video on Labiaplasty
More information about labiaplasty, including more before and after pics, is available by clicking here.
Labiaplasty is a procedure to reduce the extra tissue, primarily of the labia minora (inner or smaller lips), but sometimes also of the labia majora (outer or larger lips). Women seek labiaplasty for a wide range of reasons.
For some patients, the labia are large enough to become caught under clothing, and can be quite uncomfortable. This is often especially noticeable when exercising. There have been many women who especially notice that problem when biking or spinning
Also, with modern shaving / hair removal in the pubic area, the labia are more visible than they used to be. As a result, they can protrude, and that can be visible. In fact, modern clothing can be tight enough that the protruding labia minora produce a bulge that is visible through clothing.
For other women, the enlarged labia can get caught during sexual relations, which can be uncomfortable and unpleasant.
For all of these reasons, Dr. Nachbar has been doing labiaplasty for over fifteen years, and has a great deal of experience with labiaplasty. Modern techniques allow a much more precise result, reducing and tightening the central portion of the labia minora (often the part most affected), but also tightening the excess tissue over the clitoris, called the "clitoral hood".
As you are considering labiaplasty, be sure to consider what your goals are. If the only problem is that the labia minora protrude and get caught, and appearance is not a concern, a simple "trimming" (or "amputation") procedure, as performed by many gynecologists, may be adequate. However, I have seen women come to my office who have had that procedure, and as a result had loss of most or all of the central labia, while there is still excess tissue in front and in back. While this can be evened out somewhat, it is largely uncorrectable.
Occasionally I may use the "trimming" procedure under rare circumstances, but almost always I use a "wedge" procedure, which allows preservation of the delicate edge of the labia minora (which is sacrificed in the amputation technique), tightening of the remainder of the labia, and reduction of the extra tissue at the clitoral hood. Most women are more concerned with the appearance from the front while they are standing, and of course, it is the tissue over the clitoris which is primarily visible from the front. Thus, if the clitoral hood is not reduced and tightened, there will still be some excess tissue visible from the front
In addition to labiaplasty, which primarily improves the labia minora, the ThermiVa procedure allows improvement of the labia majora, as well as inside the vagina. Women have been reporting that ThermiVa results in tightening of loose tissues of the vagina, improvement in moisture, improvement in sensitivity, and improvement in mild cases of stress urinary incontinence. Thus, labiaplasty and ThermiVa are complementary, each adding to the result.
Most women who desire labiaplasty are interested in leaving some labia minora tissue, but others want a more complete removal of almost all of the labial tissue, sometimes called a "Barbie Labiaplasty". For the right patient, that can be an excellent procedure.
Schedule a consultation with Dr. Nachbar in Scottsdale, AZ to learn more about the benefits of labiaplasty and find out if you are a candidate. You can even speak with our staff members who have had labiaplasty performed by Dr. Nachbar.
A labiaplasty at Scottsdale Plastic Surgery by Dr. Nachbar may be helpful for women who are concerned about the shape or size of their labia, which may be enlarged due to genetics, childbirth, or trauma.
Abnormally enlarged labia may cause pain, discomfort, itching, or irritation during physical activities like exercise and sex. A labiaplasty may also help if you don't wear tight clothes (such as leggings, swimsuits, or tight pants) because of the visibility of this area.
"Labiaplasty - I thought he was fantastic. First impression I was blown away to say the least. Office is beautiful, clean and polished. He was very knowledgable and answered every question and concern of mine. I know he is going to be the perfect surgeon. Truly cannot wait to have my procedure and see my results!"- Anonymous / RealPatientRatings / Aug 10, 2017
"I went to Dr. Nachbar for a labioplasty. I immediately felt at ease after my first visit. Every question and concern was answered. I scheduled the surgery without hesitation. The surgery went extremely well and I couldn't be happier with the results. I am truly 100% satisfied. I am so happy I chose to have this surgery performed, and also with my choice to go with Dr. Nachbar. Every step of the process made me feel comfortable and I can't think of one complaint. I thought it was wonderful that you never had to wait for an appointment, appointments are readily available and the staff and doctor were there hand and foot for anything you may need. I would definitely recommend Dr. Nachbar."- Google User / Google / Oct 18, 2011
"Labiaplasty, scar revision, fat transfer to breasts - Scottsdale, AZ - Over the last few years I have been reading about labiaplasty partially for cosmetic reasons but mostly for comfort and a more positive sexual experience. The tugging of the excess skin was the biggest issue for me. I was considering a few different doctors, but after meeting Dr. Nachbar last year I felt that I did not need to continue looking for a doctor. It's not the most enjoyable..."- 4. / RealSelf / Jun 24, 2017
"Labiaplasty (33, 2 Kids) - Scottsdale, AZ - Amazing! Gave me back my self esteem. Looks perfect!"- L. / RealSelf / Sep 12, 2016
"Labiaplasty - Friendly, informative, caring, specialized."- Anonymous / RealPatientRatings / Apr 08, 2015
Labiaplasty is a very delicate procedure performed on a very delicate area. While it may be possible to do a simple "trimming" labiaplasty under local anesthetic, most patients will get a better result with a more complete "wedge" labiaplasty. Because the wedge labiaplasty passes within a few millimeters from the clitoris, Dr. Nachbar uses a real operating room, general anesthetic, and surgical telescopes to perform the procedure. This is definitely a procedure you want to get right the first time.
