Can someone with lichen sclerosus on clitoris have labiaplasty?

Question

I have lichen sclerosus on the clitoris and it’s well controlled. I discussed having labiaplasty with my dermatologist and she was concerned that the way the procedure is done can make it spread. Therefore I wanted to get a plastic surgeon’s opinion on whether the surgery would worsen lichen sclerosus or not

E. Jacob Simhaee, MD, FACOG · Answer

dear patient
Lichen Sclerosis is an auto-immune disease, and during stress, it can flare up and make life uncomfortable, 
depends on the reason for labiaplasty you need to have a detailed conversation with your physician and know if it is worthed in case your disease flares up and spread to another area of the vulva.

best of health and good luck

Mark N. Scheinberg, MD · Answer

Thank you for your questionThere are several methods of doing a labiaplasty and there are no guarantees in surgery. Nevertheless, your chances are very good to avoid problems if you pretreat with Clobetasol .05% for 4-6 weeks and use trim or natural edge techniques.

Michael A. Reed, MD · Answer

YES, labiaplasty can be performed on a patient who has lichen sclerosus.
Lichen sclerosus is a chronic autoimmune inflammatory process that most often affects the genital skin.  In some cases, the effects on the skin of the vulva can lead to debilitating scarring, atrophy of the labia minora, clitoral hood phimosis, and closure of the vaginal canal.  The aim of treatment is not only disease control, but prevention of scarring and maintaining adequate urinary and sexual function.  
To have a successful labiaplasty procedure, proper preparation is necessary. First, all genital skin affected by lichen should be well controlled.  Second, have a detailed plan of treatment if a flare should arise during the postoperative period.  Lastly, spend some time finding a physician who is savvy in biologics like PRP (platelet rich plasma) or other biologics like exosomes and amniotic fluid.  These biologics have growth factors, anti-inflammatory properties that assist with healing, improve collagen, elastin and new blood vessel growth which will have significant impact on the genital tissues during healing and beyond.  Best of Luck!  Dr Michael A Reed MD  aka @thecosmeticgyn

Stephanie Molden, MD · Answer

Having genital surgery with lichen present poses a few risks but this is not a clear-cut contraindication to surgery. I manage a lot of women with this condition and also do cosmetic gyn surgery. While lichen can cause slower wound healing and may flare postoperatively, good control 3-6 months before surgery is helpful and confers a better prognosis. If it is contained for now to the clitoral area then that is also helpful and would be out of the way of the labiaplasty unless hood reduction is also being performed. Anything, such as surgery, that increases inflammation can trigger a flare which could potentially result in new areas of sclerosis but this is not very common.

Good luck with your decision!

Good luck with your decision!

Burcak Tok, MD · Answer

Hello, after the labiaplasty application in our lichen sclerosus patients, it is absolutely necessary to support with PRP injections and vitamins. Of course, the localization, spread and degree of the lichen will also be important in the decision of operation.

Courtenay Poucher, MD · Answer

Hello. Thank you for your thoughtful question. While lichen sclerosus, which is believed to be immune mediated, may exacerbate with trauma to the skin, the true cause and mechanisms of action are unknown. I have had patients with lichen sclerosus have labiaplasty successfully and without worsening of their condition but I feel confident others may have had a different experience. Given your case of lichen sclerosus is well controlled you may be able to have labiaplasty without consequence. It ice best to consider your reasons for seeking labiaplasty and weigh them against what it would mean if your lichen sclerosus worsened due to having the procedure. Best wishes to you.~Dr. Poucher

Ali Dogukan Angin, MD · Answer

Liken sclerosis is an autoimmune disease, and difficult to cure. There is no evidence that surgery can cause it to spread, also it is an unknown disease, should they should be careful

Sue Kafali, MD · Answer

Lichen sclerosis is a chronic medical condition. Certain factors such as the duration of time you've had it and severity may be considered before recommending a labiaplasty procedure. Your gynecologist would need to assess your lichen sclerosis and ensure it is managed as this could affect post-operative healing. Alternative treatments like Morpheus8V and PRP injections, which stimulate collagen, may be recommended. Morpheus8V and PRP injections promote the development of new tissues, which could also assist with healing and recovery. We frequently manage this condition successfully in our patients. I recommend consulting with a cosmetic gynecologist or doctor who is familiar with this condition. Best of luck to you!

Adam J. Oppenheimer, MD, FACS · Answer

It’s possible to have a labiaplasty with pre-existing skin and inflammatory conditions of the vulva. Depending on the severity of the lichen sclerosus, a Labiaplasty may or may not be possible. Lichen sclerosus can tighten and shrink the tissues of the vulva, making them firm and fibrotic. It may not be the best idea to have a Labiaplasty under those conditions but in mild cases, it can work perfectly well. The best way to start is by scheduling a consultation with my team and I.

Gary J. Alter, MD · Answer

A labiaplasty should not cause your lichen sclerosis to worsen. Usually lichen sclerosis is on the clitoral hood or the labia minora but not on the head or glans of the clitoris. Lichen sclerosis often results is loss of definition of the labia minora and clitoral hood and possibly closure of the prepuce over the clitoris.

However, a labiaplasty must be performed by a surgeon with experience. One of the two most common 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. This can lead to scallops, asymmetry, and irregularities.  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. 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.  About 40% of the female genital cases I perform are revisions of labiaplasties and clitoral hoods botched by other doctors.