1 year 1/2 post surgery. What is causing persisting pain? Is revision possible and does it help in this case?

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. Your left labium was removed and the right is almost completely removed. 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" about eight years ago. Your pain is almost certainly due to the scar tissue from the surgery. Fortunately, you have adequate clitoral hood to reconstruct your labia minora with clitoral hood flaps, which I invented and published in that journal article. In this surgery. I take the remaining tissue of your clitoral hood and transfer it downward to create labia minora. Removing the scar and tender area and replacing it with normal tissue from the clitoral hood will probably eliminate or markedly improve your pain. I have done this surgery about 60 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 only get one good chance to reconstruct you, so be patient and ask a lot of questions. I am sorry but I have not trained any other surgeons in Europe to do this surgery, which is definitely your best option.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NYC -
Assistant Clinical Professor of Plastic Surgery
UCLA School of Medicine

Thank you for sharing your question and photograph. You had either complete or near complete amputation of your labia minora with poor contouring into your clitoral hood and frenulum regions. Although little options at reconstruction exist you may be able to improve upon your nerve pain but an appropriate examination of your tissues to localize the pain will need to be done. Seek out consultations with experts in your area to get the best advice.

...I'll do my best to help, but really, you will need a more formal evaluation and consultation, either in-person or "virtually" with an experienced revision specialist. I am aware that this is difficult from Albania, but there are 2 excellent female genital plastic/cosmetic surgeons nearby in Poland, Dr. Dawid Serafin, and Dr. Rafal Kuzlik. Either of them could evaluate you and treat you as an individual if you were unable to make a WhatsApp or Zoom or Skype consultation with a revision specialist such as myself, in the U.S.A. Yes, a revision is definitely possible, but it is extremely important that you see only a surgeon who can show you many photos to prove that (s)he is experienced in various techniques (wedge and linear-- both!!) so that he or she can use the best techniques for your anatomy. In regards to your pain, this is most likely neurogenic, secondary to nerve irritation when too much tissue is removed and scarring irritates the nerve(s) in the area. Personally, I have had great success by working with a local compounding pharmacist, using a neuroleptic like gabapentin (in a proper strength), and adding in a muscle relaxant like diazepam and frequently an anesthetic like lidocaine. Sometimes I also also in estradiol and/or testosterone depending on the situation. This is the "art" of genital plastics. Compounding is an "art" that can greatly improve your pain while you are deciding about a revision. ... Unë do të bëj çmos për të ndihmuar, por me të vërtetë, do t'ju duhet një vlerësim dhe konsultim më zyrtar, qoftë personalisht ose "virtualisht" me një specialist të revizionit me përvojë. Unë jam i vetëdijshëm se kjo është e vështirë nga Shqipëria, por ka 2 kirurgë të shkëlqyeshëm plastikë / kozmetikë gjenitale femra afër Polonisë, Dr. Dawid Serafin, dhe Dr. Rafal Kuzlik. Secili prej tyre mund t'ju vlerësojë dhe t'ju trajtojë si një individ nëse nuk keni qenë në gjendje të bëni një konsultë WhatsApp ose Zoom ose Skype me një specialist të rishikimit, siç jam unë, në SH.B.A. Po, një rishikim është padyshim i mundur, por është jashtëzakonisht e rëndësishme që të shihni vetëm një kirurg i cili mund t'ju tregojë shumë fotografi për të provuar se ai / ajo është me përvojë në teknika të ndryshme (pykë dhe lineare - të dy !!) në mënyrë që ai ose ajo mund të përdorë teknikat më të mira për anatominë tuaj. Në lidhje me dhimbjen tuaj, kjo ka shumë të ngjarë neurogjene, dytësore ndaj acarimit nervor kur hiqet shumë ind dhe dhëmbëzat irritojnë nervin (et) në zonë. Personalisht, unë kam pasur një sukses të madh duke punuar me një farmacist lokal të përzierjes, duke përdorur një neuroleptik si gabapentin (në një forcë të duhur) dhe duke shtuar një relaksues të muskujve si diazepam dhe shpesh një anestetik si lidocain. Ndonjëherë unë gjithashtu në estradiol dhe / ose testosteron në varësi të situatës. Ky është "arti" i plastikës gjenitale. Përzierja është një "art" që mund të përmirësojë shumë dhimbjen tuaj ndërsa vendosni për një rishikim.Regards, Michael P Goodman, MD, FACOG, IF, AAACS Davis, CA, USA.