Labiaplasty

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Labiaplasty is plastic and reconstructive surgery technique for modifying, creating, or repairing the external folds of skin surrounding the structures of the vulva — either the labia majora and/or the labia minora. It can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.[1]

There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), and other intersex conditions; and those with no underlying condition who wish to alter the appearance of their genitals because they believe they do not fall within a normal range.[2] Non-cosmetic conditions addressed by labiaplasty include tearing and stretching of the labia minora caused by childbirth and or by injury.

In genital realignment surgery for trans women, the surgery allows for the creation of labia where once there were none.

Indications

Candidates include women with enlarged inner and outer vaginal lips that cause pain or self-consciousness. For example: discomfort occurring from chronic labial irritation that develops from tight clothing, sex, sports or other physical activities. Rarely it is performed to correct female genital mutilation.

An unfortunate effect of the availability of pornography has lead many women to believe their vulva are not desirable to their partner resulting in unneeded surgery. Surgery for these demands, sometimes referred to as "vaginal rejuvenation”, is often two combined distinct surgeries of labiaplasty and vaginoplasty, to restore or enhance the vagina's cosmetic appearance or function.

For trans women, labiaplasty is frequently the second part of a two-stage vaginoplasty, where the labia minora and a clitoral hood are created. This is often performed a few (at least 3) months after the first part of the procedure. In some cases, labiaplasty is an elective procedure to improve appearance after a one-stage vaginoplasty.

The posterior fourchette (most distal/rear part or the labia minora where it intersects with the vaginal opening) must be fabricated during secondary labiaplasty due to complications of infection and/or dilation after vaginoplasty.

Contraindications

Labia reduction surgery is relatively contraindicated for the woman who has active gynecological disease, such as an infection or a malignancy; the woman who is a tobacco smoker and is unwilling to quit, either temporarily or permanently, in order to optimize her wound-healing capability; and the woman who is unrealistic in her aesthetic goals. The latter should either be counselled or excluded from labioplastic surgery. Davison et al write that it should not be performed when the patient is menstruating to reduce potential hormonal effects and the increased risk of infection.[3]

Surgery

Edge resection technique

The original labiaplasty technique was simple resection of tissues at the free edge of the labia minora. One resection-technique variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostatis (stopped blood-flow), and the surgeon resects the tissues, and then sutures the cut labium minus or labia minora. The technical disadvantages of the labial-edge resection technique are the loss of the natural rugosity (wrinkles) of the labia minora free edges, thus, aesthetically, it produces an unnaturally “perfect appearance” to the vulva, and also presents a greater risk of damaging the pertinent nerve endings. Moreover, there also exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. The advantages of edge-resection include the precise control of all of the hyper-pigmented (darkened) irregular labial edges with a linear scar that can also be used to contour the redundant tissues of the clitoral hood, when present.[4][5][6][7][8][9]

Central wedge resection technique

Labial reduction by means of a central wedge-resection involves cutting and removing a full-thickness wedge of tissue from the thickest portion of the labium minus.[5] Unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural rugosity (wrinkled free-edge) of the labia minora. Yet, because it is a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness. F. Giraldo et al. procedurally refined the central wedge resection technique with an additional 90-degree Z-plasty technique, which produces a refined surgical scar that is less tethered, and diminishes the physical tensions exerted upon the surgical-incision wound, and, therefore, reduces the likelihood of a notched (scalloped-edge) scar.[10][11] The central wedge-resection technique is a demanding surgical procedure, and difficulty can arise with judging the correct amount of labial skin to resect, which might result in either undercorrection (persistent tissue-redundancy), or the overcorrection (excessive tension to the surgical wound), and an increased probability of surgical-wound separation. Moreover, as appropriate, a separate incision is required to treat a prominent clitoral hood.

De-epithelialization technique

Labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minor (small lip), either with a scalpel or with a medical laser. This labiaplasty technique reduces the vertical excess tissue, whilst preserving the natural rugosity (corrugated free-edge) of the labia minora, and thus preserves the sensory and erectile characteristics of the labia. Yet, the technical disadvantage of de-epithelialization is that the width of the individual labium might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction.[12]

Labiaplasty with clitoral unhooding

Labial reduction occasionally includes the resection of the clitoral prepuce (clitoral hood) when the thickness of its skin interferes with the woman’s sexual response. The surgical unhooding of the clitoris involves a V–to–Y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves); thus, uncovering the clitoris further tightens the labia minora.[13]

Laser labiaplasty technique

Labial reduction by means of laser resection of the labia minora involves the de-epithelialization of the labia. The technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts.[14]

Labiaplasty by de-epithelialization

Labial reduction by de-epithelialization cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and preserves the capabilities for tumescence and sensation. Yet, when the patient presents with much labial tissue, a combination procedure of de-epithelialization and clamp-resection is usually more effective for achieving the aesthetic outcome established by the patient and her surgeon. In the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de-epithelialization labiaplasty includes an additional resection technique — such as the five-flap Z-plasty (“jumping man plasty”) — to establish a regular and symmetric shape for the reduced labia minora.[3]

Risks

Risks are typical with surgical procedures on skin surfaces and include:

  • Infection
  • Bleeding and hematoma (break in blood vessel, causing localized blood-filled area or blood clot).
  • Temporary numbness with possibility of reduced feeling in the vulva.
  • Undesired aesthetics such as asymmetry between the inner and outer labia lips, pigmentation changes, and puckering or creases of the skin.
  • Excess scar tissue buildup (appearing as lumps on the treated area).
  • Sexual dysfunction from numbness and/or scar tissue formation.

Post-operative care

Post-operative pain is minimal, and the woman is usually able to leave hospital the same day. Usually, no vaginal packing is required, although she might choose to wear a sanitary pad for comfort. The physician informs the woman that the reduced labia are often very swollen during the early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues. She is also instructed on the proper cleansing of the surgical wound site, and the application of a topical antibiotic ointment to the reduced labia, a regimen observed three times daily for two days after surgery.[3]

Criticism

The American College of Obstetricians and Gynecologists published Committee Opinion No. 378: Vaginal “Rejuvenation” and Cosmetic Vaginal Procedures (2007), the college’s formal policy statement of opposition to the commercial misrepresentations of labiaplasty, and associated vaginoplastic procedures, as medically “accepted and routine surgical practices”. The report doubted the medical safety and the therapeutic efficacy of the surgical techniques and procedures for performing labiaplasty, vaginal rejuvenation, the designer vagina, revirgination, and Gräfenberg Spot amplification, and recommended that women seeking such genitoplastic surgeries must be fully informed, with the available surgical-safety statistics, of the potential health risks.[15]

External links

References

  1. Mirzabeigi MN, Moore JH, Mericli AF, et al. (February 2012). "Current trends in vaginal labioplasty: a survey of plastic surgeons". Ann Plast Surg 68 (2): 125–34. doi:10.1097/SAP.0b013e31820d6867. PMID 21346521.
  2. Lloyd, Jillian et al. "Female genital appearance: 'normality' unfolds", British Journal of Obstetrics and Gynaecology, May 2005, Vol. 112, pp. 643–646. PMID 15842291
  3. 3.0 3.1 3.2 Davison S.P. et al. "Labiaplasty and Labia Minora Reduction", eMedicine.com, 23 June 2008.
  4. (1984) "Aesthetic Vaginal Labioplasty". Plastic and Reconstructive Surgery 74 (3): 414–6. doi:10.1097/00006534-198409000-00015. PMID 6473559.
  5. 5.0 5.1 (1998) "A New Technique for Aesthetic Labia Minora Reduction". Annals of Plastic Surgery 40 (3): 287–90. doi:10.1097/00000637-199803000-00016. PMID 9523614.
  6. (2005) "Central Wedge Nymphectomy with a 90-Degree Z-Plasty for Aesthetic Reduction of the Labia Minora". Plastic and Reconstructive Surgery 115 (7): 2144–5; author reply 2145. doi:10.1097/01.PRS.0000165466.99359.9E. PMID 15923876.
  7. (2000) "Hypertrophy of labia minora: Experience with 163 reductions". American Journal of Obstetrics and Gynecology 182 (1 Pt 1): 35–40. doi:10.1016/S0002-9378(00)70488-1. PMID 10649154.
  8. (2007) "Aesthetic Labia Minora Reduction with Inferior Wedge Resection and Superior Pedicle Flap Reconstruction". Plastic and Reconstructive Surgery 120 (1): 358–9; author reply 359–60. doi:10.1097/01.prs.0000264588.97000.dd. PMID 17572600.
  9. (2000) "Functional and Aesthetic Labia Minora Reduction". Plastic & Reconstructive Surgery 105 (4): 1453–6. doi:10.1097/00006534-200004040-00030. PMID 10744241.
  10. (2004) "Central Wedge Nymphectomy with a 90-Degree Z-Plasty for Aesthetic Reduction of the Labia Minora". Plastic and Reconstructive Surgery 113 (6): 1820–1825; discussion 1826–1827. doi:10.1097/01.PRS.0000117304.81182.96. PMID 15114151.
  11. Alter GJ. A New Technique for Aesthetic Labia Minora Reduction. Annals of Plastic Surgery. 1998 March;40(3);287–290
  12. (2000) "A New Method for Aesthetic Reduction of Labia Minora (the Deepithelialized Reduction Labioplasty)". Plastic & Reconstructive Surgery 105: 419–422; discussion 423–424. doi:10.1097/00006534-200001000-00067.
  13. Alter GJ. Aesthetic Labia minora and Clitoral Hood Reduction using Extended Wedge Resection. Plastic and Reconstructive Surgery. December 2008. 122(6):1780–1789.
  14. Pardo J, Solà V, Ricci P, Guilloff E. Laser Labioplasty of Labia minora. International Journal of Gynaecology and Obstetrics. 2006 April;93(1)38–43
  15. American College of Obstetricians and Gynecologists (2007). "Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures" (PDF).

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