Lax labia majora or excess volume in a bikini?
Most of the time, the labia minora are the focus of attention, both from the patient and the surgeon. However, I believe that the labia majora play a very important role in the aesthetics of the intimate area. Excess tissue in this region compromises the entire female intimate surgery treatment if not addressed properly. As an intimate surgery specialist in Brazil with over 20 years of experience and more than 8,000 surgeries, I always assess the labia majora carefully and diagnose any possible excess in order to achieve the best possible result. I use the most modern techniques to treat hypertrophy, laxity, and asymmetry of the labia majora, safely and with excellent results. As a board-certified plastic surgeon, I welcome international patients from the United Kingdom and worldwide seeking medical tourism in Brazil for cosmetic surgery abroad, with dedicated support throughout their journey.
Indication
I assess the excess of the labia majora with the patient standing, a position in which laxity and volume become more evident. The labia majora may present excess skin, fat, or both -- caused by genetic factors, ageing, hormonal variations, pregnancies, or weight loss. Many patients report discomfort when wearing tight clothing, bikinis, or during physical activities and sexual activity. Both the skin and fat can be surgically reduced in a straightforward, painless procedure that exceptionally complements labiaplasty. Alternatively, if volume loss is the concern rather than excess, labia majora fat grafting may be more suitable.
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Pre-operative
The consultation
During the consultation, I assess you standing to check for excess skin or volume in the labia majora. Then, with you lying down, I analyse the relationship between the labia majora and minora and outline the most suitable surgical plan for your case. I explain the need to remove skin or fat, how this will be carried out, and what care is required after the surgery.
Investigations
For labia majora reduction surgery, I request the following investigations:
- Full blood count;
- PT with INR + APTT;
- Urea;
- Creatinine;
- Fasting blood glucose;
- Total proteins and fractions
- Vitamin D
- Vitamin C
- Urinalysis;
- ECG;
- Pre-operative cardiac assessment.
The anaesthesia
My preference is for total intravenous general anaesthesia in most cases. This form of anaesthesia allows for proper treatment of the intimate area without the need for infiltration with solution, which could distort the anatomy, and also permits a very rapid recovery at the end of the procedure. For cases where the patient has some difficulty with this type of anaesthesia, such as cervical disc herniation, I perform the surgery under spinal anaesthesia.
The surgery
Labia majora reduction can be performed together with labiaplasty. I begin by marking the tissue to be removed, both on the labia minora and majora when both are being addressed. I operate on the labia minora first and finish with the reduction of the labia majora. Pubic liposuction can also be added in the same session for comprehensive vaginal rejuvenation.
The marking on the labia majora is crescent-shaped, or semi-lunar, with the concavity facing the midline, so that the final scar sits precisely in the fold between the labia majora and minora -- becoming very discreet as healing progresses. Both skin and fat can be removed at this stage. In cases of excessive fat accumulation, I even remove subfascial (deep) fat. I take particular care with haemostasis during this surgery to avoid postoperative haematoma. The tissues are closed in layers and the sulcus is reconstructed. The surgery preserves local innervation, maintaining the sensitivity of the area.
Post-operative
Labia majora reduction is, like labiaplasty, virtually painless and has a very smooth recovery. I recommend the use of silver sulphadiazine ointment for one week to protect against infection, and I advise one month without physical activity and six weeks without sexual activity -- the same protocol as for labiaplasty. The patient is discharged on the same day.
Suture material
I use Vicryl sutures, which are absorbable. These sutures do not cause pricking in the post-operative period and do not leave residual material that could cause discomfort later, as can occur with nylon sutures, for example.
Final result
Immediately, a significant improvement in the area is noticeable, even with swelling. Approximately 80% of the result is visible at two months, but the final result is achieved after six months to one year, when healing is complete and the tissues have fully settled.
Frequently asked questions about labia majora reduction
What causes laxity or excess volume in the labia majora?
In my clinical experience, the principal factors are ageing, significant weight loss, genetic predisposition, pregnancies, and hormonal changes such as the menopause. These factors can cause laxity, excess skin, or fat accumulation in the labia majora, leading to aesthetic and functional discomfort.
How is the assessment for this surgery carried out?
I assess the patient standing, a position in which laxity and volume are more evident. Then, with the patient lying down, I analyse the relationship between the labia majora and minora and define the most suitable surgical plan -- whether it will be necessary to remove skin, fat, or both.
Does labia majora reduction surgery leave a visible scar?
The marking I use is crescent-shaped, positioned precisely in the fold between the labia majora and minora. In this way, the final scar is very discreet and practically imperceptible after complete healing.
What type of anaesthesia is used?
My preference is for total intravenous general anaesthesia, which allows treatment of the area without infiltration of solution -- which could distort the anatomy. In cases where the patient has a contraindication, such as cervical disc herniation, I perform the procedure under spinal anaesthesia.
Can labia majora reduction be performed together with labiaplasty?
Yes, I frequently combine the two procedures. I begin with labiaplasty and finish with the labia majora reduction, achieving a more balanced and complete result for the intimate area. Pubic liposuction can also be added in the same session.
Does the surgery affect the sensitivity of the area?
No. The technique I employ preserves local innervation, keeping the sensitivity of the intimate area intact. I take particular care with this aspect throughout the procedure.
What is the post-operative recovery like?
The recovery is very smooth and virtually painless. I recommend the use of silver sulphadiazine ointment for one week, one month without physical activity, and six weeks without sexual activity. The patient is discharged on the same day as the surgery.
What type of suture material is used?
I use Vicryl sutures, which are absorbable. These sutures do not cause pricking in the post-operative period and do not leave residual material that could cause discomfort, unlike nylon sutures, for example.
When shall I see the final result?
Immediately, a significant improvement is noticeable, even with swelling. Approximately 80% of the result is visible at two months, but the definitive result consolidates between six months and one year, when healing is complete and the tissues have fully settled.
When can I wear a bikini after the surgery?
After the initial healing, at around two to three weeks, it is already possible to wear a bikini comfortably. I recommend that my patients wait this period to ensure adequate healing.
Book your labia majora reduction consultation
Get in touch with my clinic in Londrina, Brazil and book your consultation. As an intimate surgery specialist trained at the Ivo Pitanguy Institute (SBCP, ASPS), I use refined techniques to provide natural, safe results. I welcome international patients from the United Kingdom and worldwide seeking cosmetic surgery abroad through medical tourism.
Labia majora reduction is frequently combined with labiaplasty for a more balanced result. Also learn about labia majora fat grafting for volume replacement, pubic liposuction, perineoplasty, and vaginoplasty. Find out more about pricing and online consultation.
Dr. Walter Zamarian Jr.
Consultant Plastic Surgeon in Londrina, Brazil
Rua Engenheiro Omar Rupp, 186
Londrina, Brazil
Postcode 86015-360
Brazil
YouTube Channel: Dr. Walter Zamarian Jr.
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