The Wedge Labiaplasty involves removing the central, most enlarged portion of the labia minora, bringing the tissue from the back up to the front. The wedge extends a short distance into the vaginal opening, and for patients with an enlarged clitoral hood area, it extends alongside the clitoral hood to tighten the clitoral hood without making an incision directly over the clitoris.
Every plastic surgery is customized for each patient. Some patients want a more complete, or "Barbie," labiaplasty, removing a larger portion of the labia minora for a very "clean" look. Others have noticed enlargement of the outer lips, or "labia majora," and reduction of the labia majora can also be incorporated into labiaplasty.
Detailed Technique / Video Script
We are producing a surgical video of the labiaplasty procedure, which we will post soon. Here is the script we are working on, with lots of detailed information about labiaplasty and how it is performed.
Look for our video, coming soon!
Hello. I’m Doctor James Nachbar. I am a plastic surgeon in Scottsdale, Arizona. Today, we are going to perform three labiaplasty cases using the wedge technique.
Before we begin, I want to tell you that this is a very explicit video, with detailed views of female genital anatomy as well as surgery of that area. If you are less than 18 years old, or if you might be disturbed by surgical video or blood, please stop watching now. Viewer discretion is advised.
Techniques for labiaplasty have advanced significantly over recent years, and that, combined with modern grooming and clothing styles, has made labiaplasty a very popular procedure.
Women seek labiaplasty for a variety of reasons. With the popularity of hair removal in this area, the labial area is much more visible from the front view than it had been in the past. As a result, any problems in this area are also much more visible.
Modern clothing styles are often very tight in this area, and many women are concerned that they have a noticeable bulge from excess tissue in the labial area. Enlarged and lengthened labia can also get caught in clothing, exercise, or sex, causing a functional problem as well. For all of these reasons, many women seek labiaplasty to improve this area.
However, although women may seek labiaplasty for similar reasons, every woman has a different configuration of the various portions of the female anatomy, and labiaplasty is always tailored to the specific needs of each woman. The various areas that should be evaluated in making the treatment plan include the labia minora, or inner lips, the labia majora, or outer lips, and the clitoral hood area, which is the area in front, covering the clitoris. Also, we must evaluate the perineal area, which is the area between the vaginal opening and the anal opening, and the part of the labia at the back of the vaginal opening. Any or all of these areas can be adjusted to give the best result for each woman.
Most woman want a natural look, just with less extra tissue. Some women, however, want a very clean “Barbie” look, with removal of as much of the labia minora as possible, especially toward the back of the vaginal opening. Be sure to discuss exactly what you want with your surgeon, so we can give you the result you are looking for.
As you are considering labiaplasty, be sure to look at lots of detailed before-and-after photos, and look at them critically. When you do, you will see that some surgeons’ labiaplasty results are much nicer than the results of others. For example, when looking at before-and-after photos, you will want to ensure that, unless the goal was to remove as much labial tissue as possible, the remaining labia look natural. I have seen surgical results online that actually show more of an amputation result, with removal of too much labia minora. Of course, some patients may want that result, but if so, the surgeon should include that information with the before-and-afters.
We do have dozens of before-and-after photos on our website at plastic.org, many with very detailed views, so please take a look at those.
