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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

Indianapolis, Indiana

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