35 y/o unhappy with labiaplasty results - which type of revision procedure is best for me?

Question

I’m 35, I had my inner labia reduced but the look is still sloppy and loose… what procedure is best for me?

Jennifer Adams, MD · Answer

Hello there,
Thank you for your question.If the labia majora are now a concern, you can either tighten the skin (radiofrequency), give the area more volume (fat transfer, filler and/or PRP), or resect the excess tissue (labia majoraplasty).
Hope that helps!Sincerely,Jennifer AdamsMD, FRCSC

Gary J. Alter, MD · Answer

I wonder if you had significant weight loss as it appears that your pubic area may have descended and drooped, which may be causing you genitalia to be redundant and excessive. You may need a pubic lift to elevate your pubic skin which would elevate your genitalia and make it look more youthful.

Your labia have been reduced, but they are still redundant. That can also be reduced by doing a wedge labiaplasty, which I invented in 1995 and published in the plastic surgery textbooks.  Another trim would not help the tortuous folding of your labia.  It is also known as the "V" or wedge technique. Your clitoral hood is also long, wide, thick, and protuberant. Since you have extra tissue on your clitoral hood, it can be reduced at the same time.  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. With this procedure, I lift up the clitoral hood skin, move the clitoris closer to the pubic bone, thin the tissues under the clitoral hood skin, and then remove a large amount of excess skin. This results in a dramatic decrease in the length, thickness, and protuberance of the clitoral hood, so that the hood is now within the labia majora when the woman stands. I have performed this procedure over 300 times with outstanding results.   I have not published this technique, so no one does it like me.​

​Your labia majora are stretched, redundant, and folded. I suggest reducing the excess skin and possibly increasing the fullness with fat injections. The technique I popularized and published in the medical literature  leaves a scar on the inside of the majora in the fold between the majora and the minora and clitoral hood. If closed with sutures under the skin and performed meticulously, the scars are difficult to see.

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.​​ Approximately 40% of the female genital surgeries that I perform are reconstructions of other women's botched labiaplasties and hood reductions.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NYC

Leila Kasrai, MD, FRCSC · Answer

If you are unhappy with your results, you may consider further reduction of the labia minora to “smooth is down”. Fat transfer to the labia majora may also be considered to plump up the outer lips so that they have a smoother contour. Please discuss with your surgeon.

Mark N. Scheinberg, MD · Answer

THANK YOU FOR YPOUR QUESTIONThe "sloppy and loose" appearance in Your photo shows is predominately the outer labia called majora.There is also excess skin on the hood and prepuce( the skin above and to the sides of the clitoris) and the inner labia are irregular. If you want to optimally improve the appearance you could get a labia majoraplasty, reduction of prepuce with hoodoplasty and revision of labia minora.You really need to find someone who is well trained as well as experienced. Look at several before and after photos to see quality of work and look at their reviews. Do your homework to avoid problems.

Oscar A. Aguirre, MD, FPMRS · Answer

Hello Furth01,
You're right, your vulva appears untidy and older looking. You needed more than just a labiaplasty. Your hood is large and drooping and your labia majora is very lax and deflated.
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,

Steve Laverson, MD, FACS · Answer

Your descriptive observation of a "sloppy and loose" appearance suggests that your preference is for a more smooth and snug skin surface over labial structures.  Both labia majora and labia minora should be considered for adjustment to create the look you want.

Michael P. Goodman, MD, FACOG · Answer

…Some confusion here: the “heading” is “labia majora reduction,” but you speak of “inner labia,” which are minora… As it turns out though, looking at your photo, you “needed” both, but your surgeon only performed a conservative linear minoraplasty, doing nothing about the majora, which in your case are quite “redundant and “ptotic” (“…saggy”). That said, I can give you and other readers general advice, and give you specific advice. Your concern about still feeling “sloppy and loose” is common when a labiaplasty is performed by a surgeon only technically capable of a linear/trim procedure, who does a trim on a woman upon whom (s)he perhaps should have done a wedge. This is why it is so important for women seeking LP to make sure that her surgeon can prove that (s)he is savvy in BOTH trims & wedges (look for a lot of B&A photos of both procedures on their websites.) Here’s why: (This is one of the important elements I teach in my training courses: deciding whether to perform a trim or wedge on a given patient…) While linears are easier to recover from, if you have “stretchy” skin and/or a lot of “sag;” long, “droopy” labia, a linear/trim technique has the risk of leaving you still “droopy” and appearing “open.” For anatomy such as this, wedges will “tighten;” they will “pull up” and “curtain” the vaginal opening, leaving your labia with a considerably more aesthetic appearance. FOR YOU, and so many other women with your anatomy: large, “droopy” minora and redundant/ptotic majora, I have developed a new unified, single incision-line procedure, called the “Angel-Wing Combined Labia Minoraplasty/Majoraplasty,” the description of which will be soon published in the Aesthetic Surgery Journal,  RealSelf’s web reference below includes many linear and wedge "before & afters," including an Angel-Wing or 2, and the video talks about the difference between linears and wedges. Also, keep in mind that you may need to “travel” out of your area to get the results you wish. Unequivocally, in my opinion, an “Angel-Wing” will give your anatomy the look you desire. Cheers! Michael P Goodman, MD, FACOG, IF, AAACS. Primary and Revision Labiaplasty Specialist, Sacramento and Davis, Northern CA, USA

35 y/o unhappy with labiaplasty results - which type of revision procedure is best for me?

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35 y/o unhappy with labiaplasty results - which type of revision procedure is best for me?

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