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Dr. Barry Eppley

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Archive for the ‘labial reduction’ Category

Posterior Wedge Labiaplasty for Improved Aesthetic Results

Tuesday, August 6th, 2013


The correction of labial enlargement in women is now a common aesthetic procedure. No longer must women endure embarrassment or hygiene issues from overgrowth of the labia minora which causes a visible protrusion beyond the labia majora. Reduction of the labia minora is known under single moniker of labiaplasty which represents a diversity of surgical techniques.

These include various modifications of linear excision or amputation methods. These straight-line excisions amputate the extra labial tissue parallel to the edge of the labia minora. While effective, this method distorts the natural shape of the labial edge and may result in scar exposure and contracture. Newer techniques of labiaplasty are evolving that take a non-liner excisional approach for improved aesthetic results. A V-shaped wedge technique removes a central wedge of redundant labia that, when put back together, allows the natural contour of the labial edge to be maintained.

In the August 2013 issue of the Aesthetic Surgery Journal, a paper entitled ‘Posterior Wedge Resection: A More Aesthetic Labiaplasty’ was published. It describes the results of this newer posterior wedge resection labiaplasty in 22 patients over a three year period. The average age of the women treated was 35 years old and only two minor wound healing complications occurred. None of the women reported any subsequent problems after healing with pain, numbness or problems with intercourse.

Good healing of the labia minora is almost always assured due to its very robust blood supply. Because it is mucosal tissue, it usually heals without any noticeable scar. The concern with labiaplasty surgery then is how to improve the aesthetic result. The posterior wedge resection method allows the labial minora edge to maintain its natural color, texture and pigment. Such a technique improvement will continue to keep labiaplasty as a highly satisfying procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Labiaplasty for External Vaginal Reshaping

Sunday, August 4th, 2013


The labia are a well recognized part of the female genitalia being the major externally visible portions of the vulva. The labia majora are larger and fattier while the labia minora are folds of skin often hidden within the labia majora. In some women, the labia minora are almost non-existant while in others they can be fleshy and quite protuberant. There is great variability in the size, color and general appearance of the labia from woman to woman.  The functional purpose of the labia is that they surround and protect the clitoris and entrance into the vaginal vault.

Labiaplasty has become a popular plastic surgery procedure for reduction in the size of the labia minora.  There are numerous causes of labial enlargement of which childbirth is the most common but may also be the result of genetics and natural aging. Women seek labioplasty surgery for either its aesthetic appearance as well as a source of discomfort when wearing certain types of clothing as well as hygiene issues.

The two most common surgical techniques for labiaplasty are the trim method and the “V” wedge technique. In the trim technique, the leading edge of the labia minora (any tissue that projects beyond the level of the labia majora) is trimmed, thereby shortening and reducing it. Though technically the simplest, this method can be less aesthetically pleasing as it leaves a long flat scar along the top of the labia which can remain irritated and sensitive for quite some time. The “V” wedge technique entails excising the excess labia in a “V” manner then the upper and lower edges are sutured together.  This allows the suture line to remain relatively hidden and also allows for better reduction and tightening of the remaining labia. Regardless of the method, typically a layered closure is performed using absorbable sutures both internally and externally. The final result can be assessed after approximately three months postoperatively. After healing, labial incisions are rarely visible regardless of the technique.

After labiaplasty care consists of meticulous hygiene with sitz baths or a spray bottle several times a day and antibiotic ointment for about one week. Because of the mucosal location of the surgery, patients are given oral antibiotics postoperatively. As many women are all to well aware, any oral antibiotic can lead to yeast infections. For those with such a history, Diflucan is provided with their antibiotic prescription. Narcotic pain medication may be required postoperatively but often this can be weaned fairly quickly to just ibuprofen and/or acetaminophen. There is often a moderate amount of swelling for the first two to three weeks. Cool compresses can be used to help alleviate pain and help with the swelling.  Moderate exercise can be resumed after three weeks.

One should refrain from intercourse for a minimum of four to six weeks after surgery to prevent suture line opening. Other activities such as horseback riding, bicycle/motorcycle riding, and prolonged sitting should be avoided during this period as well. Tampon use should be avoided for three to four weeks after surgery. Scar tissue will form along the suture and this will take several months to soften.

