Labioplasty

A distinction is generally made between corrections of the inner labia (labia minora) and the outer labia (labia majora).

An inner labioplasty is defined as the correction of the labia minora. This usually entails the reduction of the labia minora, when they are too large or asymmetrical. In addition to the aesthetic concerns, enlarged inner labia can also lead to functional disorders such as physical irritation and pain during sports, cycling, when wearing tight clothing or during intercourse. Further adverse effects are psychological distress and sexual inhibitions towards the partner as well as avoidance behaviour in other social situations (e.g. swimming).

An external labiaplasty is defined as the correction of the labia majora, usually by an enlargement (labial augmentation). Reduced labial volume may be congenital or due to regression by aging and disease. Enhanced volume of the labia may be achieved by injecting the body’s own fat (lipofilling). If this is not available, then hyaluronic acid fillers can be used. Surplus skin can also be removed by surgical tightening. A reduction of the external labia, however, is rarely indicated.

Considerations

When to consider having an inner labioplasty:

• You feel that your inner labia may be too large or asymmetrical.
• The inner labia protrude considerably beyond the outer labia.
• The enlarged labia cause functional problems (mechanical irritation during sports, cycling or in tight clothing).
• The enlarged inner labia cause discomfort or pain during intercourse.
• You suffer emotionally from the enlarged labia minora and feel inhibited with your partner or in other situations (e.g. swimming, sport).

When to consider having an outer labioplasty or labial augmentation:

• Your outer labia are too small or sag.
• Because the outer labia are too small, your inner labia protrude considerably making them visually too prominent.
• The prominent labia minora cause functional problems (mechanical irritation during sports, cycling or in tight clothing).
• The increased exposure of the inner labia causes discomfort or pain during intercourse.
• You suffer emotionally from too small or drooping outer labia and feel inhibited with your partner or in other situations (e.g. swimming, sport).

Both an inner and outer labiaplasty can be combined with each other. The operation is basically possible at any age, unless there are severe underlying diseases which would tend to increase the risk of surgery. Usually the procedure is only performed once puberty is over and after the complete development of the external sexual organs. In special cases where there is severe functional or emotional distress, the procedure can be undertaken earlier. A prerequisite is the absence of hormonal or other health disorders that can affect the shape of the external sexual organs.

Consultation

A prerequisite to a successful operation is careful planning. This starts with a personal consultation at the AARE KLINIK.

• Communication of wishes and expectations ascertain what you would like to improve.
• Explanation of the possibilities and scope of the operation.

Examination:

• Medical history is taken.
• The gentital and external sexual organs are examined while standing and lying down.
• During the physical examination, particular attention is paid to the proportions of the outer and inner labia, local tissue quality and possible pathological changes.
• If necessary, additional tests will be performed (e.g. hormone evaluation, gynaecological examination).
• Measurements are made and digital photographs are taken that are subsequently used to ascertain the objective analysis of your surgery.
• Individual factors and personal wishes help in jointly deciding the choice of the appropriate surgical technique, the position of incisions and the resulting scars.
• Based on this, an individual treatment plan is developed and goals of the operation are discussed and defined.
• Risks and possible complications are discussed and documented.

To plan the operation and to make a risk assessment we require:

• Full medical history (pre-existing conditions and previous surgery).
• Current diseases (high blood pressure, diabetes, thyroid dysfunction).
• Allergies or aversion to medications.
• Any important medical reports.
• Please bring any important medical information.
• If you are planning to lose a significant amount of weight or to get pregnant, this should be considered when planning a labioplasty.
• It may be advisable to wait for the stabilisation of your weight or after pregnancy before surgery is undertaken.

Procedure

Individual factors and personal preferences determine the surgical technique chosen for a labioplasty.

1. Labial reduction (inner labioplasty)
Reducing the inner labia (labia minora) involves the removal of excess tissue and reshaping of the labia minora. They are not simply cut off, but the aim is always to ensure a natural look and to maintain function. Since the labia minora extend to the foreskin of the clitoris, it often makes sense to reduce or tighten the foreskin (preputioplasty), preserving an adequate coverage of the clitoris. This prevents an unpleasant overstimulation of the clitoris. The labia minora also extend to the perineum as a fold of skin (frenulum), which may reach the anus and may be elongated or asymmetrically formed. In these cases, a labioplasty can be combined with a frenuloplasty. If the inner labia are exposed due to an inadequate size of the outer labia, augmentation of the outer labia can be performed.

2. Labial augmentation/tightening (outer labioplasty)
The enlargement of the outer labia (labia majora) can be achieved by injecting autologous fat (lipofilling) or fillers (hyaluronic acid). Lipofilling involves taking fat from regions with fat deposits e.g. abdomen, hips or thighs and injecting it following adequate preparation. Since only small amounts of fat are needed, the fat harvest can be accomplished without visible changes at the donor site. The advantage of using adipose tissue is that it is the body’s own tissue, which is usually available in sufficient amounts and does not carry the risk of a foreign body. It can also be molded easily.
xcess skin and wrinkling of the labia majora can be corrected by a skin tightening procedure (outer labioplasty). A volume reduction of the outer labia is, however, rarely necessary.

Depending on the findings, inner and outer labioplasty can be combined with shaping of the mons veneris (monsplasty) using liposuction or skin tightening.

