Labia Majora Reduction: What You Need to Know

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.   
• The hour-long procedure is performed in the doctor’s 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 doesn’t involve any strenuous activities or movement that could place pressure on the incisions. 
• In experienced hands, complications are rare.  

Cons

Labia majora reduction is a specialized procedure that‘s very different than labiaplasty surgery (aka labia minoraplasty), the most common aesthetic procedure for female genitalia. “But like labia minoraplasty, it requires much experience and careful attention to design detail,” says Dr. Michael Goodman, an OB-GYN in Davis, California. “Make sure that your prospective surgeon has done many majoraplasties.” According to Dr. Goodman, it takes at least 10—and better, over 20—majoraplasties before a surgeon has the skill to tailor the procedure for your specific needs.

• Full healing takes about six weeks, and you’ll be advised to avoid exercise and sexual intercourse during this time. 
• 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. 

“Very often, it’s someone who’s lost a lot of weight—for instance, after bariatric surgery—and they get deflated and saggy down there,” says Dr. Pelosi. 

At the opposite end of the spectrum are people who are heavy and have excess fat. “They feel a little too puffy,” says Dr. Pelosi. 

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. “Women do not like that bulge that they get in their swimsuits or yoga pants,” says Dr. Gary Alter, a plastic surgeon in Beverly Hills, California. ”This can easily be fixed by labia majora reduction.”

Another factor to consider is whether your skin is prone to hyperpigmentation or developing an overgrowth of tissue. “If you tend to ‘scar dark’ or with keloids, that tendency is still alive down there,” says Dr. Pelosi. “A diligent surgeon will definitely ask about that and make you aware of it.”

You’ll need 1-2 weeks of downtime after your surgery, depending on the extent of your procedure and how well your body heals.

You‘ll have swelling, bruising, and soreness, but “there are fewer nerves in this area compared to the labia minora, so you’ll be a little bit sore, but not as sore as someone who’s had a labiaplasty,” 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 “Frankenstein phase,” when the area looks irregular, bumpy, and swollen. “It can look scary, and you may think the surgery has been botched, but it’s the healing process.” Because the labia majora are at the bottom of the torso, blood is prone to pool in this area (what’s known as venous congestion, so the area will probably look extremely swollen post-op. 

Some dos and don’ts to help speed your recovery:

• Don’t directly apply ice packs, especially in the first 12 hours post-op, when the area is desensitized from the anesthetic. If you can’t feel it, you might accidentally cause frostbite. Instead, intermittently apply cold packs (ice wrapped in a towel) to the genital area to reduce swelling. 
• 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. 
• Don’t soak in the tub for prolonged periods. You can shower, but don’t take a long bath. “This would soften up the stitches, and that’s never a good idea,” says Dr. Pelosi. 
• Don’t 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. You’ll see the final result at about the six-week mark. 

The results are permanent. “Once you’ve reduced the tissue and have a healed scar, that shape is the final product,” says Dr. Pelosi. 

If you lose a lot of body fat, however, you could lose fat in the area. “It’s not going to regrow or get saggy again to any degree,” says Dr. Pelosi. “It could just get wrinkled and have more of a deflated look.”

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. 

In unskilled hands, however, there’s always a risk for complications, including:

• A visible scar. “This could come in two varieties,” says Dr. Pelosi. “If the surgeon places the incision in the visible portion of the labia majora, you’ll have a scar that’s out in the open and might be obvious.” Secondly, the scar could develop a keloid, an overgrowth of scar tissue. This would need to be managed with scar excision and steroid injections. 
• Scar separation. This occurs if too much tension is placed on the scar, causing it to stretch during the healing phase. “Separated scars sometimes can be closed right away, but may need to be closed later on, which would require additional, unplanned work,” says Dr. Pelosi. 
• A poor aesthetic result. “If too much tissue is removed, you might end up with a result that’s under tension and flat-looking and might even splay the vagina open, creating a gaping effect,” 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, “many physicians [who perform labia majora reduction] are not comfortable or trained in this procedure, resulting in poorly placed scars, asymmetry, and poor results.” To help ensure that you get the result you’re after, read patient reviews and check out before and after photos of the doctors you’re considering. 

Another tip to finding an experienced surgeon: “If a surgeon doesn’t have an area on their website that discusses labia majora reduction, then they probably don’t do enough of the surgery,” says Dr. John Miklos, a urogynecologist in Alpharetta, Georgia.