What procedures do you recommend for labia minor reduction, clitoral hood reduction and skin lightening?

Hello and thank you for submitting your photos. 
You seem to be a perfectly suitable candidate for Labiaplasty and conservative reduction of the clitoral hood. You are suitable for a "central wedge resection " and for "linear trim".  
I would perhaps prefer the "wedge" technique in your case, mainly because of the thickness of the tissue to be excised. 
With regards to the pigmentation issue, I would address this quite carefully, as I do not think that a conservative labiaplasty would get rid of the pigment- entirely.  On the other hand, you would't want your surgeon to carry out an over-resection (excessively generous resection) of the labia in order to solve the pigment issue.  Over-resection of the vaginal lips can have serious functional consequences that may be very difficult to solve and could negatively impair your quality of life. 
You may consider additional laser treatments, or gentle chemical peels to address the hyper-pigmentation, once you are fully healed and recovered from surgery. 
Safety comes first - always!

Best wishes 
Linda Fiumara 

 

Dear Donna332,Thank you for writing in with your excellent question and for sharing your phots.The first question back to you is what do you want to change about the appearance of your vagina aside from the pigmentation?Yes you are a candidate for a labia minora reduction which will reduce the length of your minora to be within your labia majora.  Most of the pigmentation can be removed but there will be a little left.  This will greatly improve the look of your vulva if that is what you want to achieve.  Women have various degrees of pigmentation of the vulva and this is due to hormonal shifts over time.  Puberty, pregnancy and peri-menopause are all times where increases in body pigmentation can occur due to stimulated melanin production.  There is no guarantee that pigmentation of the smaller edges left behind won't reoccur over time, but the edges will be much less visible.There are topical creams that can help reduce the pigmentation but they have to be used on a regular basis to maintain.As has been mentioned, it is important to do your homework to find the right surgeon for you.  Look for a cosmetic-plastic gynecologist who has done hundreds of labiaplasties and hood reductions.  Ask to see lots of before and after pictures, read reviews, ask how they address complications when they occur and their accessibility after surgery.  It is recommended to get more than one opinion before committing to surgery.  I am offering phone consults for no charge during these COVID times.  Call my office if you would like to set one up.To learn more about labiaplasty, please visit the link below.I hope this information is helpful.Sincerely,Troy R. Hailparn, M.D., FACOG, FAACSCosmetic Gynecology Center of San Antonio

I reviewed your photos. Your labia minora 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. 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. The sides of your clitoral hood are reduced during the wedge excision. If you wish to further the reduction of your clitoris as it is difficult to tell if it is very  protuberant, I pioneered a clitoropexy with clitoral hood reduction. In this procedure,  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 300 times with excellent results.  I have not published this technique, so no one does it like me.   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.
Gary J. Alter, M.D.Beverly Hills, CA - Manhattan, NY - Dubai, UAE

An experienced board certified plastic surgeon who routinely performs vaginal rejuvenation and enhancement procedures, or a gynecologist or urogynecologist with an interest in such, would be able to advise you specifically. Based you your photos alone, it appears that you would be an excellent candidate for, at the very least, a labia minor reduction. Whether or not a clitoral hood reduction would be indicated can only be determined with a physical examination. Interestingly, for the patients in whom we have performed clitoral hood reduction, a significant number have reported significant improved or enhanced sensation. Vaginal tightening can be accomplished both non surgically for minor degrees of looseness, and surgically for more significant laxity. Non-surgical can be either via radio frequency devices, or with light based devices (laser). 
With regard to the pigmentation, your photos do not demonstrate anything unusual and I'm not sure I would recommend pursuing to improve this. Best of luck to you.   

Allow me to answer your question as best i can based upon your photos. However, please keep in mind that an in-person consultation with physical exam is first necessary before any legitimate analysis or final surgical recommendations can be made. Nonetheless your story and concerns are in good company with almost ever other patient that undergoes labiaplasty and/or clitoral hood reduction (aka hoodectomy). Based upon your photos, your anatomy is not only within the wide range of normal but, at the same time, very typical of someone who seriously considers having these procedures and experiences a major boost in (sexual) self-confidence and pleasure thereafter. I would strongly recommend you visit not just any plastic surgeon (or gynecologist) but one whom is a reputable labiaplasty specialist to confirm all the above. This surgery is probably the number one botched surgery by many inexperienced novice surgeons thinking the procedure is so easy they can just do it without much training or skill. By the way, the Trim technique Labiaplasty will likely reduce the need for any skin lighting because it is best at removing the darker pigmented edges of the labia. Glad to be of help.

