What's wrong with my folds when I spread my legs a little? (Photo)

Question

It didn't used to look like this. The folds/lips used to be puffy and fatter, and now they're kind of deflated. And when I spread my legs there's this big crease and a gap and depression in the crease, as well as a textural change. It's not wet. Is there any way to fix it? I don't know if this is the right procedure subcategory.

Marco A. Pelosi III, MD, FACOG, FACS · Answer

The labia majora get their fullness from the fat beneath the skin. If you're lean or if you drop significant weight, this fat can shrink away creating the deflated appearance that bothers you. Fullness can be restored by injecting fat into the labia majora. The fat can be taken from your thighs or anywhere else. The procedure is painless and the recovery is very quick. I would recommend that you schedule a virtual consultation for complete info. Check out the video of the actual procedure.

Mehmet Bekir Sen, MD · Answer

Thank you for sharing your concerns. From your description and image, you are experiencing some changes in the labial area, specifically regarding volume loss and textural changes. This is not uncommon and can be a result of various factors including aging, hormonal changes, or significant weight fluctuations.
The condition you're describing, where the labia have lost their former fullness and appear deflated, can often be effectively treated with a procedure known as labial augmentation. This can be done either through autologous fat transfer, where fat is harvested from another area of your body (inner thigh) and injected into the labia to restore volume, or through the use of dermal fillers specifically designed for this sensitive area.
The crease and gap you mentioned, along with the textural change, can also be addressed during the same procedure. The goal would be to not only restore volume but also to improve the overall appearance and texture of the labial skin.
As for the dryness, this could be a separate issue related to hormonal changes, and there are treatments available for that as well, including topical hormonal, prp ,some special creams and non-hormonal therapies.
It's important to have a detailed consultation with a qualified surgeon who specializes in genital aesthetics. During the consultation, a thorough examination will be done, and the most appropriate treatment plan will be discussed based on your specific condition and desired outcome.
If you're considering proceeding with this treatment, I recommend looking for a surgeon who has extensive experience in genital aesthetic surgery. Patient comfort, safety, and achieving a natural-looking result should be the top priorities.
Feel free to reach out if you have any more questions or would like to schedule a consultation.
Best regards,
Dr. Mehmet Bekir SENGenital Aesthetic Surgeon

Gary J. Alter, MD · Answer

Many women with sagging or wrinkling of the majora have stretching of skin and normal fat. In that case, the skin only can be removed. If the skin only is saggy due to fat loss, then only fat can be injected. However, over-injection can cause a large bulge in the genitalia, which can be unsightly. If skin is excessive and fat is diminished, then skin can be excised and fat injected at the same time. If you only have slight wrinkling, then a laser can tighten the skin. If your labia majora skin and fat are excessive, then skin and fat can be excised to make them smaller and less protruding. The skin excision technique I pioneered leaves a scar on the inside of the majora in the concavity between the majora and the minor and clitoral hood. I have published and lectured extensively on this procedure in textbooks and throughout the world. Many physicians are not comfortable or trained in this procedure resulting in poorly placed scars, asymmetry, and poor results. You need to have the surgeon show photos of his past patients.

Dr. Gary Alter

Beverly Hills, CA - Manhattan, NY

Dr. Gary Alter

Beverly Hills, CA - Manhattan, NY

Burcak Tok, MD · Answer

Hello, it is the decrease in the fat tissue in the big lips due to age and weight loss, and there may be sagging. The best solution to fix this is to fill with oil or HA.

Mona Hardas, MD · Answer

Looking at your picture looks like you have some laxity of the skin of your outer labia or labia majora. Excessive weight loss or some times hormone changes as well as aging can decrease the collagen and elastic tissue in the labia giving it a saggy appearance . It can lead to the extra folds in the outer labia. This can be treated very easily either with labia fat transfer or with combination of PRP ( platelet rich plasma ) with HA fillers ( hyaluronic acid filler) . Both the procedures are associated with great patient satisfaction. Please contact us for more information nd we can discuss this in details.

Michael A. Reed, MD · Answer

Just like you, many other women in the world, don’t look like they used to …what you’re asking for is simply knowledge and choice.

Here is the knowledge, you are beginning to experience laxity of your vulvar skin. That means the the tissues have become more stretchy while at the same time losing structure and tone.  Simply put you’re aging…loss of collagen and elastin leads to laxity.

Laxity of the vulvar structures can lead to bulging in tight fitting clothing, chafing, ill fitting underwear, swim suits, or even the need to  rearrange before intercourse.

How to regain your freedom?

Here are the choices: you can live in your skin as it is, which is totally “cool” choice or you may consider another option, like:

a non-surgical treatment called “Vampire Wing Lift” This process uses your own blood to obtain  PRP (platelet rich plasma)and combines it with hyaluronic acid fillers. This treatment will result in natural filling of the deflated vulvar structures. 
ThermiVa or ThermiSmooth- this is also a nonsurgical option that uses radio frequency waves to SHRINK deflating tissues of the vulva. 
I prefer to combine these two modalities of treatments (1&2) resulting in synergy by plumping up the tissues from underneath while at the same tightening the skin from above. One important caveat, these non-surgical options are temporary and usually last 9-12 months. 
Surgical options- labia majoraplasty or “Tummy tuck of the vulva” this procedure is designed to remove the lax skin of the outer larger lips and create a flatter, taut, more youthful appearance. 
Lastly, fat transfer or labia puffing can be used to plump the area back up using one’s own fat by grafting fat from one area of the body and placing it in the labia majora to restore volume.

There it is-Knowledge & Choice! Before you stop reading, I ask that you empower another woman with the knowledge by sharing what you have learned in this space. Once a person has knowledge, they have choice… ultimately leading to EMPOWERMENT! Best of luck! 
Dr Michael Reed aka @thecosmeticgyn Davis, CA

Michael P. Goodman, MD, FACOG · Answer

Are you speaking of your outer lips, the "labia majora? As you age, or with weight loss, the majora can become redundant and "sag." I have developed a new minimally invasive surgical procedure, "Labia Majora Lift," designed to reduce "ptosis" (sag) of the labia majora. If the redundancy of your majora is bothersome to you, this may (relatively inexpensively) do the trick. Or, you could have a filler or nanofat replaced in the majora, but that is not permanent & would need to be repeated periodically. In any case, I see nothing abnormal about your anatomy, but recognize that the change can be disconcerting, and that you may wish to do something about it...

Very best,

Michael P Goodman, MD, FACOG, IF, AAACS
Sacramento, CA, USA

Very best,

Michael P Goodman, MD, FACOG, IF, AAACS
Sacramento, CA, USA

What's wrong with my folds when I spread my legs a little? (Photo)

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