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Labiaplasty: The critics

Article-Labiaplasty: The critics

Sure, they might think it’s fine to tuck a tummy, broaden a bust or re-engineer a rear end. But some cosmetic surgeons think a single common procedure — the labiaplasty — goes over the line, and they’re not afraid to let their colleagues know it.

Audience responses to an electronic survey at the 2016 Aesthetic Meeting tell the story: 40% of those who performed labiaplasties acknowledged getting negative feedback from other physicians, with most saying some or all of the flak came from fellow cosmetic surgeons.

Indeed, there are plenty of critics within the cosmetic surgery industry and beyond. The obstetrician-gynecology establishment, feminists, bloggers and others continue to criticize the rapid growth in demand for labiaplasty.

But a few years after the procedure entered the public consciousness, are the negative feelings within the profession on the decline? It’s hard to know for sure, but cosmetic surgeons who specialize in the procedure say they’re seeing a change.

Dr. Jugenburg"The stigma around labiaplasties is evaporating rapidly," Toronto plastic surgeon Martin Jugenburg, M.D., tells Cosmetic Surgery Times. "I feel like the newer generation of plastic surgeons views this procedure as just another cosmetic procedure we normally offer because of the exposure it has been getting the last few years at plastic surgery conferences."

And there was plenty of conference chatter at this year’s The Aesthetic Meeting, the annual gathering of the American Society for Aesthetic Plastic Surgery, which featured at least four sessions about the topic with titles like "Cosmetic Vaginal Surgery: Labiaplasty and Beyond,” and “Why Patients Request Labiaplasty."

The session "Incorporating Labiaplasty into Your Practice: Tips for Success" featured a survey-response system that asked hundreds in the audience if they perform the controversial procedure. More than 70% responded via electronic device that they do, but 3% agreed with this arch line: "Wouldn’t touch it if my life depended on it." And 2% agreed that the procedure should “Never be performed ever, don’t ask me again."

In fact, labiaplasties have long bDr. Streichereen an acceptable surgical procedure to improve comfort and functionality in areas like urination, says Lauren Streicher, M.D., associate clinical professor of Obstetrics and Gynecology with the Feinberg School of Medicine at Northwestern University. "Some women are born with or acquired very long labia which cause urine to spray all over the place and, quite frankly, just get in the way."

Over the past several years, however, "we’ve gotten much more into doing it for cosmetic reasons" as changes in pubic hair styles have uncovered female genitalia, she tells Cosmetic Surgery Times.

"Suddenly they are able to see their labia far more clearly, when 10 to 15 years ago, women couldn’t even see their labia, much less be critical of it. That’s when the plastic surgeons got on board."

Indeed, The American Society for Aesthetic Plastic Surgery estimates that 8,745 labiaplasties (excluding vaginal rejuvenation) were performed in 2015, including 400 in girls under the age of 18. At an average cost of $2,800 per procedure, the procedures accounts for more than $24 million in revenue, still far below the annual $1 billion-plus for breast implant surgery alone.

According to the 2015 statistics, labiaplasties jumped by 16% over 2014 and now rank as the 21st most popular cosmetic surgical procedure, just below lower body lift. The procedures weren’t ranked in 2010 or 2005.

NEXT: The Labiaplasty Critics


The Labiaplasty Critics

So who are the critics within the cosmetic surgery world? "There is an education gap with older plastic surgeons who have trouble understanding the need for such surgery," says Christine Hamori, M.D., FACS, a Boston plastic surgeon who spoke with Cosmetic Surgery Times. She’s performed more than 400 labiaplasties.

"Since most plastic surgeons are male and the concept of labiaplasty is driven by women, it is not surprising that some are critical of cosmetic vaginal procedures," she says. "They miss the fact that women do this for themselves to feel better and not to please men. Husbands and boyfriends are usually dismissive of labia hypertrophy, as to them it is not really an issue."

Dr. AlterGary Alter, M.D., a plastic surgeon in Beverly Hills and Manhattan, helped popularize labiaplasties and tells Cosmetic Surgery Times he’s performed 3,000 or 4,000 of the procedures. "I don't think there’s a stigma now," he says. "What you might have misinterpreted is that most plastic surgeons and, I’m sure, most gynecologists don’t feel comfortable doing them because they’re not really trained. They’re worried they’re not going to do a good job."

But critics of labiaplasty do exist, and they have powerful platforms. In 2007, a committee of the American Congress of Obstetricians and Gynecologists issued a statement warning about the lack of data regarding the safety and efficacy of "vaginal rejuvenation," "designer vaginoplasty" and similar procedures that are not medical necessary. The committee reaffirmed the statement in 2014.

Dr. Streicher, who has a public profile of her own, isn't entirely opposed to performing labiaplasties for non-medical reasons. "It’s a valid procedure in very specific women. I have a lot less problem with the 45 year old who comes to me and who’s had a couple of kids, is getting divorced, and is getting out there," she says. "I have a very different take regarding the 18 year old," especially if her labia is normal.

What about patients? Do they feel a stigma when they get labiaplasties? Their unwillingness to chat about their procedures with friends may provide a glimpse into their attitudes.

"Patient referrals are uncommon, and post-op patients do not talk," says John G. Hunter, M.D., FACS, a prominent labiaplasty surgeon in New York City, in his comments at The Aesthetic Meeting.

This level of reticence is unusual in the world of cosmetic surgery, he says, and requires surgeons to consider that "patients overwhelmingly get procedure information and seek consultations from the Internet."

What’s next? Boston’s Dr. Hamori says attitudes are changing, but slowly. "It is a long road," she says, "because of stern feminists who don’t understand that women themselves desire these procedures to feel better."

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