Archive for category labiaplasty
I want one side labiaplasty reduction on my larger inner vaginal lip. Is this possible? Are there any risks?
Labiaplasty surgery is usually done on both sides when the goal is to produce the optimal evenness between them. There are women however who come wanting to have the minimal amount of surgery who do have one side labiaplasty surgery. Some of these cases can be done under local anesthesia in the office which does help provide discretion of course. The risks of surgery are the same as in the both sided case, but only involve the one side of course. The results are a bit less “pretty” than the both sided surgery as well.
A client recently had this type of surgery and her before and after images and information are available at my practice site for those interested.
John Di Saia MD
Labiaplasty is portrayed by some online as akin to heresy. Jezebel takes a stab at it in a post entitled: Unhappy With Your Gross Vagina? Why Not Try ‘The Barbie’?
It is probably true that some surgeons might have earned some of this sarcasm due to their “polyester clad used car salesman’s pitch” for the operation. I don’t easily fit into the caricature that the author portrays:
Dr. B, by the way, is less of a vulva-hater than some of his colleagues. Consider Dr. A who invented the “Barbie” surgery, which amputates the entire icky labia minora. Why the fuck do women want their vulvas to look like they’re made out of plastic? (A minority of women seek out labiaplasty for non-aesthetic reasons, but most do because they’re embarrassed or ashamed of their “abnormal” lower lips.)
“Vulva hater?” That’s a new one. We have actually discussed Barbie labiaplasty here before. I am not a fan. I don’t like the idea of removing any part of a woman’s anatomy completely without good reason. I do not call any part of a woman’s genitalia “abnormal” or “icky” by the way. And in my patients about half seek the surgery for non-aesthetic reasons. I don’t “sell” the operation and my patients seem pretty happy after having it. Specifically I do not use embarrassment to encourage my patients to have surgery.
One thing to which I have become accustomed since I started offering labiaplasty some ten plus years ago is mischaracterization. There are those who do not believe women should seek this surgery and that it is dangerous. They believe that women should be happy with what they have “down there” and any man who operates for this reason must certainly be a misogynist.
Then again they do not have issue with their privates and other women do. Some women have large enough Labiae to actually hurt in clothing even though by definition they are normal in size. Other women admittedly just don’t like the way they look and if I can figure a way to be of assistance, we have a place to start talking. Sometimes surgery comes out of that. Sometimes it doesn’t.
John Di Saia MD
Women considering going under the knife for a “vagina lift” are being warned that the internet is rife with misinformation and inaccuracies in a new study released this week. In recent years, genital plastic surgery has become increasingly popular among women looking for “vaginal rejuvenation,” “G-spot amplification,” and other procedures that reshape the external lips or labia of the vagina.
But in a paper published online in Obstetrics & Gynaecology, researchers called for guidelines in genital cosmetic surgery to be drawn up after finding major gaps in the breadth, accuracy, and quality of the clinical information provided among the first five British and American websites which popped up on Google for the procedure. Among the most disturbing findings was the absence of setting age limits, authors note. Sixteen is the age of legal consent for surgery.
The labia police are back at it. As I have iterated here more times than perhaps than anyone else has one anywhere else is the fact that plastic surgery on the internet is a carnival of sorts. Surgery of the privates both in the way it is presented and at times performed certainly fits this description.
One of my reasons for writing my humble blog has been to set some of the misinformation plaguing my specialty straight. As a surgeon with significant experience performing labiaplasty surgery, I think I have earned the right to respond to this piece.
I have presented my philosophy of labiaplasty surgery here before many times. I have warned of the heterogeneity of those offering procedures in the privates of women. I have advised that women “stick to the outside” when having these operations (that means labiaplasty on external structures in my book.) I am not a fan of vaginoplasty or the term designer vagina.
Moreover I have encouraged those considering these operations to look carefully into the technique to be used and to choose proper surgical talent. I have also discussed dissenting opinions including a statement from the American College of Obstetricians and Gynecologists (ACOG) in 2007 warning of the dangers of the trending surgery and the relative lack of regulation or even categorization. I did point out that the specific type of the surgery that I perform was the only one that the ACOG committee considered potentially beneficial at the time.
I have poked fun at procedures in the area that I consider laughable…such as the G shot. In other areas of concern to the ACOG and their European equivalents, I am in total agreement:
Clinics offering the procedure also preyed on unnecessary and oftentimes unfounded fears about appearance of female genitals researchers said, reinforcing negative feelings towards the vagina also known as ‘pudendal disgust.’
