all you really want is to tighten up the majora so they don't sag then just the resection of the excess skin is needed.  Please take the time and get evaluated by someone who has experience.   Dr Moore and myself wrote the first paper on simultaneous labia minora and majora reduction.   Please see the paper on my site to see the results of the surgery.  Many surgeon make an ugly vertical scar.... the key to cosmetic surgery is to minimize the scar.  Please choose a surgeon who is well versed in majora surgery.  If the surgeon doesn't have an area on their website which discussed majora reduction then they probably do not do enough of them.

d) LASER OR RADIOFREQUENCY FOR MAJORA - this can tighten the skin but it is a maintenance procedure where you will need to go back 3x the first year and then annually ( sort of like doing botox).  Most women who are going to surgery will just prefer to get everything done at once but this is a patients choice.

Finally 

4) Vaginal Rejuvenation or tightening surgery--- 

Vaginal rejuvenation really means the internal tightening of the vagina and tightening of the vaginal opening usually to enhance friction for intercourse.   In experienced hands this surgery is approximately 85-90% successful as defined by the patient ( i.e. she is satisfied with the enhancement of friction during the act of intercourse 12 months after surgery).   There are only 4 papers written on this topic and my partner, Dr Moore and I are co-authors of two of these papers.    This surgery is usually accomplished by performing posterior vaginal wall surgery ( known as a posterior repair and coupling this with a levator muscle plication) + a vaginal opening repair known as a perineoplasty.   This requires experience, expertise, and good knowledge of  the pelvic floor.      Patients who have had spinal trauma i.e. lower back injury, chronic straining due to "constipation' and or lifting heavy things, multiple childbirths may need more than just tightening procedure they actually need vaginal reconstruction and this depends upon whether their is more than just the floor of the vagina is broken.  If more is broken and you have a cystocele ( bladder drop) and uterine drop/prolapse this all would be addressed at the time of your appointment.  

I hope this is helpful and please choose a surgeon with experience, expertise, a great reputation and one who achieves great results.

John R Miklos MD

Atlanta  ~ Beverly Hills ~ Dubai

Yopur desires- DOABLE- would be correctly termed "...vaginal rejuvenation"

YES, your goals for your "Vaginal Rejuvenation" are obtainable. A well-performed perineoplasty (aesthetically repairing, raising, and supporting the opening), vaginoplasty (re-building the vaginal floor, removing all scar tissue from childbirth(s), and bringing the muscles and connective tissue together in the midline, bulking & strengthening the vaginal floor, plus a carefully contoured linear or V-wedge labiaplasty will do the trick. Viewing your anatomy, a curvilinear labiaplasty, carefully bevelling over the hood should produce an aesthetic result. Your labia majora look modestly full without excessive redundancy. HOWEVER, all your money, hopes, and time will be for naught if you pick the wrong surgeon. There are perhaps a dozen (max) surgeons throughout the U.S. who have the know-how, experience, and technique to do all you wish. You'll do best with one who has >100 cases experience; the more the better. Look for a surgeon with at least 25 before and after labiaplasty and 10 or more before & after vaginoplasty + perineoplasty pics on their site. Few pics = inexperience! The "out-the-door" fee for everything noted above in our office in Davis, CA is ~US$9250, all-inclusive (surgeon, facility, anesthesia, supplies. "...Happy, happy..."


Best wishes,


Michael P Goodman, MD


Davis, CA, USA

Labiaplasty suggestions

There is a trend to have less prominent labia, but this is a matter of choice and there are no medical reasons to do so other than improving your appearance down there. Candidates for a Labiaplasty procedure are women who are concerned about the appearance of their labia or experience discomfort due to exceptionally large or long labia of either the inner our outer lips. Labia unevenness can result in discomfort with intimate contact, chronic rubbing, as well as psychological discomfort, which leads to the inability to wear certain types of tight clothing. Most women live with these symptoms, and actually are not even aware that a certain surgical procedure exists to help to correct this problem and restore their femininity.