Risks

Preparation

Our aim is to make the time before and after your surgery as comfortable as possible. By following a few recommendations you can support our care:

• To aid the healing process, avoid smoking for two weeks before and after the operation.
• Avoid medication that increases the risk of bleeding, like aspirin, non-steroidal anti-inflammatory drugs, as well as vitamins and homeopathic remedies for two weeks prior to the operation.
• Labioplasty is mostly performed as an outpatient procedure under local anaesthesia.
• Make sure that you can be collected and cared for by someone for 24 hours after the procedure.
• In some cases (e.g. if labioplasty is done in combination with other procedures like liposuction or abdominoplasty) it may be recommended to stay overnight as an inpatient in hospital.

Day of surgery

In most cases, labioplasty is performed under local anaesthesia as an outpatient procedure at the AARE KLINIK. In individual cases, when necessary, the procedure can be undertaken in an affiliated private hospital.

• During surgery you will receive various medications for your wellbeing.
• Usually, labioplasty is performed under local anaesthesia.
• After surgery you will be taken to the recovery room, where you will have continued monitoring until you are fully awake and are able to get up.
• You will be allowed to return home after a few hours.
• If you are operated in the hospital, you will be taken from the recovery room to the ward where you stay under surveillance until the next day.
• Already on the day of the surgery you should get up regularly for a few minutes in order to minimise the risk of thrombosis.
• The level of pain after a labioplasty usually not severe and can be compared with muscle soreness.
• You are advised to take mild pain relief that reduces swelling and should be continued for several days after surgery.
• In case of an ambulatory procedure, you should have someone to care for you continuously for 24 hours postoperative.
• We also provide the option of an over-night inpatient stay at the AARE KLINIK in a single room with a personal nurse care, if needed.

After surgery

• It is important to realise that recovery from an operation varies for every individual.
• You should rest in the first days after the procedure.
• In the first few days after surgery you should not exert yourself physically and cool the area around the wound.
• To reduce the risk of thrombosis, you should regularly walk short distances, even if you are in slight discomfort.
• Only take the prescribed painkillers and avoid any medication that contains aspirin or other blood-thinning substances.
• In the first 2–5 days after the procedure, a feeling of tension and light pain will be felt in the region of the surgery.
• Pubic skin may feel temporarily numb and hypersensitive. This is usually temporary.
• However, it may take weeks or months, in some cases even longer for sensation to return to normal.
• Slight swelling and bruising in the area of surgery usually subsides within 2–3 weeks.
• Typically you will be able to resume most of your daily activities one week after surgery.
• After a few days you can shower as normal.
• Full baths and excessive heat (e.g. sauna), however should be avoided for several weeks until swelling has receded.
• Most stitches will dissolve by themselves and do not need to be removed.
• Non-dissolvable stitches are removed after one week.
• Activities that require prolonged sitting may initially be uncomfortable.
• Physically demanding activities and sport should be avoided for 4–6 weeks.
• Sexual intercourse should be avoided for 6 weeks.
• After surgery you will be examined at the AARE KLINIK at regular intervals, so that the healing process can be assessed until the final result is achieved.

Outcome

• Swelling and bruising may remain for some time after surgery.
• The healing process is gradual and it takes several months before the surgical result can be conclusively determined.
• Minor superficial wound complications occasionally occur as the skin of the labia minora is very delicate, but these usually heal spontaneously if the wound is properly cared for.
• Scars will fade and become hardly visible with time.
• Following labioplasty most women feel more self-confident and find it easier to wear tight-fitting clothes or swim suits.
• Although a labioplasty can eliminate functional symptoms such as inhibition or pain during sexual intercourse, an increase in the capacity for sensation or even an improvement of sexual function cannot be guaranteed.
• The result of a labioplasty is usually long lasting.
• The aging process, weight fluctuations, pregnancy and lifestyle continue to affect the outcome over time.

Costs

Labioplasty is usually an aesthetic procedure, in which case the costs have to be carried by the patient. In exceptional cases, where there is functional impairment, (e.g. chronic infection, pain or physical obstruction), the correction may be medically indicated. In this case, the treatment costs may be covered by the health insurance, if a prior cost estimation is given. The decision for, or against reimbursement depends on the recommendation of the medical officer in each individual case.

The costs of an aesthetically motivated labioplasty are variable and mainly depend on the complexity of the operation and the facility in which the surgery is performed (hospital or AARE KLINIK). A more accurate cost estimate can therefore be made only after a personal consultation.

The costs are composed of:

• Surgical fee (including consultation and post-operative care)
• Anaesthesia fee
• Technical infrastructure costs (AARE KLINIK/hospital)
• Inpatient hospital costs
• Medication
• Diagnostics (laboratory, ECG, scans, etc.)

Appointments for labioplasty with Dr. Scheufler in Bern

Before any intimate surgery you should have a comprehensive consultation and additional examination. Only in this way can you be sure whether the type of surgery will lead to the result you expect. In addition, your consultation will give you a good impression of our experience in the field of intimate surgery. Feel free to ask for before and after photos to get an idea of what the results look like.

PD Dr. Oliver Scheufler, board certified plastic, reconstructive and aesthetic surgeon and author of this website, is pleased to be at your service for a personal consultation. Besides his main occupation at the AARE KLINIK, Dr. Scheufler is also scientifically active and lectures at the University of Basel. He also was a visiting professor at Duke University (USA). Please do not hesitate to contact him if you wish a professional consultation!