Hello. Thank you for submitting photos with your questions. Based on your photos I would recommend labiaplasty to reduce their size. Most ladies having labiaplasty need a clitoral hood reduction at the same time and you very well might but need an in person exam to confirm. The labiaplasty procedure will significantly lighten the area but a whitening cream can be used to gently light any areas of darkness that may remain following the procedure. Best wishes 
~Dr Poucher

Thank you for sharing your question and photographs. There are a variety of options available to improve the aesthetics, but it will depend on having a thorough discussion of your goals.  I would recommend a clitoral hood/frenulum reduction with a labiaplasty through a trim technique in order to address most of your concerns.  Hope this helps.

You need to explain yourself better or you're going to be severely disappointed even if the work is done perfectly.What I like or dislike means nothing. I don't really know what you find pleasing or displeasing about your vagina or why. I I asked 10 different people what they thought about your vagina, I would get 10 different answers. Some would love your current appearance and find it pleasing.I will take a wild guess that you don't like the length and the color of your labia minora. Reducing the length would require a labiaplasty and a little bit of contouring along the clitoral hood. The dark skin would be removed as side effect of doing this. This is expert level work, but the most important part of the process is figuring out what you really want.Even though an in person exam is best, many experts, myself included offer virtual consults to discuss these important issues in detail just by asking when you reach out via RealSelf. I won't ask you to put your vagina on FaceTime. It's just a conversation by phone or a screenshare on Zoom.

Hello Donna332,Thank you for sharing your photos which show long, dark labia minora and a large droopy clitoral hood which give you an aged appearance. You are a great candidate for labia minora reduction and clitoral hood reduction with clitoropexy. This combination of procedures is essential in making your genitalia less dark and more youthful and attractive.   Keep doing your research and be sure to find an expert cosmetic vaginal surgeon. Be sure to review photo galleries and reviews to help you decide the best surgeon for you. You may need to travel depending on the part of the country that you live in.Best of luck,Oscar A. Aguirre, MD, FPMRSUrogynecologist & Cosmetic Vaginal SurgeonDenver, CO - USA

Thank you for your query and your good-quality photos. Personally, I have performed ~ 800 labiaplasties, ~ 1/2 by curvilinear, and ~ 1/2 by wedge-type procedure. With your anatomy and aesthetic desires, you would be a candidate for either, depending on your specific outcome desires and recovery realities. Regarding color lightening, it is easy to say this would be accomplished with a linear procedure, but it is important for your labiaplasty surgeon to individually design a procedure for you personally, and with your darkened color blending so deeply on both your inner and outer surfaces, while with either a wedge or linear you will lighten color modestly, you cannot get it "pink" without an "amputation," which would be an unfortunate outcome, so take care about just whom you choose to perform your procedure. A hood reduction can be performed at the same time with either procedure so as to "sculpt" your resulting labia minora into more pleasing anatomy for you. This all has to do with individual design, not "cookie-cutter" technique, so I would urge you to make sure that your surgeon specializes in labiaplasty, as evidenced by special pages on their site describing LP, and at least 2 dozen minimum "before and after" photos and.or definitive evidence about their training in aesthetic LP. By the way, even "Board Certified" general Gynecologists, who may offer to do your surgery "under insurance" get absolutely no training in this cosmetic procedure in their training programs, unless they can prove to you that they have attended either mine, or Drs. Pelosi, Alinsod, Hailparn, Matlock, Bader or ECAMS' female genital plastic surgery training programs.RealSelf's web reference below gives you useful information about cosmetic labiaplasty, and an array of B&A photos. Very best wishes in your choice and surgery,Michael P Goodman, MDDavis, Northern CA, USA