There’s no question that labiaplasty is growing in popularity among patients and plastic surgeons. The question is, are you thinking about adding it to your practice?
In the right hands, the procedure is safe, effective and ranks high in patient satisfaction, according to plastic surgeon Alexes Hazen, M.D., associate professor of plastic surgery, NYU Langone Medical Center.
But there are best practices that help surgeons avoid complications and optimize outcomes, Dr. Hazen says.
Labiaplasty, or labia minora reduction, is the most common procedure for women who are concerned with the appearance of their vulva areas. It’s usually performed by trimming the labia minora and, sometimes, the labia majora; then sewing them shut, according to Dr. Hazen.
American Society for Aesthetic Plastic Surgery (ASAPS) statistics suggest demand for the procedure is increasing. In its 2014 national totals for cosmetic procedures, ASAPS reported surgeons performed 7,535 labiaplasty procedures. It ranked 19 out of the 20 most performed surgical procedures that year, up from a ranking of 20 in 2009. Labiaplasty increased by 49% in 2014, compared to the prior year, and nearly 90% of those patients were 19 to 50 years old.
By 2013, 29% of ASAPS surgeons reported performing labiaplasties, up from 21% in 2012. http://www.surgery.org/media/news-releases/labiaplasty-and-buttock-augmentation-show-marked-increase-in-popularity
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What’s Up Down There
Dr. Hazen says she thinks the majority of patients are interested in labiaplasty for cosmetic reasons. One of the drivers could be that women tend to have less pubic hair than in the past. And, specifically, they don’t like the protrusion of the labia minora or the dangling of it beyond the majora.
“Then, there are patients who pursue it for more functional aspects… particularly in activities, such as biking or spin classes, where, if they are a little bit larger, they can be uncomfortable,” Dr. Hazen says.
Dr. Hazen offers these tips for safer labiaplasty surgery and better outcomes.
Labiaplasty is best performed in an accredited surgery center or hospital operating room — not in the office. Not only because of sterility, but also because the labia is very vascular, so it can bleed. And surgeons performing the procedure should have access to an operating table that allows them to do the procedure with patients in the lithotomy position.
While labiaplasty can be done with just local anesthetic, it’s better to use a combination of local anesthetic and sedation. And the local should be lidocaine with epinephrine, 1:100,000 injection, to reduce bleeding.
“If you injected with straight lidocaine (no epinephrine) it’s going to bleed a lot,” Dr. Hazen says.
Planning the resection is based on the individual patient’s needs.
“Often, the issue is that there is an asymmetry and one side is larger than the other. So, sometimes, it may be a resection of just one side, while other times it’s both sides,” she says. “It’s important to design the resection so that it will close without any tension. You don’t want to clip off too much, so that you have any tightness on the suture line.”
The good news is that because the labia is so vascular it, not only does it heal well but it typically heals with almost no scar, according to Dr. Hazen.
NEXT: Best Operative Practices
Best Operative Practices
Dr. Hazen numbs the area and starts the resection, making sure there is adequate hemostasis.
“The best way to do that is with electrocautery under direct visualization. Then, you suture it closed,” she says.
Surgeons differ on their approach to the suturing. Many use a two-layer closure, creating deep and superficial sutures.
“The best approach, I think, is to use a suture on the skin that will dissolve on its own, so you don’t have to be removing stitches on the labia, which would be very painful and uncomfortable,” Dr. Hazen says.
The plastic surgeon uses fast-absorbing Vicryl or a fast-absorbing gut suture.
For labial majora resections, surgeons would want to design the scar so that it’s on the mucosal skin junction of the labia, where the scar is undetectable.
“You have to be extremely careful, taking away labia majora, not to make it too tight. You have to be very conservative in your resection. The worst thing you can do is make somebody tight there, so that the suture line could be disrupted or the patient has discomfort,” Dr. Hazen says.
Surgeons can avoid making the area too tight by having it tension free upon closure.
“You would cut one side first and then re-drape it and, then, cut the other side when you’re sure that it will re-drape well,” she says.
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To dress the area, Dr. Hazen typically uses ointment and bacitracin along the suture line; then puts gauze on the area to keep it dry for about 24 hours.
“We don’t usually put a catheter in the patients,” she says.
What patients do need is a water bottle-like device, so they can squirt the area after urination, which prevents urine from getting on the suture line.
“Basically, when patients go to the bathroom, they shouldn’t wipe but can use warm water to spray on the area and pat it dry with the gauze. Typically, they need to do that for about three days,” she says.
The surgical area typically heals by five to seven days. That’s when patients no longer have to worry about cleaning the area post urination. Dr. Hazen recommends that patients wait three to six weeks before resuming sexual activity.
“The surgeon wants to look at the area and make sure it’s really healed before starting sexual activity because it could open up again, especially given how vigorous a woman’s sexual activity is. In general, things do not fully heal to their full strength for six weeks. But if it looks perfectly fine at three weeks, we might allow patients to resume sexual activity,” she says.
As for complications, bleeding is probably the most common, Dr. Hazen says.
“It’s not typical to have an infection but it is possible. Dehiscence and the need for re-operation because of under-resection, over-resection or asymmetrical outcomes are other possible complications from labiaplasty, according to Dr. Hazen.
Surgeons who might be reluctant to perform labiaplasty should consider the procedure’s driver: satisfied women, according to Dr. Hazen.
“It can be done very safely, very effectively and you have a very satisfied patient,” she says.
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