Labiaplasty of the labia minora and majora

Labiaplasty: indications, contraindications, techniques, outcomes.

The term labiaplasty refers to correction of both the labia minora and the labia majora. The most commonly performed procedure in cosmetic gynecology is reduction of the labia minora, i.e., labiominoroplasty. In general, the procedure consists of reducing both the length and the height of the labia. It is also very often accompanied by reduction of the clitoral hood by reducing the skin folds located on its right and/or left side. Sometimes a properly performed labia minora reduction includes repositioning (transposition) of the clitoris itself along with its hood. Such a step is necessary when there is hypertrophy of the clitoral hood with significant exposure above the labia majora, which, if only the labia minora were reduced, would result in the appearance of a micro penis (Eng. ‘penis-like shape’), a look completely unacceptable to women. Hence one conclusion suggests itself: there are many different surgical techniques, and the choice depends on the specific case. At least, that is how it should be. There is no single technique for all patients. Each woman should be treated individually and a method planned to suit her needs so that the final result meets the expectations of both the patient and the surgeon and, equally important, looks natural with scars that are unnoticeable.

The most commonly performed techniques worldwide include: classic (edge, trim) and wedge (wedge). Others are to a greater or lesser extent modifications of the above, although they sometimes differ significantly, e.g., the fenestration method, that is, windowing.

The first consists of linear trimming of the edges of the labia, achieving two goals — reducing their size and removing the often discolored parts of the labia. The longitudinal wound is most often closed with absorbable sutures

in a continuous intradermal fashion. Placing transverse interrupted stitches is contraindicated due to the resulting shell-like, scalloped scars (hence the term “scalloping”).

The second method is based on preserving the natural edge of the labia. The wedge is a triangle whose base is the excised labial edge and whose apex lies in the groove between the labium minus and labium majus.

There are two types of this technique — a central wedge and a posterior wedge. The former is still often used by plastic surgeons, but it has a fundamental drawback. When the central part of the labium is excised, the largest blood vessel of this structure — the central artery — is removed, which carries a high risk of wound dehiscence. Moreover, a transverse scar crosses a longitudinal structure. Posterior wedge resection involves excising a wedge at the base of the labia, that is, on the side of the vaginal vestibule and perineum. With such a wedge excision, the incision and subsequent suture line run in the labial sulcus. Thus, a longitudinal scar will form on a longitudinal structure — in any case, not visible, unlike the former.

With both methods, there may be a need to reduce the skin of the clitoral hood or the skin folds running along its sides. Removing these tissues is necessary, because failure to perform this procedure is associated with the aforementioned fact of leaving a protruding clitoris with its hood, whose appearance resembles a small penis. Clitoral hood reduction is most often performed simultaneously with labia minora reduction. It can be performed with a single incision (technique „one cut” or „linear Z”), or with separate teardrop-shaped incisions running along both sides of the clitoris. The aforementioned operation „one cut” is a proprietary technique

of Dr. Rafał Kuźlik, MD, PhD, and one of the most widely recognized techniques in the world today. From a surgical and technical point of view, it is a demanding method that requires extensive experience; however, the final outcomes are exceptionally good. A few months after the procedure, the vulva looks natural and any traces of the correction are unnoticeable.

Indications for the procedure:

Aesthetic considerations
Pain or discomfort when wearing tight clothing (e.g., pants) or while cycling
Frequent inflammation in this area
Difficulties with sexual intercourse
And many others—the main assessor of the indications is the patient, who does not wish to continue living with this particular body structure

Contraindications:

Infection of the vulva and vagina (active or within the past week).
A general infection, such as flu, a cold, or herpes within the last 2 weeks
Abnormal blood test results, particularly complete blood count and coagulation profile
Uterine bleeding of unknown origin, or the time of menstruation (gynecological procedures may be performed after menstruation and never before or during it)

Labia majora plasty, i.e., labiomajoroplasty. The procedure is performed in women who complain of overly prominent labia majora that, in a bikini, look like male testicles. Sometimes patients are very bothered when underwear forms the characteristic shape known as a “camel toe.” The described symptoms cause considerable embarrassment. Another reason women report for seeking surgery is laxity of the labial skin, which often occurs after significant weight loss, when the skin of the whole body becomes saggy and there is simply too much of it. In such cases, conservative measures will be insufficient and one must resort to surgical techniques.

The most popular and most commonly performed technique involves a longitudinal excision of a fragment of the labial skin. One incision line runs along the crest of the labium, and the other below, from the side of the groove between the labia minora and majora, meeting at the apex and the base in a spindle shape. After removing the skin fragment and an appropriate amount of adipose tissue and tailoring the skin edges, the wound is closed with a continuous intradermal suture. Of course, as in the previous procedures, only absorbable sutures are used here.

Indications for the procedure: