Are these stitches normal? 18 hours post labiaplasty and hood reduction.

Question

Any advice would be very much appreciated. I asked for my inner labia to be contained within the out Labia. I have been looking in the mirror at the stitches, the surgeon has sewn my inner labia onto my outer labia. Is this normal please help, I have been crying for hours with worry. I still wanted SOME inner labia!! If this is not right what sall i do??

Marco A. Pelosi III, MD, FACOG, FACS · Answer

Your results are neither a properly conducted linear labiaplasty nor a wedge. This is a crudely overdone removal of the entire labia minora. Unfortunately, the minora cannot be restored. An option to camouflage the area would be to inject fat into the labia majora to hide the area. This wreaks of inexperience.

Kristi Hustak, MD · Answer

Thank you for your question. It is difficult to tell because there is so much swelling, but it does appear that the majority of the minora have been removed throughout its length with some agglutination of the minor and majora, usually consistent with a trim technique. Without pre-operative pictures to compare, its difficult to know how much redundancy you had pre-operatively. It is still VERY early in the healing process to tell definitively. The type of sutures used  in the picture are a normal variant for the trim technique. Swelling in the first week is normal. There is extensive bruising posteriorly, so monitor this for increase or worsening and seek consultation with your provider for the concern for a hematoma.Once the swelling goes down, you will have a better idea of what tissue is left and you may be surprised how well they look after.  For now, concentrate on resting and healing. If the resection was more aggressive than you anticipated or desired, reconstructive procedures by a board certified plastic surgeon can be done in the future if needed to modify the appearance. Serial discussions with your surgeon are helpful and I encourage you to have these with your surgeon as you heal. Best wishes for a speedy recovery. Dr. Hustak

Adam J. Oppenheimer, MD, FACS · Answer

Based on the amputation photos, your doctor is not a nuanced labiaplasty specialist surgeon. It also appears that you may have internal bleeding. This is an appearance I have never seen in any of my patients because I do not do amputations like most GYNs. I use an extended wedge technique that is very delicate and usually results in minimal swelling. Hematomas require surgical evacuation and control of bleeding. I would see your surgeon or a better one who understands the anatomy and surgical procedure a bit better. Once you have this acute issue addressed, and you're completely healed, you can have a re-evaluation by a different doctor to see what can be done in the future, if anything is needed. 6 months are required for the full healing process before any revisions are considered, but there are other issues to be dealt with first.

Nelson Castillo, MD · Answer

Thank you for your question and for sharing your photographs.  I see your areas of concern but your swelling, bruising, and possible hematoma are obscuring some of the results of your surgery.  It appears that much if not all of your labia minora was removed during your labiaplasty.  Unfortunately at this point the only treatment is to allow your body an opportunity to heal and assess your results for a possible revision at 3 months based on what remaining tissues you have of your clitoral hood, though much was already removed.  Use pelvic elevation, cold compresses, arnica montana, and bromelain to try and minimize your swelling.

John R. Miklos, MD, FPMRS, FACS · Answer

Dear 321321:I am sorry to hear and see of your surgical dilemma.  It is obvious you do have a ton of swelling but to be honest it appears that your minora are sewn to your majora because your labia minora are completely removed.  This is another example of a surgeon who doesn't know what they are doing or their complete lack of experience.  This is also another example of why woman need to do their due diligence  before signing up to have surgery done based on location or other reasons.  I am so sorry that the results of your surgery is not what you have planned.   The only thing you can do is wait and see if after the swelling resolves and see what is the final outcome.  Your labia minora can not be replaced especially since your surgeon removed the lateral prepuce too.  Fortunately for you you have a small clitoris and clitoral hood and perhaps after all the swelling goes down the results will be more acceptable.John R Miklos MDUrogynecologist  & Cosmetic Vaginal SurgeonAtlanta ~ Beverly Hills ~ Dubai

Kimberly Singh, MD · Answer

Hello and thank you for your candid post and question. I am unable to see your photos unfortunately, so I am answering your questions based on your written post. Labiaplasty in general typically involves reduction of the inner labia. It would be very unlikely that your surgeon has sewn your inner labia to your outer labia. Since surgery was so recent, swelling and bruising is likely obstructing a clear view of your anatomy. I would strongly encourage you to see your surgeon so that he or she may fully assess you.