This is a new term by me. I thought I had heard of everything. Those of you who know me know that I carefully screen my patients and do not talk anyone into anything. I do not deceive to operate. This may be amongst the reasons I am in solo practice but that is another story.
With all this being said, I still defend that surgery in the privates of women can be performed safely. I have done so for over ten years. Reduction labiaplasty utilizing the proper techniques is a safe and satisfying operation when offered to the proper patient. No operation is right for everyone after all.
John Di Saia MD
“Octomom’s porn came out and she’s gotten an EXTREME labiaplasty that people are noticing and commenting on twitter and TMZ. If you can stomach it, would you be able to comment on that and her obvious body lift scars?”
We have discussed Octomom and her plastic surgery exploits here before. She must think she is a celebrity because she has been in (at least) public denial about obvious body lift scars. How a woman on public assistance with over eight children affords expensive plastic surgery is a difficult concept.
On the question of labiaplasty, I have not seen images and am not sure I would want to see images. With the Octomom porn out, certainly many have seen her privates. It would not surprise me if Ms Suleman had had labiaplasty surgery and went extreme on the removal. We have discussed the wide variability in the practice of labiaplasty here before. Some women want their lips completely removed which is not my practice. I favor reduction not complete amputation. Then again I am not Octomom’s surgeon.
John Di Saia MD
A recent study…shows that male physicians and plastic surgeons are more inclined to recommend surgery to alter the physical appearance of an otherwise healthy vulva. Published in the Journal of Sexual Medicine, the study was conducted in the Netherlands with a set of 210 doctors who were shown photos four healthy vulvas, two pre-labiaplasty and two post, following about six months of healing. These vulvas belonged to two women, one age 35 and the other 40, who underwent cosmetic surgery to shrink the size of their labia minora (aka inner pussy lips) which they felt extended abnormally beyond their labia majora (aka outer pussy lips). 164 of these 210 doctors completed this survey, and most (90 percent) agreed that the smaller labia minora were closer to society’s ideal.
I have written a labiaplasty article for the Journal of Sexual Medicine. I have also served as an article reviewer for articles being considered for publication at the journal. I did not review this article. Even if I had I am not sure I would have recommended it for publication.
Needless to say there are quite a few misconceptions about labiaplasty surgery. Each labiaplasty surgeon has his (or her) own particular philosophy through which he offers the surgery. Mine has not been to judge women’s privates, but rather serve to make them more to the liking of their owners within reason. I am not running some kind of Playboy bikini contest. Local Orange County women do not drop their drawers to ask me whether they “need” their Labia reduced either. When the question is presented in this manner, very few do. Women have their reasons for considering labiaplasty surgery and some of these make pretty good sense.
This study seems to have looked at the impressions of a group of doctors regarding what was more acceptable by current societal standards in the way of the Labia. My contention is that these standards really do not matter. “Normal” labial lip size can still be large enough to cause pain in today’s small string underwear. So normalcy per se has little to do with the consideration of labiaplasty in many cases. In consultation, the patient and I try to figure out what bothers her and what I might do about it. I am not there to label. I am not there to judge. We are there to figure what (if anything) might be improved.
Studies like this one just muddy the waters and they are already pretty muddy. It is all a matter of philosophy anyway.
John Di Saia MD
I did labioplasty after I saw some ads that suggested that big labia were abnormal. Before that I had no physical discomfort or insecurities. But after I heard about labioplasty I got extremely ashamed of myself. Now that I have done it I look mutilated and after 7 months I still have agonizing pain and sex is impossible.
To what extent do we have to butcher our normal bodies to catch up with the media created “ideals”?
What can you say to a comment like this?
First of all, although I feel for your situation, patients really need to educate themselves before having this type of surgery and choose good surgical talent. I am not sure you did this. This surgery has many variants so what exactly you had done is unknown to me as you are not my patient. Some operations are obviously better than others.
I do not recommend people have surgery based upon advertisements alone and my practice does not advertise for this type of work. I never suggest that a woman’s Labiae are “abnormal” or “need surgery.” This is a matter of philosophy.
My labiaplasty patients do not have the experience (or the complications) you describe. They are examined periodically until they are healed and back to sexual activity. They report they look and feel better. Not one of them to date has desired to go back (even if she could) to her pre-operated condition. Long term pain is extremely unusual when the operation is properly performed by modern techniques.
