What are realistic labiaplasty and CHR expectations? (Photos)

Question

I am getting a labiaplasty soon and am wanting to know how much of a tucked in/ smooth look i could get with a labiaplasty and chr given my anatomy and whether a wedge or trim would suit my anatomy best. I have smaller labia majora, and am getting the surgery due to discomfort for the most part but want it to look smaller and tucked in.

Gary J. Alter, MD · Answer

Your labia minora and clitoral hood are very enlarged.  I am the inventor of the central wedge technique, in which I remove triangles of tissue and bring the normal edges together.  It is also known as the "V" or wedge technique. Thus, the normal labial edges, normal color, and normal anatomy are preserved, but the darkest labial tissue is usually removed.  Since you have extra tissue on your clitoral hood, I can reduce it at the same time using various techniques.  I have been featured performing this operation on Dr. 90210 on the E! Channel as well as on multiple other television shows.   I travel and lecture all over the world on my techniques and am published in most plastic surgical textbooks.  I invented the surgery in 1995 and reported the seminal article in the plastic surgery literature.

FYI:  Gynecologists and most plastic surgeons perform a labiaplasty 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.  This technique often results in scallops, asymmetry, an unnatural edge, hanging frenula, and over-resection. In contrast, I remove 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.   My technique is performed with magnification to ensure an accurate approximation of the normal labial edges, whereas the other technique often takes 15-30 minutes and results in a linear scar as the labial edge.  That scar can cause chronic discomfort and aesthetic disfigurement.

The clitoral hood is the skin above the labia minora and the skin that overlies the head of the clitoris. The type of hood reduction depends on the patients anatomy and desires. I routinely remove the sides of the clitoral hood with a labia minora reduction if there is excess tissue. However, this would not be adequate for you to achieve your desired result.  You have a very large, protuberant, long, wide clitoral hood. I invented a procedure called a clitoropexy with a clitoral hood reduction.  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, width, and protuberance of the clitoral hood, so that the hood is now more more within the labia majora when the woman stands. I have performed this procedure over 400 times with outstanding results.   I have not published this technique so no one does it like me.

I doubt any procedure would completely result in your clitoral hood and labia being completely within the labia majora when standing. However, a skilled wedge reduction and clitoropexy with hood reduction would give you the most natural and aggressive result without creating a deformity or visible scars.

About half of the labia surgeries I perform are reconstructions of botched labiaplasties done by other surgeons. Do your research and make sure you choose an experienced surgery.  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.

Sincerely,

Gary J. Alter, M.D.

Beverly Hills, CA  -  Manhattan, New York City

Oscar A. Aguirre, MD, FPMRS · Answer

Hello Genuine,
You are an excellent candidate for a labiaplasty with clitoral hood reduction. Seeking a natural, youthful, and aesthetically pleasing result should be your goal, but because of your small mons and labia majora a fully tucked-in appearance is unlikely. You should seek out a surgeon who has experience in addressing such a large hood which has so much excess and redundant lateral tissue. Once this is performed the labia minora may then be reduced to match and create a natural look. The way I address the hood then necessitates a curvilinear trim technique. The advantage with this technique is creating labia that are smoother and lighter in color. Function is also preserved.
Go to the link below to look at hundreds of before and after photos. From there you can initiate a virtual consultation process. I encourage you to consult with more than one surgeon so you can be comfortable with your decision.
Best of luck,

Leila Kasrai, MD, FRCSC · Answer

Labiaplasty would reduce the prominence of your labia minora, so that it doesn’t protrude a much. Fat transfer to the labia majora may also help “tuck it in” more. The surgical technique suitable for you depends on the experience of your surgeon.

Nicole E. Williams, MD, FACOG, FACS · Answer

Thank you for your question!  Either technique would work, but to achieve the most tucked in look possible, make sure to inquire about a clitoral hood reduction given there appears to be excess tissue which may also be contributing to your discomfort.

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

The “tucked in” look you’re describing is usually very achievable, but the exact degree of smoothness depends heavily on your starting anatomy, skin characteristics, pigmentation patterns, tissue thickness, and the size of the labia majora surrounding the area. Patients with smaller outer lips, like you described, often need especially careful planning because there is less natural coverage available after surgery.

One important point that many surgeons oversimplify:
the trim vs wedge discussion applies mainly to the labia minora themselves. Clitoral hood reduction (CHR) is a separate component requiring its own judgment and technical skill. While the hood can sometimes be integrated into either a trim or wedge excision pattern, that integration is not automatically built into the procedure. It is a separate aesthetic decision and one of the areas where surgical experience matters the most.

In my practice, I generally favor the trim method for patients seeking the smoothest, most tucked-in appearance and for patients whose main goals include both comfort and aesthetics. It allows very precise reshaping along the entire edge and often gives more predictable contour control than a wedge in properly selected patients. A wedge can work well in certain anatomies, but it is not inherently more “natural,” despite how it is often marketed online.

The most realistic way to predict your own outcome is not by looking at random “best results” online, but by reviewing before-and-after photos of women whose anatomy closely resembles yours before surgery. That gives you a far more accurate expectation of what your individual tissues can realistically achieve.

The good news is that your goals — reduced discomfort, a smaller appearance, and a more tucked-in contour — are very commonly aligned goals and are often achievable together when the procedure is properly designed for your anatomy rather than forcing a one-size-fits-all technique.

A detailed virtual consultation with an experienced cosmetic gynecologic surgeon is usually the best starting point because surgical planning in this area is highly anatomy-specific.

What are realistic labiaplasty and CHR expectations? (Photos)

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