Labia majora reduction (aka labia majoraplasty) is a quick, in-office surgical procedure that permanently reduces the size of the labia majora, the hair-bearing outer lips of the vulva, by removing sagging skin and unwanted fat.
This cosmetic surgery creates a more youthful, taut appearance and minimizes bulging or âcamel toeâ in tight-fitting clothing. It can also improve comfort by reducing the chafing and irritation caused by oversized tissue. Â
During the procedure, excess skin and fat is removed from the inner side of these outer lips. The scar is carefully hidden along the inside margin of the labia majora. âItâs a very thin line thatâs almost invisible,â says Dr. Marco Pelosi, an OB-GYN in Bayonne, New Jersey. âAnd since itâs in a natural crease, you never see it.â
RealSelf Tip: Labia majora reduction can be combined with other vaginal rejuvenation procedures, including:
- labiaplasty, aka labia minora reduction, which can make the inner labia more proportional
- monsplasty, which reduces the mons pubis
- clitoral hood reduction, which removes excess tissue from around the clitoris
- labia puffing, which uses transferred fat or dermal fillers to plump up wrinkled labial lips
- vaginoplasty, which can reconstruct or tighten the vaginal canal
Pros
- Removing excess tissue can increase confidence for women with oversized labia majora, who may have felt self-conscious about wearing tight clothing like bathing suits or yoga pants, or being intimate with a partner.  Â
- The hour-long procedure is performed in the doctorâs office under local anesthesia.
- The amount of tissue removed is tailored to your exact needs and desired result.
- You should be able to return to work a day or two after the procedure, as long as your job doesnât involve any strenuous activities or movement that could place pressure on the incisions.Â
- In experienced hands, complications are rare. Â
Cons
Labia majora reduction is a specialized procedure thatâs very different than labiaplasty surgery (aka labia minoraplasty), the most common aesthetic procedure for female genitalia. âBut like labia minoraplasty, it requires much experience and careful attention to design detail,â says Dr. Michael Goodman, an OB-GYN in Davis, California. âMake sure that your prospective surgeon has done many majoraplasties.â According to Dr. Goodman, it takes at least 10âand better, over 20âmajoraplasties before a surgeon has the skill to tailor the procedure for your specific needs.
- Full healing takes about six weeks, and youâll be advised to avoid exercise and sexual intercourse during this time.Â
- Like all surgical procedures, labia majora reduction comes with risks, including infection (which can be mitigated via antibiotics), scarring, and asymmetry.
- The procedure is expensive and not typically covered by insurance.
The ideal candidates are healthy adults who are concerned that their labia majora look saggy, wrinkled, or too large in relation to the rest of their anatomy.Â
âVery often, itâs someone whoâs lost a lot of weightâfor instance, after bariatric surgeryâand they get deflated and saggy down there,â says Dr. Pelosi.Â
At the opposite end of the spectrum are people who are heavy and have excess fat. âThey feel a little too puffy,â says Dr. Pelosi.Â
The outer labia (and other parts of the genitals) can change in unwanted ways throughout life. "The labia majora can enlarge after pregnancy, weight gain, or aging, which can cause the labia majora to stretch. âWomen do not like that bulge that they get in their swimsuits or yoga pants,â says Dr. Gary Alter, a plastic surgeon in Beverly Hills, California. âThis can easily be fixed by labia majora reduction.â
Another factor to consider is whether your skin is prone to hyperpigmentation or developing an overgrowth of tissue. âIf you tend to âscar darkâ or with keloids, that tendency is still alive down there,â says Dr. Pelosi. âA diligent surgeon will definitely ask about that and make you aware of it.â
Youâll need 1-2 weeks of downtime after your surgery, depending on the extent of your procedure and how well your body heals.
Youâll have swelling, bruising, and soreness, but âthere are fewer nerves in this area compared to the labia minora, so youâll be a little bit sore, but not as sore as someone whoâs had a labiaplasty,â says Dr. Pelosi. Your surgeon will probably prescribe pain medication for the first few days and recommend over-the-counter options after that.
