Would labiaplasty fix all that is going on or do I need multiple procedures?

I had a horrible episotmy with my 1st child, the doctor is honestly known as "the butcher". Cut down to annus. The loose skin on rectum was looked at by a specialist and it's not hemorrhoids. He said he could remove it but that it would be very painful and unnecessary. It tears, bleeds, & is unsightly as well. I want to end up with Way less folds of skin, as well as the outer labia being tighter so they aren't deflated. Is that a reduction of skin or would fat be injected?

Doctor Answers 7

A perineoplasty plus labiaplasty should help

Labiaplasty is often associated with reducing the inner labia, but certainly the outer labia could be enhanced with fat grafting for a more sensual look. As for the excess skin, perineoplasty can restore a smooth look to your outer perineal area so you feel more comfortable and confident. While a perineoplasty may repair an undesireable episiotomy scar and/or lengthen the perineal body (distance from the vagina to the anus) and decrease the size of the vaginal introitus (opening), it will not "tighten" the vagina. For this you may need a vaginoplasty. For the best results, take the time to look for a board certified plastic surgeon who specializes in genital rejuvenation procedures and who will take the time to talk with you about your options and what you can expect after your surgery.

Chicago Plastic Surgeon
4.9 out of 5 stars 72 reviews

Will I need multiple procedures for genital reconstruction?

I reviewed your photos.  You would benefit from labia minora and skin only labia majora reductions. You also need a perineoplasty and possible vaginal tightening.  For your anal area, you need a colorectal surgeon to give a more attractive appearance.  All these procedures can be performed at the same time.  

A labiaplasty with a clitoral hood reduction will 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. If you have extra tissue on your clitoral hood, it can be reduced it 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 decreased.

Your labia majora have stretched which resulted in excess skin. In addition, they probably have lost some fullness. I suggest reducing the excess skin and maybe increasing the fullness with fat injections if there is a fat deficiency. The technique I use leaves a scar on the inside of the majora in the fold between the majora and the minor and clitoral hood.

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, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 20 reviews

Labiaplasty fix all this?

Because you have a very delicate situation with an extremely delicate area, it is not really fair to give much advice without an in person consultation and physical exam. That being said, surgical options do exist to improve your problem(s). A combination of labiaplasty, hoodectomy, vaginoplasty, perineoplasty, and/or the equivalent of external hernia excision may be necessary. Glad to help. 

Ryan Stanton, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 101 reviews

Labiaplasty, perineoplasty questions

Sorry to hear about your experience with the episiotomy. The photographs you provide are helpful but an in-person examination will give you the best answers.  It appears you may need a perineoplasty and, based on your concerns, that you could also benefit from a labia majora reduction.  Sometimes it takes a complete reconstruction with labia majora , labia minora and perineoplasty to achive a patient's goals. Make sure to consult with a board-certified plastic surgeon or gynecologist who has expertise in perineoplasty and labia majora/minora plasty.   That in-person consultation is invaluable and should be your first step. Best wishes.

Below is a patient who had labiaplasty and perineoplasty simultaneously. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 29 reviews

Labiaplasty | Vaginoplasty | Perineoplasty

Thank you for your question and pictures.

You will need an in-person consultation to sort out what might be best for you, likely some combination of labiaplasty, vaginoplasty or perineoplasty

To be sure, see two or more experienced, licensed and certified providers for a complete evaluation to make sure you are a good candidate and that it is safe for you to have the procedures.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 142 reviews

Complex repair of perineum and labia

.Hello Friend from Santa Barbara,

Thank for for providing good-quality photos that give me a decent idea of the "lay of your land" and what you wish to accomplish.

Both before and after babies, women present iin a wonderful array of shapes, sizes and appearances, and it is all "...normal."  However, I can see where your individual anatomy might be bothersome to you.

Exactly what to do depends both on what specifically YOU wish to accomplish, the anatomy, and the skill, experience, and instrumentation of your surgeon. Although i am located in Davis, near Sacramento, I operate on many women from the SF Bay area, L.A. area, and Central valley, so I see many women "virtually" for a first appointment, either via telephone or Skype. As we consult, I look at several selected photos that show all the areas that are problematical, to decide beforehand approximately what will be done both for discussing, scheduling, and pricing purposes.

So, what about YOU, specifically?  First off, and most importantly, since your anatomy and desires are highly individual and not just "...a simple labiaplasty, you would be best served by going to an experienced genital plastic/cosmetic surgeon who has done many cases and can show you many "before and after" photos of combined complex perineoplasty/labiaplasty combinations.  Again, pending an in-person exam, my recommendations would revolve around exactly what is bothering you,  If the redundancy of your outer lips, the labia majora, bothers you, a well-done vertical reduction would remove the redundancy. I would reduce the redundant skin below the vaginal opening with a cosmetic perineoplasty going down all the way to the anal verge, removing the anterior hemorrhoidal tag at the bottom (although that is the area that will bother you most during healing...).  The bases of the labia minora (called the "posterior commisure") would be reduced most likely in a linear fashion, but I would withhold judgement on technique pending evaluation.

Most importantly: yours is a complex situation-- best handled by a surgeon who is well experienced in complex, combined procedures and who has done many and has either a laser or radiofrequency needle at his or her disposal so as to be able to "scroll" as indicated around the perineal redundancies.

Very best wishes!

Michael P Goodman MD

Aesthetic Repair of Vaginal Distortions, Skin Tags, Deflated Labia after Episiotomy

After a "bad" episiotomy, the corrections needed to restore a normal appearance may include a variety of procedures. An episiotomy that winds up extending into the anus is more common in women who have a short perineum to begin with and in women who deliver a large baby. If you have a short perinuem, the cosmetic correction will most likely require a perineoplasty at the very least to reduce any skin tags and rebuild the perineum into a longer, thicker configuration. If you delivered a large baby, there may be loosening of the vaginal muscles and pelvic supports that might require a colpoperineoplasty (a full vaginoplasty) as well as pelvic floor reconstructive surgery. The outer labia can be effectively tightened with fat injections if you undergo a perineoplasty at the same time. Without perineoplasty, the labia might require too much fat to tighten them up and might appear unnaturally full.

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.