Labiaplasty - Surgical Technique

Surgical Technique

Labiaplasty by de-epithelialization

Labial reduction by de-epithelialization cuts and removes the excess tissues and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and so preserves the capabilities for tumescence and sensation. Yet, when the patient presents much excess labial tissue, a combination procedure of de-epithelialization and clamp-resection usually is more effective for achieving the aesthetic outcome established by the patient and her plastic 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.

Pre-operative matters

• Consultation — To understand the aesthetic goals of the patient, the plastic surgeon evaluates the labial hypertrophy that the woman presents when standing. Afterwards, in the operating room, with the patient in the lithotomy position (as if for a urinary-bladder stone-removal surgery), the surgeon then delineates the resection-pattern markings (incision plan) to each side of each labium (lip) to facilitate the de-epithelialization required for reducing its size (length and width). Afterwards an anaesthetic solution is infiltrated to the labial tissues to numb and swell them for easy resection of the excess tissues. As required by the patient’s health, the physician–surgeon might instruct the woman to take oral antibiotic and anti-inflammatory medications before the operation; if not, they are intravenously administered to the patient at the start of the labiaplasty operation.

Operative technique

For the optimal exposure of the vulvo-vaginal complex, the patient is positioned upon the operating table in the lithotomy position. After confirming regional anaesthesia and labial tumescence, the surgeon then cuts and removes (resects) the excess tissues of the labia minora. After the resection step, the suturing of the surgical wound is the procedural step that most influences the aesthetic outcome of the labial reduction — suturing the tissues of the labia minora with a running absorbable-suture occasionally produces a scallop-edged surgical scar-line, whereas suturing the tissues with a running buried-suture usually produces a wound closure (scar-line) of natural appearance.

Post-operative matters

• Convalescence — Post-operative pain and surgical-wound care are minimal, which conditions permit the woman to leave hospital and return home the same day she underwent the labial reduction procedure; 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 often are very swollen during the early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues. She also is instructed on the proper cleansing of the surgical-wound site, and the application of a topical antibiotic ointment to the reduced labia; a wound-care regimen observed 3-times daily for 2-days post-operative.

• Follow-up therapy — The woman’s initial, post-labiaplasty consultation with the plastic surgeon is recommended at 1-week post-operative. She is advised to return to the surgeon’s consultation room should she develop hematoma, an accumulation of blood outside the pertinent (venous and arterial) vascular system. In accordance with her wound-healing progress, the woman can resume physically un-strenuous and undemanding work at 3–4 days post-operative. Moreover, to allow the full and proper healing of the labiaplasty surgical wounds, the woman is instructed to not use tampons, to not wear tight clothes (e.g. thong underwear), and to abstain from sexual intercourse for 4-weeks post-operative.

Complications

Medical complications to a labiaplasty procedure are uncommon; yet the occasional complications — bleeding, infection, labial asymmetry, poor wound-healing, undercorrection, overcorrection — do occur, and might require a revision surgery. An over-aggressive resection might damage the nerves, which condition subsequently causes painful neuromas. Furthermore, performing a flap-technique labiaplasty occasionally presents a greater risk for necrosis of the labia minora tissues.