I do the more complex wedge-type labiaplasty at a real accredited surgery center, and under general anesthesia with a physician anesthesiologist, because I believe that setting gives you the best chance for the best result the first time. This is definitely a surgery you want to get right the first time.
The wedge-type labiaplasty technique takes an hour or longer and involves incisions within a few millimeters of the clitoris. By using a real surgery center under general anesthetic, I know you will be in the safest-possible setting, and that you will be comfortable and will not move during this delicate procedure, and I will have the best possible lighting, exposure, and help. Remember, we are cutting within a few millimeters of your clitoris, so this is not a time to move. I also use surgical telescopes for all labiaplasty procedures, so I can clearly see every tiny detail.
The surgical center has professional cradles for your legs, to ensure that excess pressure is avoided. We also use alternating pressure pumps on your calves during the procedure, to reduce the chance of getting a blood clot during surgery.
On the other hand, simpler labiaplasty procedures, such as labia majora or perineal procedures, or trim-type labiaplasty, can sometimes be performed in the office under local anesthesia.
This first patient has quite a bit of enlargement of the labia minora, with significant excess tissue at the clitoral hood area as well. You can see the elongation of the labia minora. The design of this wedge labiaplasty will preserve the normal free edge of the labia minora in the posterior, or back, part of the labia minora. Therefore, I will remove the elongated central labial tissue, and bring the more normal labia minora forward, so the labia minora that remain are smooth and natural. The front incision is only a few millimeters behind the frenulum of the clitoris, and this design removes the tissue between those two areas. The inner closure is then hidden inside the vaginal canal, and the outer closure often extends forward on each side of the clitoral hood, pulling the central clitoral hood tissue to the sides and tightening this area, without cutting anything in the midline or over the clitoris itself.
Women often ask about clitoral sensation when clitoral hood tightening is performed. The clitoris has its two main dorsal sensory nerves, one on each side, going forward and deeply with the vascular tissue that then runs along the pelvic bone to the pudendal nerve, which then enters the spinal canal at the sacrum. The way I perform this procedure, I never come close to the clitoral nerves.
In addition to the clitoris, the other midline structure that must be carefully preserved is the urethral opening, which is where the urine comes out. If this area were to be injured in surgery, it could cause significant problems, including urinary retention, or incontinence or leaking. To be absolutely certain the urethral opening is protected, I put a Foley Catheter through the urethra into the bladder at the beginning of a wedge labiaplasty, and I leave it in place during the procedure, so the urethral opening is always completely visible and protected.
I then carefully mark the surgical plan. This is harder than you might think. The tissue is very soft and moist and has often been compared to operating on wiggly gelatin. I first carefully check the amount of excess tissue and determine the front and back level of the wedge excision at the free margin of the labia minora. On the outer part of the labia minora, the back incision passes forward, just like the front incision passes forward, so we can remove the excess tissue between them. On the inner part of the labia minora, the excision passes a short distance into the side of the vaginal canal on each side, where it remains hidden.
Once the markings have been done, I make some superficial cuts, to ensure that I can see where I want to put the incisions, even if the surgical ink comes off. This is important because, once the local anesthesia is injected, the tissue will become distorted.
This is one of the other advantages of using general anesthesia, because it would not be possible to make these score marks before injecting the local anesthesia unless the patient were already asleep. Because this tissue is so soft, injection of local anesthetic necessarily distorts the tissue. The goal is to do this delicate procedure without compromise, and general anesthesia is better for that.
Then, I inject local anesthetic, both to reduce discomfort after surgery and also to minimize any bleeding that might occur during the surgery.
Once the local anesthesia has been placed, I make the mucosal incisions and start the dissection. I then use a fine scissors to start removing the tissue. At the sides of the clitoral hood area, only a very superficial amount of tissue is removed, because that is all that is needed to tighten the clitoral hood. In general, we want to preserve as much normal tissue as we can.
However, along the free margin of the labia minora, most women need removal of some of the deeper tissue. This is especially important for women who notice a bulge in clothing, because unless this bulging tissue is reduced, removing the mucosa alone will not adequately reduce the fullness, potentially leading to a disappointing result.
The two labial margin incisions are then deepened with a scissors, and connected to the front part of the excision, and the tissue is removed. The same procedure is done on the other side.
