I had a labiaplasty, wedge technique, 3 weeks ago, on one side. Was too much skin taken out? (Photo)

It seems as though the labia minors is now attached to the labia majora, in that if I pull it open, it pulls with it, as if there's a thread running beneath the skin, and actually creates a tiny puckered hole, on the very inside, where the sutures started. I'm also unhappy with the puckering and pleating. Is this going to resolve itself into one lip? The whole thing feels too tight. Is this a normal result? If not, what can be done? Thanks

Doctor Answers 10

Wedge technique - not standard

Dear TigerWillow:

thanks for sharing the pictures as well as the question. You will help others from repeating what has been done.  It appears you have had a wedge resection but it is not even a "standard wedge"  . Wedge resection procedures should be performed  through the labia minora only.  If it is an extended wedge ( i.e. with a hockey stick shape) the wedge has an extension anteriorly ( i.e. upwards and lateral towards the clitoral hood). You have neither of these procedures  

I have revised many labiaplasties in my career and I have not seen anything quite like your before. It appear he took a deep cut ( i.e. wedge through the labia minora) lateral prepuce, prepuce and the incision extends into the labia majora.  It is a little difficult to determine as the anatomy is all pulled together and I can not compare to the opposite side because your fingers on that side.  

It appears you only had a unilateral wedge resection and Though I perform both wedge resections and linear contouring -   I would rarely recommend a wedge resection if it is a one sided procedure.  Why?  because the goal of the reconstructive vaginal surgeon is to restore symmetry and to attain aesthetics for his/her patient.  It is too hard to achieve usually with a unilateral wedge...........especially this type of wedge resection.  

Based upon my experience you will get some relaxation overall to the area which has had surgery but the puckering and the scar  the actual incision line most likely will stay.  The scar does not relax over time if fact in the next 6 weeks the scar itself will most likely get firmer.  Now I might be wrong but i have revised dozens of labiaplasties including labia majora labiaplasties,

The best thing to do is allow it to heal and do not allow anyone to touch this area for at least 4 months.  When one is considering revision of the labia minora it is OK to operate sooner say at 3 month i.e. 12 weeks as the labia minora tissue is not as thick and is different than the labia majora area. Labia majora tissue scars more aggressively than minora and takes longer to heal.   Lets sit back and let nature take its course and  perhaps it will loosen up where you are comfortable with the feeling and look

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

Unusual procedure

is what you describe as I can't imagine any knowledgeable surgeon extending an excision through the sulcus/reflection between the majora and minora unless you had some very extenuating circumstances.  The majora is dealt with a completely different approach - nothing horizontal.  As for trying to achieve symmetry, by this time you have healed adequately to get a good idea if excessive tissue was removed... and in my opinion, you are going to be smaller on the right side and stuck to the majora.  If you are not, excellent.  If you are, then your surgeon has an obligation to help you achieve what you desired because what you had is very unorthodox.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

I had a right-sided wedge labiaplasty. Was too much skin taken off?

Thank you for your question but it is a little difficult for us to comment on what the final look will be. For one, it is still in the early phase of the recovery and second the pictures are not from the best angles.

I would certainly keep in close contact with your surgeon or seek a second opinion after 4 to 6 months

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I had a right-sided wedge labiaplasty. Was too much skin taken off?

Dear Tigerwillow,

Thank you for your question and photos.  It is actually hard to tell in terms of is it symmetrical with the other side because your fingers are holding back/hiding the left labia for comparison, but it appears that your left side is larger than your right at this point in time.  Usually wedges are done on both sides at the same time as the goal of cosmetic surgery is to maintain symmetry.

In terms of the suture line  going onto the labia majora, that is not a common technique but the end result is more important than where the scars are.  At this point in the healing process, the incisions do feel tighter as the collagen is forming to put the edges back together under the skin.  I recommend to my patients to start using anti-scarring cream like Mederma or Biodermis, vitamin E oil or Emu oil can help with the healing process at 2 weeks after surgery, as long as there are no raw areas.  It takes about 3 months until your final results will be apparent so be patient and hopefully you will be happy with your results. 

If you are not, be sure to research cosmetic gynecologists or uro-gynecologists with extensive experience performing labiaplasties and their complications.  For more information about labiaplasty, please visit the link below.

I hope this information is helpful.

Sincerely,

Dr. Troy Robbin Hailparn
Cosmetic Gynecology Center of San Antonio

Troy Hailparn, MD
San Antonio OB/GYN
5.0 out of 5 stars 25 reviews

Was too much skin taken out?

