Labiaplasty and hoodectomy - what are my reconstruction options? (photos)

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. However, no attempt to revise your labia should be done until you are at least five months after your past procedure as your appearance will improve, and the swelling will be less. You need to control your anxiety and wait. 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" over ten years ago. You will need various reconstructive techniques to give you a good appearance, but this won't be known until all the swelling is gone. I may use multiple wedge excisions to reduce your labia, eliminate many of your scallops, and improve symmetry. Alternatively, I may need to reconstruct your labia minora with clitoral hood flaps, which I invented and published in that journal article. In this surgery, I take the tissue on the sides of your clitoral hood and transfer it downward to smooth out your labia minora. I have done this surgery about 80 times with excellent results. The surgery takes about 3+ hours so it is not a simple office procedure. If any surgeon reduces more of your clitoral hood, you will be ineligible for this repair.

You clitoral hood can also be reduced at the same time. Your clitoral hood is 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.

You only get one good chance to reconstruct you, so be patient and ask a lot of questions.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NYC

Tank you for your questionYour photos show that the prepuce and hood were not addressed in your surgery. The e scalloping is due to the type of labiaplasty procedure you chose.( see labiaplasty video below). There are two pair of inner labia: lower pair that inserts into the clitoris(where you have the scalloped edges and an upper pair, called prepuce, which forms the hood( the skin immediately above the clitoral glans). this prepuce can enter and even overwhelm the lower pair. This ideally should be addressed prior to treatment of the lower pair. The prepuce appears untouched as is the hood itself. These can be treated to give a "bridge of the nose " appearance to the prepuce and a reverse -V hoodoplasty can be done to let the clitoral glans just peek out from under the hood. The scalloped lower pair can be can be trimmed to give a smoother appearance.You need to do your homework and find someone well trained to do these procedures and look at their before and after photos as well as reviews.

Hello, you should wait eight weeks after the second revision. As a result, if there are still areas you do not like, the scalloped appearance, especially on the inner lips, can be removed. In my opinion, the clitoral hood looks better after the second revision, but the inner lips may need another revision.

A second revision can be done but this must be done by an experienced surgeon that understands and has done many labiaplasties regions. You also will need to wait about 6 months to have any revision done. So do your due diligence to find a surgeon that has done several labiaplasty revisions. I suspect you will have to travel.

Thank you for sharing your question and photographs. You can seek a revision procedure but it will need to be a subtle reshaping of the tissues for contour and symmetry as you have little remaining excess. Be sure to seek out a series of specialists to get the best in-person advice.

You will not need full reconstruction, and you are right that you will need to wait a bit (difficult to do, I'm aware...) If you decide on a second revision, I counsel you to wait until you are ~ 5-6 months out from your second surgery. Understanding that it is difficult to give fully accurate advice based on only partial, 2-dimensional photos, I opine the following: 1) The scalloping" you ended up with is from the use of "through-and-through skin sutures that lasted too long & produce the "grooving" that bothered you. I see this frequently from surgeons who use skin sutures that stay in too long, are put in too tight, and linear ("trim") technique. This is one of the advantages of "wedge" for many women: no possibility of serial "grooving..." Using cautery for your revision may not have been the best choice, but I don't know the exact technique utilized. 2) I counsel you to (figuratively) "...take a deep breath," let it all heal, and see how you feel about things 3-4 months after your revision. You may wish to "...leave well enough alone..." 3) If you definitely wish to "smoothe things out" and further reduce clitoral hood size, in my hands would utilize a radiofrequency needle to "Airbrush" the protruding bumps in conjunction with judicious tissue skimming with a long curved Iris scissors to smooth out your labia, using no sutures 9or only fine sutures under the skin only) and letting things heal by what is called "secondary intention," sort of like when you skin your knee: a scab forms & new smoothe skin forms underneath. 4) For the hood would need to do a hands-on exam at time of your revision to see if there is enough excess hood skin to remove more using "kayak-shaped" excisions on either side of the hood to "pull things down..." It may be that you have a robust clitoris, not excess skin. 5) As far as WHO shoould perform your revision, closest to you would be Dr. Alexandros Bader on Harley Street in London. Also Dr. Stefan Gress in Munchen, or Rafal Kuzlik in Warszawa. In the U.S., Dr. Red Alinsod in Irvine, CA and myself in Davis, Northern California do this type of work. You are in good hands with any of us; check out "out-the-door" price totals (including transportation). This surgery can be performed in an in-office surgery suite under "local" anesthesia, with only a 1-night stay in a hotel prior to returning home.

Best wishes,

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