Labiaplasty

You're definitely a candidate for a labiaplasty and possibly a vulvoplasty and vaginal rejuvenation procedure. I prefer a modified posterior wedge labiaplasty procedure to give you a more aesthetic looking vulva. Click on the link below for further information. Good Luck

Robert L. True, MD
Grapevine OB/GYN
4.9 out of 5 stars 7 reviews

Labiaplasty, vaginoplasty, hood reduction

Your labia minora and the sides of your clitoral hood are enlarged. A labiaplasty with a clitoral hood reduction can reduce your size. However, it must be performed by a surgeon with experience. One of the two most common labiaplasty techniques is the central wedge technique, which I invented in 1995 and published in the plastic surgery textbooks. It is also known as the "V" or wedge technique. Gynecologists and most plastic surgeons perform a labioplasty very differently. They essentially trim the labia minora (inner vaginal lips) and leave a long suture line instead of the normal labial edge. Their technique is the same whether a scalpel or a laser is used. In contrast, the central wedge removes triangles of tissue and bring the normal edges together. Thus, the normal labial edges, normal color, and normal anatomy are preserved, but the darkest labial tissue is usually removed. If you have extra tissue on your clitoral hood, it can be reduced it at the same time. Your clitoral hood only needs to be decreased  by reducing the sides.  

Your labia majora have stretched which resulted in excess skin. In addition, they  have lost some fullness.  The majora fullness can be increased with fat injections.  I suggest reducing the excess skin and maybe increasing the fullness with fat injections if there is a fat deficiency. The technique I use leaves a scar on the inside of the majora in the fold between the majora and the minor and clitoral hood.  Alternatively, the labia majora can be tightened and decreased with a laser resurfacing of your majora.

Your vagina can be tightened with internal lasering or by surgery if very loose.

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.

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY

Gary J. Alter, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 20 reviews

Labiaplasty, vaginoplasty, hood reduction - are my expectations unrealistic?

Thank you for your sharing your questions and photos. Based on your photos, you would be an excellent candidate for labiaplasty and labia majora reduction. Both of these procedures reduce the excess tissue that you are bothered by and would create a more aesthetic appearance of the vagina. Keep in mind that every woman's anatomy is different and therefore outcomes will differ slightly as well. In regards to vaginoplasty, you would need an evaluation and examination to determine and discuss which options are available to you. My best recommendation for you at this point is to find a board certified surgeon who specializes in labiaplasty and vaginal rejuvenation and set up a consultation.  During this visit you and your surgeon can discuss expectations, procedures, your anatomy and what procedures would be best suited for your needs. Below you will find a link to our website that reviews the procedures and anatomy and what to expect before, during and after these procedures.

Vaginoplasty /pelvic reconstruction and labiaplasty will make you over like a champ!

Your request is the poster child for millions of women many of whom live silently with your same concerns. The process starts with a thorough pelvic exam to determine the extent of any pelvic floor vaginal support issues. The centerpiece of total vaginal mommy makeover is a solid vaginoplasty. The heart of successful vaginoplasty is a solidly supported vagina with any pelvic floor issues reconstructed at the time of the surgery.

Realistic goals, just find the right doctor

You need to find the right doctor who will work through each of your concerns. I would recommend an extended wedge labiaplasty with hood reduction, a small amount of fat injected into the outer labia, and a vaginoplasty/perineoplasty procedure to tighten the vagina and perineal muscles.
Now is not the time to "buy local" as there are very few practitioners who can perform all of these procedures: each to address a specific concern you have. Do lots of research. Realself is the right place to start!

Labiaplasty, vaginoplasty, hood reduction - are my expectations unrealistic?

Thank you for sharing your question and photographs.  As for your labia minora and majora appearance you can achieve a nice improvement with a labiaplasty to reduce the size of the tissues to have them tucked behind your labia majora.  This can be done with either a wedge or trim technique, but used on your location of excess I would favor a wedge.  Your clitoral hood does not demonstrate significant tissue excess in either length or width but an in-person examination would offer better information for a possible reduction.  As for your labia majora you can have either a small amount of excess skin removed or a small amount of fat grafting or dermal filler can be placed to fill out the skin.  Your goal photograph indicates skin resection may be a better option.  Lastly for internal rejuvenation I would first see your ob/gyn to discuss any symptoms you may have and then discuss options at tightening, such as ThermiVa.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.