Then, it is important to control any bleeding spots to reduce the chance of bleeding occurring after surgery. This is done with a delicate radio-frequency electrocautery device at a low setting. Once any bleeding has been controlled, closure is carefully performed in layers. First, the deeper closure is begun using absorbable suture. The first suture lines up the main closure, but then many other additional supporting sutures are used. It is very important that this deep layer is strong, in order to ensure that the closure cannot be pulled apart, and also to eliminate any pockets where blood or fluid could otherwise accumulate after surgery.
Once the deeper sutures have been placed, the mucosal layer is already almost closed, as you can see. A continuous mucosal closure is then done in two portions, one for the outside of the labia minora and one for the inside.
Then, closure is begun on the opposite side. The deep closure is done first. Following that, the mucosal closure is done.
Once the closure is complete, the reconstruction is inspected, and the Foley catheter is removed.
Here you can see the immediate result. You can see how nicely the clitoral hood tissue has been tightened, as well as the nice, normal-looking remaining labia minora tissue behind the wedge excision. You can also see how the inner closure is hidden inside the vaginal canal. Of course, if this woman had had excess tissue in the labia majora area, that area could have been addressed as well. Again, every labiaplasty is tailored to each woman’s needs and desires.
Here is our second labiaplasty patient. She has a clitoral hood piercing in place, which we will remove for the surgery.
To make management of the piercing easiest for the patient, we will wait until she is asleep, and then I unscrew the ball on one end of the piercing and slide the piercing out.
Here you can see the main, curved bar of the piercing, and the ball for the end of the bar.
The labiaplasty is then performed similarly to the previous patient, although this woman does not have as much excess labial tissue as the first one.
After the excess tissue is removed, closure is performed.
Once the closure is done, the Foley catheter is removed, and then the piercing is replaced.
Here you can see where the piercing goes, under the edge of the prepuce and through the opening. The forceps is shown going through the hole for the piercing.
The piercing is then put back into place, and the ball screwed back on the end to hold it in place.
And, here you can see the final result at the end of surgery with the piercing in place.
This is our third labiaplasty patient today. This woman also has excess labial and clitoral hood tissue, but in addition has two small skin tags between the vaginal opening and the anus that she wanted to be removed at the same time as her labiaplasty. Therefore, that excess tissue was removed at the beginning of the procedure.
The labiaplasty is then performed by removing the excess tissue and then closing the wedge.
After the labiaplasty is closed, the skin tag incisions are closed with absorbable suture as well.
And here is the final result at the end of surgery.
I hope this has been helpful to you in understanding wedge-type labiaplasty. Again, I encourage you to critically look at lots of before-and-after photos. Close-up views are important, and make sure that the tissue that remains after the labiaplasty looks normal, unless, of course, the patient requested a more complete removal.
We do not charge for our cosmetic consultations, so if you are considering labiaplasty, before you make a decision, I urge you to call my office at 480-289-5300 to set up your complementary consultation. You can also go online at plastic.org to schedule an appointment 24/7.
I see many patients from outside the Scottsdale area as well, and for patients outside our local area we can do telemedicine consultations. We look forward to helping you achieve your goals.
What to Expect
There is not usually very much pain after labiaplasty, but there can be some swelling, and the use of ice to reduce the swelling after surgery may be helpful. If ice is used, it is important not to leave it in place for more than 15 minutes, and leave it off for 15 minutes between cooling sessions, in order to reduce the risk of frostbite from the ice.
Some bleeding from the incision is to be expected for several days after the procedure, so women generally use a pad to collect any bleeding. You should avoid putting a tampon into the vagina during this early post-operative period, and of course, a tampon will not catch bleeding from the labia.
After surgery, you should avoid direct pressure on the labial area, as while spinning or riding a bicycle, until the area is well healed. However sitting is not usually affected.
We recommend that you avoid sex for eight weeks after surgery, as we know that it takes that long to get maximal strength of healing after any surgery.
Plan Your Procedure
Comfortable and Confident
If you do not feel comfortable or confident because of the size and shape of your labia, learn more about labiaplasty. We have dozens of sets of photos of labiaplasties on our website. These include photos both standing and also direct photos, as women have requested that I post them. I thank the patients who have agreed to let us show their photos, and patients have thanked me for having posted them.
Then, talk to plastic surgeon Dr. James Nachbar about your concerns and goals so he can create your custom treatment plan for your specific needs. Schedule a consultation with Dr. Nachbar at Scottsdale Plastic Surgery in Scottsdale, AZ to learn more about vaginal rejuvenation with labiaplasty.