How would I be able to tell if I need labia puffing or skin removal?

Hello, in patients whose outer lips are too saggy and who generally lose a lot of weight quickly, we prefer to remove the excess tissue and then apply filler if necessary when full recovery is completed. However, if there is not much excess tissue upon examination, it will be sufficient to apply only filler if the fat content inside has decreased and it looks dull.

Great question! The best option for you depends on your anatomy, physical characteristics, and personal preference. There are some patients whose labia majora are so deflated and lax that the only option is labia majora reduction. There are other patients who have noticed premature aging with subtle deflation and laxity who would do great with augmentation. This would be determined at the time of an examination.
Go to the link below to see hundreds of before and after photos where you will find many examples that are similar to you. 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,

If you post a photo or schedule a virtual consultation and share a photo, I'll tell you exactly what you can expect from either labia majora puffing with fat injections or labia majora skin removal. I'll also share some nonsurgical extras that can be done at the same time to boost your results further. The decision comes down to the amount of loose skin present in the labia majora. If there an excess of loose skin, it would take a large volume of fat to inflate the labia to make them tight... and you would wind up with a huge cameltoe. If that's your situation, but not your goal, then skin excision would be the better choice. If there is not much excess skin and you seek conservative youthful fullness, then labia majora fat injections (puffing) would be the better choice.

That’s a great question, and one we get often.

The best way to determine whether you’d benefit more from labia puffing or a labia majoraplasty depends on your anatomy and goals.

Labia Puffing is ideal if your labia majora appear deflated or hollow but the overall shape and amount of skin are still appropriate. Puffing restores volume using filler or fat (often combined with PRP), giving a fuller, smoother, more youthful look. It’s non-surgical, quick, and has minimal downtime.

Labia Majoraplasty is better suited if there is excess skin, sagging, or significant tissue redundancy. In this case, surgical contouring is used to remove excess tissue and reshape the labia for a tighter, more refined appearance.

Sometimes, we even combine both procedures—removing excess skin while restoring volume for optimal results.

The best way to decide is through a personalized consultation. We’ll assess your anatomy, listen to your concerns, and guide you to the treatment that will give you the most natural, satisfying outcome. Let us know if you'd like to schedule a visit!

Generally, the best procedure is surgical (either a classic, tear-drop, "Angel-Wing" or the new "Labia Majora Lift"), as it is a "one-and-done" procedure, while "puffing" needs to be repeated every 6 months to 2 years, and can get a bit arduous, time consuming, and VERY expensive. Often, docs who do "puffing" do it because they are not surgeons trained to do the more complete surgical procedure. If you will be having surgery, make sure you see a surgeon who can assure you (via B&A photos) that (s)he is savvy in ALL of the above-named surgeries...

HOWEVER-- I can give you no further advice without a photoset..! RealSelf's web reference below shows many, many LPs. Look carefully, and you will see several that are labia majoraplasties...

Very best,

Michael P Goodman, MD, FACOG, IF, AAACS
Sacramento, CA, USA