Laguna Beach, CA
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Aesthetic Vulvovaginal Surgery Considerations
May 21, 2013 2:39 PM
Your photos are very helpful and tell me quite a bit on what may be bothering you. First of all, your labia are all within the wide range of normal and you do not have to have any surgery
Your photos are very helpful and tell me quite a bit on what may be bothering you. First of all, your labia are all within the wide range of normal and you do not have to have any surgery done if you have no discomfort or symptoms of pain, pulling, social unease. The large majority of women do not need anything done and most live with these variations of normal. If the physical discomfort of pulling and tugging and pain bother you then you can consider labial reduction surgery. If you have social and personal confidence issues that disrupt your self esteem or personal relationships then you may consider surgery. By the time many women see me they have addressed these issues and may have even had counseling to help them deal with the non-medical issues. Once these have been resolved and surgery is considered then you should find a well trained, well respected, and full-time labial/vaginal surgeon. My bias is obvious in that you should have a surgeon who does nothing this type of surgery in the huge majority of his or her work. That is how I would choose my surgeon if i was having something done. I would go to a shoulder specialist if my shoulder needed repair. I would not go to a generalist. I would not go to someone who is remarkable with hands or knees. Makes sense to me. Once you choose your consultant surgeon you should pick their brains, ask about their techniques and why they do what they do. Ask where they trained and who trained them then do research on those instructors. Being trained by a famous gynecologist or a famous plastic surgeon means little if that famous surgeon was not famous for the type of surgery skill they imparted on the student surgeon. Consult with more than one specialist if you can. Fly or drive to wherever they are. Do not be restricted by geography if you can afford it.
Once you have your info you then get to stress to the surgeon what bothers you most. Don't let the surgeon say "I think you should do this and that" when they examine you without your actual input of what is bothersome to you. Get specific. Get a plan of action.
Now for your case, before I even get to see you personally or find out what is the most bothersome symptom or appearance to you, and just bey evaluating the photos you send, I can make a generalization. Here it is: you have a bulky appearing vulvar area with thick labias. This gives the pulling down and heavy sensation. I would recommend a surgical reduction in size and mass. i would also reduce the clitoral hood skin and leave the clitoris alone. If the labia majora was also an issue and bothersome then a modest majoraplasty can also improve the youthfulness of the genital region. You can even use non-surgical radiowaves to shrink up the labia major so that it feels fuller and does not hang down like tired upholstery. When you do decide on surgery, consider gentle awake sedation and local anesthesia for best safetly.
Here are my biases out on the open: Avoid wedge labiaplasty for most cases because of the higher breakdown rates. Use the wedge only if you want to maintain the dark edges of the labia and not just want a reduction in size. In general, go with the curved linear resection technique. Plastic surgeons like to demean that technique and refer to it as "amputation." Really puts the fear in you hearts doesn't it :). As for my bias on the clitoral hood, do the reduction laterally and not on TOP of the hood area. Those anterior hood scars can become firm and tender unlike the lateral scars that are hidden in the crease and soften dramatically with time. One more thing, stay away from the costly surgery centers and avoid the anesthesiology fees if possible. Find a surgeon who is skilled in awake, no IV, local anesthetic surgeries. That is the state-of-the-art. I am sure not everyone will agree with me but I am being honest and saying it as I see it.
Hope this helps.
Red Alinsod, MD