What are options to enhance my deflated and wrinkly labia majora? (photo)

I reviewed your photos.  You have some excess labia majora skin with some deflation.  If you have fat injections to plump up your majora, then your majora may be bulky in tight clothes.  I developed a majora skin reduction procedure which has minimal scars and eliminates the wrinkling. In some cases, I may remove the excess skin and also inject fat to plump up your majora.  I suggest you include photos standing the determine which is the best treatment- skin removal, fat injections, or a combination of both.  Your labia minora can be reduced, but you also might need a clitoral hood reduction with a clitoropexy to decrease the hood protrusion.  

Labiaplasty, which most commonly involves
surgical reduction of the labia minora (inner/thinner lips), has become a
relatively common procedure over the last ten and even more so last five
years. Whether the surgery is done using a laser, scalpel, or scissors
does not really matter but what does matter is "symmetry".
Symmetry is the most important aspect to the final aesthetic result.
Also, it's not how much tissue is removed but how much is left remaining
because a certain amount is necessary to maintain proper form and
function. And finally, most patients are also quite self-conscious about
the darkly pigmented edges of the labia minora, thus desire removal of most if
not all of this part.To achieve these three
most important elements, I prefer the “Trim” much over the “Wedge” method.I personally have also found the scar to be
better concealed and less perceptible with the Trim method.  And by the way, the same can be done for the labia majora (outer lips) to kind of snug them up again.  I don not recommend fat grafting as there is wide variation in outcomes and intense prolonged swellling post-operatively.  As you can see, it is extremely important to
consult with a board certified plastic surgeon that specializes in this
operation (performs at least 1 - 2 per week). It may cost you a bit more
but it this type of result you will want to live with for the rest of your
life. Typical (all inclusive) fee at my office/surgery center is
$4500. Now for recovery, because the labia tissue
is so robust with blood supply it has an amazing ability to heal
relatively quickly. Most patients are sore for 4-5 days before things
start to get a lot better from there. Some patients can resume work
before this time depending upon their occupation. No exercise for two
weeks, no baths/jacuzzi or swimming for 3 weeks, and no sexual activity for typically
4 weeks. My patients are given an oral pain medication such as Vicodin
but icing the area for the first 48 hours and applying some custom
made take-home topical local anesthetic cream seems to work the best.

The labia majora can often loose volume over time. A combination of fat grafting and/or skin excision can help improve the appearance. You want to be conservative with the fat transfer though to ensure it doesn't get overdone.
You could consider nonsurgical rejuvenation as well - with ThermiVa or PRP injections.

Hello and thank you for your question!

Just so you know, you definitely are not alone- these are very common issues.

I provide both volume addition to the labia majora as well as skin tightening as office based procedures.

Volume addition in my office is with fat and platelet rich plasma or hyaluronic acid and platelet
rich plasma.
Skin tightening is by removing a wedge of skin/mucosa at the junction of the dry-wet skin.

These can be done individually or together, based on priorites. Many women stage them.

Hope that helps!

In good health,
Ellen Mahony, MD

Hello, a labiaplasty minora and a clitoral hood reduction may be needed. For the majora fat transfer to the area can help fill the issue with the loose skin. If a bulky area persists a skin reduction of the majora can be performed. 

I typically offer two options for my patients with deflated labia majora.  I either perform a fat transfer under local anesthesia in the office or perform a series of Sculptra injections (off-label) in the office which has less downtime.Hope that helps!Dr. Sheila Nazarian

Deflation of the Labia Majora can be treated either with removal of the loose skin or with a plumping procedure involving injection of your own fat into the area.  Good luck!

I would recommend fat grafting to fill the labia majora.  "Aging" of the vulva can occur for a variety of reasons, childbirth, intercourse, hormonal changes.Fat grafting first involves liposuction to the tummy and/or inner thighs, and fat injection or grafting into the labia majora.  About half of the fat stays and half gets reabsorbed after fat grafting.The photo above also demonstrates mild excess of the labia minora (in addition to atrophy of the majora) and clitoral hooding. I would perform a clitoral hood reduction with a very small component of a trim labiaplasty in order to remove the hooding and also restore a normal coloration to the edge of the labia.The ThermiVa radiofrequency device has shown some promise in tightening the vaginal opening and providing a fuller vulva. This is still somewhat experimental but very low risk, and I would use this as well as part of your treatment.

Labiaplasty can certainly help remove the excess skin that exists, however it cannot address any discolouration effectively. Labiaplasty can be performed by laser or be excision. 

Labial fat grafting or Labial fillers may further enhance the interface between the labia majora and labia minora. Our office specializes in labiaplasty surgery and labial rejuvenation.