During the first week or two, be prepared for what Dr. Pelosi calls the âFrankenstein phase,â when the area looks irregular, bumpy, and swollen. âIt can look scary, and you may think the surgery has been botched, but itâs the healing process.â Because the labia majora are at the bottom of the torso, blood is prone to pool in this area (whatâs known as venous congestion, so the area will probably look extremely swollen post-op.Â
Some dos and donâts to help speed your recovery:
- Donât directly apply ice packs, especially in the first 12 hours post-op, when the area is desensitized from the anesthetic. If you canât feel it, you might accidentally cause frostbite. Instead, intermittently apply cold packs (ice wrapped in a towel) to the genital area to reduce swelling.Â
- Do keep pressure off the surgery site when sitting by using a ring cushion or leaning to one side.
- Do keep your butt higher than your chest when lying down, to reduce venous congestion.Â
- Donât soak in the tub for prolonged periods. You can shower, but donât take a long bath. âThis would soften up the stitches, and thatâs never a good idea,â says Dr. Pelosi.Â
- Donât use tampons, engage in sexual activity, or exercise for 4-6 weeks post-op.
Results start to become evident once the swelling subsides, after 4-6 weeks. Youâll see the final result at about the six-week mark.Â
The results are permanent. âOnce youâve reduced the tissue and have a healed scar, that shape is the final product,â says Dr. Pelosi.Â
If you lose a lot of body fat, however, you could lose fat in the area. âItâs not going to regrow or get saggy again to any degree,â says Dr. Pelosi. âIt could just get wrinkled and have more of a deflated look.â
The labia majora reduction photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.
When performed by a proficient board-certified plastic surgeon, labia majora reduction is considered safe.Â
In unskilled hands, however, thereâs always a risk for complications, including:
- A visible scar. âThis could come in two varieties,â says Dr. Pelosi. âIf the surgeon places the incision in the visible portion of the labia majora, youâll have a scar thatâs out in the open and might be obvious.â Secondly, the scar could develop a keloid, an overgrowth of scar tissue. This would need to be managed with scar excision and steroid injections.Â
- Scar separation. This occurs if too much tension is placed on the scar, causing it to stretch during the healing phase. âSeparated scars sometimes can be closed right away, but may need to be closed later on, which would require additional, unplanned work,â says Dr. Pelosi.Â
- A poor aesthetic result. âIf too much tissue is removed, you might end up with a result thatâs under tension and flat-looking and might even splay the vagina open, creating a gaping effect,â which requires revision surgery to correct, says Dr. Pelosi. Another possibility is an asymmetrical result.
Most of these things are unusual and unexpected in experienced hands, Dr. Pelosi says. However, according to Dr. Alter, âmany physicians [who perform labia majora reduction] are not comfortable or trained in this procedure, resulting in poorly placed scars, asymmetry, and poor results.â To help ensure that you get the result youâre after, read patient reviews and check out before and after photos of the doctors youâre considering.Â
Another tip to finding an experienced surgeon: âIf a surgeon doesnât have an area on their website that discusses labia majora reduction, then they probably donât do enough of the surgery,â says Dr. John Miklos, a urogynecologist in Alpharetta, Georgia.
Surgery is the only way to permanently and dramatically improve the size, shape, and texture of the labia majora.Â
If youâre not ready for or interested in having surgery, nonsurgical options include:Â
- ThermiVa, a treatment that heats tissue with radiofrequency energy to boost production of skin-firming collagen. This, in turn, helps to shrink vulvar tissue and reduce laxity.Â
- FemTouch, a CO2 laser that works on and below the surface of the vulvar skin to stimulate new collagen production.Â
Keep in mind that these procedures:
- Deliver a modest improvement and work best to treat mild laxity.
- Require a series of sessions to produce the desired benefits.
- Take a few months to see results, since it takes time for new collagen to develop.
- Need touch-up sessions to maintain results.Â
- Are expensive. Your total tab could cost you much more than surgery.