What procedure would I benefit from? (Photo)

Labiaplasty/clitoropexy/vaginal rejuvenation? Id ideally want the barbie look. I want to remove as much inner labia as possible especially the darkened areas. I have a large clit that protrudes quite a bit that id also like to be removed/lifted? I have perineum weakness and a larger vaginal opening I'd like to tighten is that included in any of the above procedures or Is each priced separately.

Doctor Answers 7

Cosmetic surgical options

Hi and thank you for your question!  From you picture it appears that various options are at your disposal based upon what your desires are.  From what I can see you may benefit from a labia majora reduction, labia minora reduction, prepuce reduction and possibly perineoplasy.  If you desire concurrant vaginal tightening to enhance friction you may consider surgical vaginal rejuvenation procedures or nonsurgical options such as Femilift which requires three treatment dates.   The best bet is to see someone experienced in these surgeries and from your inquiry it appears we may be just down the street from you!   I hope this helps!

Scott M Gulinson MD
Obgyn and cosmetic vulvovaginal surgeon
Glendale, AZ

Glendale OB/GYN
4.8 out of 5 stars 5 reviews

Restoring and Rejuvenating with Female Genital Enhancement

I perform a variety of treatments and surgeries to enhance, restore and rejuvenate the female genital region. This includes procedures to improve moisture, sensitivity and tighten the vaginal canal; which can enhance orgasm and restore or improve the appearance of the vulva. This includes the labia minora, labia majora, the clitoral region and the vestibule of the vagina.
A vaginoplasty (commonly referred ton as vaginal rejuvenation) is when a diamond shaped section of tissue is excised from the inside of the vagina and brought down to the outside of the vagina.
Often times a small triangular area is also excised from the perineum (the area right below the vaginal opening). This is called a perineoplasty or perineorrhaphy. The size of the tissues removed rarely are larger than a domino block. If needed, sutures that bundle loose muscles together are used to narrow the vaginal opening.
If necessary, this may be combined with a #Labiaplasty which is a surgical procedure that will reduce and/or reshape the #labia. Labia minora are the inner lips of the vagina that cover the female clitoris and vaginal opening. Women with excessively large labia may experience pain during sexual relations, feel discomfort during normal activities or while wearing tight clothing. Or, the labia may be asymmetric or may #hang below the labia majora (the outer lips of the vagina) which some women find this unattractive. At times the outer labia or labia majora may also be excessively large, uneven, or may be too small. The size may be increased with fat injections.
Candidates for treatment include women concerned about the appearance of their genitals, those who experience discomfort, pain or difficulty with sexual relations.The specific problems are noted below in each section. These problems may exist at birth or with growth and development. They can occur with childbirth or other trauma to the region. All of these issues can cause a woman great emotional distress that is often difficult to talk about with their partner, friends and even their doctor. The best procedure approach will be discussed in greater detail during your in-person one-on-one consultation.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

What procedure would I benefit from?

Based upon your picture and the information that you've offered, I think that you have several issues to address. Firstly, if the posterior vaginal wall muscles have separated, you may need to have a surgical repair. If not, then a less aggressive, non-surgical option will likely suffice. The fractional CO2 laser devices are best for internal vaginal rejuvenation and, amongst the devices out there, the FemiLift by Alma lasers is the most effective system out there. As far as the labia minor and the clitoral hood, of course they can be reduced by the new FemTight laser attachment (to the FemiLift laser system) that has been used internationally for some time and was just recently FDA approved for use her win the USA.  We are seeing outstanding results with FemiTight for labia minora and clitoral hood reduction as well as for labia major and mons pubis skin tightening.  We do still do surgical labiaplasty and I prefer the wedge technique as described by my friend and colleague, Gary Alter, MD. Lastly, RadioFrequency based devices are also effective for labia minor reduction and there are many out there.

