Which procedure(s) would help improve the appearance of my labia/clitoral hood and excess perineal skin? (photo)

\Your labia minora and clitoral hood are enlarged. A labiaplasty with a clitoral hood reduction can reduce your size. However, it must be performed by a surgeon with experience. One of the two most common labiaplasty 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 often causes asymmetry, scallops, and a wide suture line. 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. You have extra tissue on your clitoral hood, which can 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 400 times with excellent results. I have not published this technique, so no one does it like me. In addition, I would remove the excess skin in your perineum.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

Thank you for your question First understand the anatomy. There are two pair of inner labia: a lower pair that inserts into the clitoris and an upper pair called prepuce that forms the hood (the hood is the skin covering the clitoris) which can grow into and even overwhelm the lower pair. Your photo shows significant excess prepuce which should be reduced giving a “ bridge of the nose appearance “ before addressing the reduction of the lower pair. In your case either the trim or natural edge procedure, in my opinion, would give the most aesthetic effect.This can be carried down to the extra skin on the lower area. Do your homework and research your surgeon well with before and after photos and reviews. The video below can be helpful to be more informed

Hello Catl0ver23,
Thanks for question and photos. You have a large droopy hood that needs both reduction and lifting at the time of a labiaplasty and excision of excess perineal skin. Go to the link below to see hundreds of before and after photos where you will find many examples that are similar to you. From that link you can schedule a virtual consultation via phone or zoom, at which time we can discuss in depth your anatomy, expectations and concerns. Women from all over the world travel to my Center for their Intimate Makeover.
Best of luck,

Hi! Your case is a scenario I see often. The best approach would likely be labiaplasty with hood reduction, plus a perineoplasty. This would result is a more tucked in labia minora with a balanced hood and smoother between the vagina and rectum. And office examination would be best for proper evaluation. Good luck!

There are several ways to reduce the excess skin at the perineum that is either connected to the labia minora or simply present nearby. The most common method that I use is called a horseshoe labiaplasty where I simply continue the labiaplasty incisions across the midline to create one smooth line. In other situations, I excise and reconstruct that skin separately. In others still, I conduct a perineoplasty. The exact choice requires a virtual consultation to discuss your goals in more detail.

Thank you for your question and photos. Based on these photos, I would do a wedge resection labiaplasty and clitoral hood reduction. The excess skin close to the perineum can be removed as well. It is not a continuation of the labia minora, but it is on the inner side of the labia majora. Some might recommend a trim method and incorporating this skin with the labial reduction. I would not do that due to the postop scarring and restrictions you will have. That skin needs to be removed separately.
See a board certified plastic surgeon or gynecologist experienced in cosmetic female genital rejuvenation for an in person consultation/evaluation. Good luck.

If perinoplasty and clitoral hoodoplasty are performed together with labiaplasty, a proportionally beautiful appearance is obtained.

Thank you for your question and photos. I am sure you realize that an examination and evaluation in person by a board certified plastic surgeon or gynecologist who regularly performs genital aesthetic surgery would be required to provide you with specific treatment recommendations. That said, the short answer to all of your questions is "yes". It appears that you would benefit form labiaplasty that extends to the redundant tissue closer to the perineum, and CHR is definitely an option for women who find that there is redundancy in that area as well. Do your research, and always consider that a second or even third opinion might be in your best interest before you schedule your surgery. best of luck to you.

clitoral hood reduction surgery should be performed together with labiaplasty surgery.
In addition, the perineum area in the lower part of the vagina should be corrected.

Q: What can be done to improve the look of the main branch (trunk) of the labia minora, clitoral hood, and clitoral frenula?

A: It can be done to restore all the surgically created anatomical abnormalities and additional deformities. It looks to me, judging from the two attached pictures, that the labia minora were subjected to the prior cosmetic surgery, which resulted in major complications a) 1/3 lower labia minora were over-resected, led to unnatural fused with the skin between the interlabial groove and the labia majora (the thick labia); b) "railroad truck" complications that are directly related to the surgical applications of sutures; c) the bottom of right labium minus was brought by the surgeon on the crotch and connection between both labia was impossible to create the labial frenulum.


How do I cope with such multiple surgical complications and address additional anatomical deformity:

1. Under no circumstance will I perform labial trimming because it will create potential complications associated with over-resection (please look at the prior reply that I presented on the RealSelf Q&A page),

2. I resect the scars and the fused labia minora bilaterally (I did the clinical study on this very topic, termed that new operation - Labiolysis, and published it under my name in a professional medical journal),

3. In the 2nd step, I expand the tissue of the labia minora and perform the upper part of the labia minora, clitoral frenula, and clitoral hood esthetic operations.

With regards,
Prof. Dr. Adam Ostrzenski
USA