Thank you for sharing your questions and photographs.  It appears that your wedge labiaplasty extended into the tissues of your labia majora.  This has caused the current appearance of your scar.  This is not the typical correction used for excessive labial tissue as most wedge techniques will stop before the interlabial groove on the side of the labia or have some extension towards your clitoris to address the hood.  The unilateral approach as also left you with a significant asymmetry between your two sides.  Though your incision line puckering and pleating will improve with time, allow your results to fully heal over the next several months to assess your appearance and determine the need for a revision.  Best wishes.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Unilateral (one-sided) labiaplasty: when will I know final results?

Let me try and insert some common sense into this firestorm of "expert commentary." The issue should not be whether you had a procedure performed exactly the way this or that "expert" would do it. Rather, it is how the final outcome will be, and how this relates to you personally.

I have performed approximately 400 wedge variation LPs and ~ 300 linear variation LPs. Each woman's anatomy and post-op desires vary. Good results may be obtained with linear; good results may be obtained with V-wedge for unilateral LP, depending on the anatomy of the other labum the surgeon is trying to match. It is my belief that each surgery should be individually designed depending on anatomy, patient's desires, and surgeon's training and familiarity with different procedures. I agree that it is not "usual" for the wedge incision to extend through to the labum majus, but I have done this occasionally to take up redundancy of the majus if needed.

That said, and most importantly: What About YOU?! Incisions heal initially by fibrosis under the skin, knitting tissue tightly. It takes ~ 3 months for this fibrosis to relax, and for you to appreciate the final results. Additionally, the last thing to heal in a V-Wedge in that portion of the incision inside the vagina; it is not rare to have a small opening which eventually "fills in" quite nicely. My advice, for what it is worth, is to do your best to just let it be, not tug on it, and wait until 3-4 months to evaluate the results. Success is appearance approximating the other side (it's virtually impossible to get it "exact") Additionally, it is not rare to have a subtle "groove" at the area of anastomosis. This will not effect how it "feels" or the final overall outcome, unless you feel the need to frequently "inspect" it, which will, will only produce distress. 

Best wishes to you for an outcome that you are comfortable with. I urge you to not stress right now: let it heal!

3 weeks ago labiaplasty

Hi and thanks for submitting your pictures. 

It seems like you had a unilateral wedge resection, and I don't usually recommend this for my patients, as you will likely not be able to achieve symmetry with a one sided approach. 

I would still give it some time to heal and see if the results are satisfactory to you, however, if not, you will need to consider a revision surgery. Many of the revisions I have performed are because either poor surgical technique was used or symmetry was not achieved to the patents desire. 

Hope this helps and keep us posted!

Kurian Thott, MD
Fredericksburg OB/GYN

Tight groovy scar 3 weeks after wedge labiaplasty

At 3 weeks, residual swelling might be contributing to the tightness that you feel. The same for groove-like contour along the scar. I would recommend highly that you stop pulling on the scar. If it is under tension it is likely to rip apart with the extra tension of any pulling motion. There is no way to tell how wide the wedge was without a before photo, but the clitoral hood is clearly under tension and pulled and splayed to an abnormal lateral position along it's inferior borders. The technique was crudely forced on the anatomy rather than altered to fit the anatomy as evidenced by the extension of the scar onto the majora.

Unilateral labiaplasty

Hi. 3 weeks is very early post operatively and it will settle down - the hardness and tightness will resolve but can take a few months. It's not clear why you only had the one side done - at the very least, if this was to achieve better symmetry, it does not seem to have checked that box at all. I suggest waiting a full 6 months and then review - you may require an adjustment of some sort of the right (perhaps a Z-plasty), and perhaps a conservative wedge by a board certified plastic surgeon to the left.

Paul Jason Skoll, MBChB, FRCS, FCS (SA) Plast
South Africa Plastic Surgeon
4.8 out of 5 stars 13 reviews

Time and patience

It looks like you had a standard wedge technique, which is not quite the correct way to do it. The extended wedge is the right approach, because that helps to reduce some of the extra folds of tissue on the sides. Things will relax and hopefully enough that it won't bother you or require a revision. If you watch the video you'll see the difference in the hockey stick wedge that I perform, versus the pizza type wedge you had done. It also may be more of a contrast because you only had the surgery performed on one side, which is atypical. Even when there is asymmetry, a bilateral (both sides) procedure is usually indicated. Best of luck in your recovery.

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.