It seems very likely that you had the wrong operation by the wrong surgeon. Better research by others will help them avoid your unfortunate mistake. I do hope you are able to have your result improved to your satisfaction.
John Di Saia MD
Originally posted 2010-02-22 17:00:19.
As my Labiaplasty YouTube video in which I describe Wedge versus Trim method surgery (Pros and Cons) was getting hits and likes lately, I decided to update it. The initial intro segment of yours truly was originally shot with an older video camera so I fixed it up.
The narration while I give the Powerpoint portion of the video is sadly not fixed up much. I might get to it later depending upon time.
John Di Saia MD
Reader Laura’s Comment:
The English health system has a new study out talking about the increase in what they call genital cosmetic surgery. In this study they are stating that most of the women requesting this surgery do not need it and are in fact doing it because they are trying to have a so called perfect vagina as shown in porn movies. That they felt pressure to have ‘perfect’ sexual organs by pictures seen in the media. There was even one girl in the test study that was only 11 years old. When are they too young to have this surgery? How old do you think a female should wait before considering this surgery? They study also mentioned that they didn’t know of the long term risks of this procedure might be. Do you agree with this statement?
We talk about labiaplasty here quite often as I do a version of this surgery. The question of the long term risks of the procedure naturally begs a secondary question:
Exactly what operation?
When the operation is properly performed (my opinion of course) I have ten years of experience showing that women do quite well afterward. Then again that only pertains to the operation I am doing. These operations vary between surgeons in regards to what is done, to what structures and by what techniques. Some of the variations I do not recommend are done by others and can at times have horrifying results. In essence there is good labiaplasty and bad labiaplasty. Prospective patients need to educate themselves as to the differences before having surgery.
Other concerns raised by the writer of this article are probably a function of the fact that this surgery is (at least some of the time) covered by NHS in the UK. If like here in the US, the surgery were predominantly a cosmetic cash item, you would likely not have as many really young women coming for consideration. I do not believe really young women should be having this surgery. I somewhat arbitrarily draw the line at the age of legal consent. As my labiaplasty practice does not involve health insurance, I do not have many really young women coming through my doors.
Labiaplasty is only in rare cases entirely medically-necessary and usually even in those cases cosmetics play into the equation. Women who come to my practice care about how things look afterward. I see very few women looking for perfection and the women I operate upon are almost invariably happy afterward. I establish reasonable goals for a patient at consultation. When I cannot, I decline to become that client’s surgeon.
The question of porn images in the motivation for the operation is an interesting issue. I think the availability of images of female privates on the internet allows comparison not previously possible. This may factor into the demand for the surgery.
So while I can see some of the issues raised by this report as having some basis, I do not see a problem regarding the way I have been managing my Orange County labiaplasty practice.
John Di Saia MD
Originally posted 2011-08-30 07:30:56.
I have made no secret of the fact that more often than not I recommend a modified Wedge labiaplasty to the patients in my Orange County practice. In the last few weeks however I saw a few new patients for whom the “Trim” method would probably yield good results.
The arrangement of a woman’s privates is not always the same. Some women have very thin vaginal lips relative to others. I like a three-layer repair for my Wedge method and doing this on really thin tissue is not too practical. In these cases a Trim actually performs better. I don’t see this very often though.
In the big picture I recommend a Wedge 95% of the time as most women have turned out better utilizing this technique over the last eight years or so. Choosing a technique for labiaplasty of course involves taking the patient’s anatomy into consideration.
John Di Saia MD
Labiaplasty is a common topic here. Motivation and post-operative results are probably the most common issues, but how a woman gets on sexually afterward is a pretty common concern as well. Sexual function is one of the more common reasons patients consider having this operation in the first place. In my own Orange county practice of reduction labiaplasty (mostly of the Labia minora,) patients are usually advised to abstain from sex for 4-6 weeks. I prefer to see a patient a few times over that time to ascertain the healing of her wounds before she “stress tests” them. Then I advise she eases into things such as not to have problems. Having a four hour sex session as a first post-operative sexual experience is not a good idea.
This has worked well over the last ten years as I have had a 0% major revision rate. No one has broken anything having sex when they have waited for the “OK” first. Some people have poked fun at this statement, but it is true.
These are my general recommendations for my own wedge Labia minora reductions. If you have had surgery elsewhere you are advised to discuss any variations from your surgeon’s plan with your surgeon before implementing them.
John Di Saia MD