What surgery should I get? Do I need a revision labiaplasty? (Photo)

Question

I already got a labia plasty and clitoral hood reduction and am still not satisfied. I feel like there is barely a difference even though lots of skin was taken off. Is this just my anatomy and something I will have to deal with. Do I need a revision? Please let me know I'm desperate. First picture is before the surgery and second is after.

Peter Castillo, MD, FACOG · Answer

Thank you for your question and for sharing your photos. Although difficult to see the full results of your Labiaplasty from the photos that you’ve submitted, your concerns are apparent. Very commonly surgeons unfamiliar with vulvar anatomy, perform a Labiaplasty in the simplest form. That is give the patient what they asked for…smaller Labia. However, it is also the responsibility of the surgeon to take into account not only what is taken away but what is left behind.
When the labia minora are elongated, asymmetrical or darker than the surrounding structures, they become the focal point. However, once the labia are addressed, the eye goes to a new focal point if left unbalanced.
From your photos it appears that your surgeon did not address the redundant prepuce or perform a Clitoral hood reduction. By only addressing the labia, your results are nice however top-heavy.
I see this frequently when labiaplasties are performed by surgeons that are not specially trained in vaginal cosmetic surgery.
A prepuce and Clitoral hood reduction with pexy would likely complete the appearance that you are looking for. I recommend waiting a minimum of 3-6 months before performing the next step and research surgeons on this website for level of experience in performing Clitoral hood reductions. 
Best of luck,
Peter Castillo, MD FACOG FPMRS
Aesthetic and reconstructive vaginal surgery
Los Gatos, CA

Gary J. Alter, MD · Answer

As the inventor and innovator of the wedge technique in 1994, I reconstruct many women who have had labia reductions by other surgeons, both wedge and trimming techniques. The reconstruction technique depends on the deformity. The reconstruction is more difficult than a primary labiaplasty and should be done by a plastic surgeon with extensive experience in labia reconstruction. I published the first and most extensive paper on labia reconstruction in the prestigious journal "Plastic and Reconstructive Surgery" about ten years ago. You may need various reconstructive techniques to give you a good appearance, but this won't be known until all the swelling is gone.

Your labia minora and clitoral hood are still enlarged. A labiaplasty with a clitoral hood reduction can reduce your size.  However, it must be performed by a surgeon with experience.

Your primary problem is your enlarged clitoral hood, which is still thick, wide, and protuberant.  It can be decreased somewhat by reducing the sides.  I pioneered a clitoropexy with clitoral hood reduction in which the clitoris is pushed closer to the pubic bone and the width, thickness, length, and protuberance of the clitoral hood can be drastically decreased. I have done it over 350 times with excellent results.  I have not published this technique, so no one does it like me.  This is the most powerful procedure to 
reduce your hood available. 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 my labia cases are reconstructions of other surgeons' labiaplasties.

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

Vasileios Vasilakis, MD, FACS · Answer

Thank you for the question. Although an in-person examination is necessary, it appears that you would benefit from revision in order to further reduce the labia minora. I hope this helps. I wish you the best of luck. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

Mark N. Scheinberg, MD · Answer

Thank you for your question Your photos show inadequate reduction of both prepuce, hood and and lower pair of labia. You are correct in your evaluation. You need to do your homework and find a surgeon who knows the anatomy and can do it right.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It is apparent that you have residual tissue left that could be revised in order to create a more proportional result and approximate your goals further.

Zoran Potparic, MD · Answer

It is very difficult to give you advice on this matter without in person evaluation. You may need revision (based on photos) by means of removal of residual skin both from hood and labia but that decision can be dome only on the basis of in person consultation. Good luck.

Ram Kalus, MD, FACS · Answer

An examination in person is clearly required to properly evaluate you and make appropriate treatment recommendations. That said, it appears that you indeed have residual excess tissue that may be amenable to revision surgery. please consult with an experienced board ferried plastic surgeon or gynecologist who routinely performs genital aesthetic surgery as part of his or her practice. Best of luck to you.

Ozgur Kartal, MD · Answer

hello, your post-surgery photo is insufficient. I can't comment on this photo. You need to send pictures as I shared.
If you send more detailed photos, I can make a clearer comment.

Laura A. Katz, MD · Answer

Hello there.  If these are before and after pictures, it seems like you would be a good candidate for a revision with additional skin removal and retraction.  Since you have already had one surgical labiaplasty, I would recommend an an aviva scarless labiaplasty in the office to decrease the chances of developing scarring or distortion after having two surgical procedures.  The aviva scarless labiaplasty uses directly inserted radiofrequency energy to further cause skin retraction, muscle contraction, thus shrinking the labia further.  This can also be done to the clitoral hood and mons pubis,

John G. Hunter, MD · Answer

You seem like an excellent candidate for labia minora reduction. Please be sure to seek a board certified plastic surgeon who specializes in this procedure and is well known and respected for it.

What surgery should I get? Do I need a revision labiaplasty? (Photo)

Answers (13)

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