Steven M. Gitt, MD, FACS (in memoriam)
Phoenix Plastic Surgeon
4.8 out of 5 stars 36 reviews

I think I would benefit from genital plastic/cosmetic surgery. Which procedures might I benefit from?

It is not so much my telling you "...what you should have done..." as you telling me what you wish to accomplish (e.g "look more trim;" "get rid of the elephant ears sticking out;" have a tucked-in "Barbie appearance;" "reduce the vaginal opening size & help it to look like I did before kids;" "narrow the vaginal caliber so that I feel more friction & pleasure with lovemaking..." etc. etc. It is up to you to tell your personally picked experienced genital plastic/cosmetic SPECIALIST what you'd like to accomplish, and negotiate with him or her your verbalized desires and the fact of your specific anatomy to arrive at a realizable goal.

That said, your anatomy as I visualize from your photo, is definitely conducive to meeting your goals of: 1. trim, out-of-the-way labial size, harmonizing with the size of your modestly reduced clitoral hood, and 2. An aesthetic remodel of your vaginal opening, continuing inward into the vagina as requested/required to narrow vaginal caliber and strengthen the pelvic floor and the pelvic floor musculature to produce more friction, pressure on the G-spot, and sexual enjoyment (if that is part of your "issues".)

The "trick" is to find a specialist either in your community or within a relatively easy plane-ride of you who has the savvy, understanding, and experience to model an operation especially for YOUR anatomy & desires, rather than performing a "boilerplate" surgery he or she uses on everyone. Perhaps you can find it in Phoenix, perhaps you'll need to travel.  This is your body, your most special parts, so finding the most experienced practitioner and one whose  office staff and whole program "resonate" with you is most important.

Take your time, look here & there, call and consult with several offices before you choose the couple best to visit (either in-person or "virtually " via a phone consult with photos... While you're researching, the weblink below and other areas of this site will be helpful!

Very best wishes,

Michael P Goodman MD
Davis, CA, USA

Woman wants the works and details

Vaginal tightening (aka vaginal rejuvenation, vaginoplasty) includes tightening of the deep vaginal muscles (the kegel muscles) and the perineum (the outer muscles and skin between the vagina and the anus. Labiaplasty and clitoral hood work are not part of the vaginoplasty, but are frequently done at the same time. Recovery time is the same for the combo as for either done alone, but with slightly more swelling and discomfort, but back to work (desk job) in 3 days is typical. Anesthesia is local with optional sedation. Fly in the night before, stay for 2 days, then travel home. Email to discuss details whenever you're ready.

Marco A. Pelosi III, MD
Jersey City OB/GYN
4.6 out of 5 stars 24 reviews

What procedure would I benefit from?

Dear ChelllyNicole,

Thank you for your question and sharing your photo.  I can only answer your question from the information you have provided, but know a physical exam would be definitive in understanding the anatomy of your vagina to best advise you.

The Barbie look is the removal of the entire labial edges and can put you at risk of chronic pain or hypersensitivity due to nerve exposure and/or scarring at the opening or along the edges themselves.  It is also impossible to remove all of the pigmentation or to prevent it from returning as hormonal shifts as we age (puberty, pregnancy, and peri-menopause) affect pigmentation.  However, it is possible to create very small edges and reduce the majority of the pigmentation as well as to reduce the tissue on the sides of the clitoral hood and to pull it up and reduce protrusion.

In terms of strengthening the perineum and tightening the vaginal opening, this can be done with a perineoplasty which pulls the damaged muscles together and cleans up any extra skin.  This is usually done with a vaginal rejuvenation or tightening procedure called the posterior colporrhaphy which pulls the muscles of the back vaginal wall together and removes extra vaginal mucosa.  Some women may also need the front and/or side walls tightened.  This depends on how much damage is in the birth canal and what your symptoms are.  Usually childbirth can affect bladder, bowel and sexual function, but each woman's body is affected differently.  Some have only bladder issues, others constipation and hemorrhoids or have to assist in moving one's bowels by pressing or rocking, while some just have reduced sensation, gas-like noises due to air, and/or fall out issues due to the stretched canal and weakened perineum.