Michael P. Goodman, MD, FACOG · Answer

Unfortunately, it is not unusual to look like you've been hit in the vulva with a baseball bat the first 4-7 days after surgery, Black & blue, swollen 3X "normal" size, etc. Even understanding that, it appears that your surgeon was quite aggressive in the amount of tissue removed. However, you really won't have even a general idea of how things will turn out until ~ 2-3 weeks post op, and it won't be until at least 6-12 weeks post op that you will really appreciate the long-term results. Please send us photos at that time if you are dissatisfied.That said, HERE IS IN-DEPTH INFORMATION ON APPEARANCE DURING THE FIRST 7-10 DAYS POST-OP.  Any legitimate, experienced genital plastic surgeon should both clearly discuss this with you, give you a written sheet describing your post-op appearance, post-op activities, and be easily available for your queries and concerns during the first 7-10 days post-op.

WHAT TO EXPECT:

Day of surgery& day after: Largest amount of pain is when anesthesia wears off day of surgery.  Ask your doc when this might be, and take your first pain pill(s) 1 hour before, and every 4 hours (with food!) through the day and at bedtime.  Take as needed after that.  Expect some minor to moderate red blood leakage, minimal swelling first 1-2 days.  Ice the area as directed for 15-20 min. every few hours beginning after surgery & for 4-5 days.

Days 2-7.  LOTS of swelling, discoloration ("black & blue"), even out to the outer lips and clitoral area; size irregular, frequently more swelling one side than the other, lots of bumpiness in-between stitches, some yellowish coating, rough edges, sometimes tiny superficial separation.  Looks positively "awful." Remember also, the clitoral area will stay swollen longer than the rest of the labia...

Days 7-10.  Swelling goes down, still bumpy, irregular, tissue somewhat "hard"

Danger signs: "Drip-drip-drip" bleeding; significant separation (look carefully- DO NOT PULL OR TUG); a large "goose egg" on one side; increasing reddening or pinkish "halo" developing in the surgical area.

What to do; not to do. TO DO (first 7-10 days):  Off your feet; greatly minimize stairs, walking, outside activities. Rinse area 2-3X/day with shower or peri bottle; pat dry or dry with hair dryer high blow, low heat. Ice carefully with re-freezable soft ice pack or frozen peas/corn for 15-20 min. 5-6 X/day.  If it gets REALLY SWOLLEN, try Ibuprofen 600 mg (3 OTC tabs) with food every 6-8 hours continuously for 3 days. NOT TO DO: Running, lots of stairs, out & partying, handling, touching, tugging at the area to look more closely

Last words:  Your surgeon should go over IN DETAIL your recovery and give you a clear written instruction sheet.  He/she should be easily available to you for questions; you can communicate with your surgeon by sending him/her a small photofile of "selfies" to show what you're concerned about.  PROBLEMS?  CALL YOUR SURGEON!!  Remember, it will be a month before you should resume full normal activities, and 3-6 months before you will really know how it will look, long-term.The attached weblink may be of help, as will the video. Very best wishes,Michael P Goodman, MDDavis, Ca, USA

Erika Sato, MD, FACS · Answer

It appears from your photos that you had the trim technique. The sutures look like a normal variant for this technique. Everything appears to be healing okay. You have pretty extreme bruising which is still within the normal range. Because you have a lot of swelling it is difficult to tell what exactly is going on. It appears that you had a very aggressive trim reduction and that the majority of your labia minora are now gone. At this point, you just have to let things heal up. Too aggressive excision of the labia minora can also lead to discomfort, so there is a fine line between not enough excision and too much excision.

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