Labiaplasty has a high patient satisfaction level and the procedure is frequently combined with other common cosmetic body contouring procedures such as tummy tucks, breast augmentation/lifts and liposuction.

Dr. Barry Eppley

Dr. Jane Namkung

Indianapolis, Indiana

Different and Unusual Procedures in Plastic Surgery

Thursday, July 3rd, 2008

As plastic surgery has worked its way into the mainstream of American society, it is no surprise that procedures are being done today that were not imaginable a mere ten years ago. And I am not referring here to surgery wonders of technology and scientific advancement (although that exists also), I am talking about what patients desire to have done. This is a reflection and commentary on contemporary American culture, not necessarily how far the science of plastic surgery has come.
As I talk with friends and colleagues about some of the plastic surgery procedures that I do today, I have come to realize that some of them may be considered ‘unusual’ . Certainly, some of them are different than traditional perceptions of plastic surgery. Many are relatively minor procedures that can be performed in the office and probably reflect the trend toward treating smaller concerns. They are the opposite of bariatric plastic surgery, for example, where a new subspecialty of plastic surgery has developed to treat the sequelae of gastric bypass and massive weight loss patients. The emergence of larger plastic surgeries and big procedures doesn’t occur very often but every few decades. But the emergence of more minor plastic surgery procedures occurs much more frequently. Here is a list of my unusual plastic surgery procedures that have emerged and become popular in the past decade.
Buttock Implants/Fat Injections – The appeal of a larger, more rounded buttocks is certainly a body image of recent note. Whether done by transferring fat from one body part to another or by an implant placed through an incision near the tailbone, the desire for buttock enhancement could not have been envisioned ten or twenty years ago. There is actually a great number of patients who would like buttock reduction but no single good procedure exists for that problem.
Labial Reduction – Whether due to discomfort from rubbing on clothes or during inetrcourse or simply to ‘look better’, reducing the size of a woman’s labia is now a common procedure. One would never have thought that such a concealed part of the anatomy would create a demand for treatment. A very simple and effective procedure, labial reduction restores the outer appearance of the vagina to a more youthful appearance.
Earlobe Reduction/Enhancement – As woman age and with the lifelong use of ear rings, the ear lobes will frequently get longer. The size of the ear lobe can easily be reduced (earlobe reduction) in the office and it is a procedure that I often do at the same time of a facelift. Aging may also make one’s earlobes get quite thin and almost shriveled in appearance in very thin females. Injectable fillers, such as Juvaderm or Radiesse, can give an immediate rejuvenation effect to the earlobes that may last as long as a year.
Eyebrow/Eyelash Hair Transplants – The science of hair transplantation has evolved to the point that single hair (follicle) transplants are now routinuely done in scalp hair restoration. It is quite logical that single follicular transplantation be applied to very small areas such as the eyebrow and even the eye lashes. The alternatives of permanent makeup, colored pencils, and false eyelashes made opting for actual hair tranplants a difficult decision. But some few patients do.
Umbilicoplasty – While every full tummy tuck patient gets a new bellybutton (umbilicus), some non-tummy tuck patients want one also. Most commonly, it is to change an outie to an inne belly button.
Nipple Reduction/Nipple Enlargement – I have seen it both ways. The concern of large nipples is that they can be very visible through clothes…and at all times. Reducing the size of the nipple is a simple procedure and some women may lose a little sensation. Most recently, I have started to some men that want their nipples reduced also! Conversely, nipple enlargement or enhancement is about changing an inverted nippled (which is turned inward) to one that has some outward projection. While not quite as predictable (long-term result) as nipple reduction, the nipple can be released and brought more outward.
Corner of Mouth Lift – The downturning of the corners of one’s mouth with age gives a sad or angry appearance. A simple procedure in which a small amount of skin is removed and the corners lifted up and the mouth line leveled gives a nice and subtle improvement. Such a procedure is a simple office operation or is often done as part of a facelift. This is actually an old procedure that has now been ‘reinvented’ or rediscovered.

One wonders what this list will be in another ten years!

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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