The labiaplasty and clitoral hood reduction are charged for as separate procedures but most surgeons will offer a discount when these are combined.  The vaginal opening and canal are usually tightened together for one fee, but again this is surgeon-dependent.  Cost will vary depending where you go and the experience of the surgeon.

Please be sure to research cosmetic gynecologists and urogynecologists who are trained and highly experienced in performing these procedures as routine Ob/Gyns do not receive the education and training in labiaplasty and hood reduction during residency, and many women find themselves needing revision surgery because it was not done right the first time.

For more information about these procedures, please visit the link below.

I hope this information is helpful.


Dr. Troy Robbin Hailparn
Cosmetic Gynecology Center of San Antonio

Troy Hailparn, MD
San Antonio OB/GYN
5.0 out of 5 stars 33 reviews

Beneficial Procedures

Dear CN:

Thank you for your question as well as the picture.  Sometimes it is hard to definitively diagnose a patient using a single picture by itself. However  I will do my best using your request and the picture.  First of all you want the Barbie look ---  be careful many surgeon will over promise and under deliver.  In your situation it is going to be extremely difficult to accomplish this goal due to your starting anatomy.  Second - you really need to define "Barbie look"  -   I understand what most patients are looking for but you need to fully explain to your surgeon what you want to accomplish. For most patients that means you do NOT want to see the labia or the cltioris-----

So I would start off recommending what you are suggesting:  1) labiaplasty - by a linear contour; it sounds as though you are well informed and you probably already understand that you can not get rid of the dark edges with any type of wedge resection!! So don't let a so called expert talk you into one  2) clitoral hood lift - the hood can be shortened and lifted along with the clitoris ( make sure you choose a surgeon who knows what they are doing) --- the surgeon will need to resect the lateral prepuce in his attempt to lift the hood to get you the most streamline appearance 3) Perineoplasty - will only tighten the vaginal opening but this will not increase friction during intercourse by itself , you will most likely need a posterior repair/vaginoplasty to tighten the inside of your vagina too.  If you just want the cosmetic appearance of tightening the opening of the vagina then you can just have a perineoplasty, but I promise you this will not enhance friction with intercourse without performing a posterior repair with vaginoplasty (i.e. tightening)  4) Labia Majora - autologous fat transfer to plump the labia majora ( this is going to give you the best attempt at the Barbie look--- that is if you really do NOT want to see the minora and much of the clitoral hood.  This is the optical illusion approach -- with your anatomy a surgeon can not completely remove all the minora and cltioris without hurting you and if your want to minimize the visual appearance of the minora and clitoris the way to enhance this  would be to plump the majora to gently cover over the minora if possible.

Please choose a surgeon wisely.... save your money to get the best possible surgeon for the best possible results.  Choosing a cosmetic vaginal surgeon or any surgeon should be one of the most important decisions of your life. Failure to choose a surgeon with experience, expertise and one who achieves excellent results is not easy find. There are a lot of surgeons who think they are experts in the field but they don’t work on vaginas daily. Some surgeon have practices that allow them to operate and perform: breast augmentations, tummy tuck, butt lifts, hair transplant and then there are surgeons who dedicate their whole practice to vaginal reconstruction and cosmetic vaginal surgery. It is obvious which surgeon has more experience, expertise and better insight as to the a patients desires of their gynecologic area. Please don’t just choose a surgeon because they claims to be specialist in plastic surgery --- choose a surgeon who can prove to you they are specialists in your gynecologic area of concern.

John R Miklos MD
Urogynecologist and Cosmetic Vaginal Surgeon
Atlanta ~~ Beverly Hills ~~ Dubai

John R. Miklos, MD, FPMRS, FACS
Atlanta Urogynecologist
5.0 out of 5 stars 19 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.