Do your labia minora appear larger than they should?
The intimate area has a significant impact on a woman's self-confidence. Changes such as enlarged labia minora can cause discomfort during physical activities, when wearing certain clothes, or during sex. If you feel your labia minora are larger than they should be, know that this is far more common than you might imagine -- and there is an effective treatment. Labiaplasty (labia reduction) is the plastic surgery procedure for reduction of the labia minora, with a quick recovery and virtually no pain. I am a Consultant Plastic Surgeon in Brazil, trained by the late Professor Ivo Pitanguy in Rio de Janeiro, and I am an intimate surgery specialist with over 20 years of experience and more than 8,000 surgeries performed. I travelled to the United States to learn the wedge technique personally from its creator, Dr. Gary Alter. Whether you are local or an international patient considering medical tourism in Brazil for cosmetic surgery abroad, I can recommend the best approach for your case, offering excellent results through a safe and straightforward procedure.
Indication
Patients with excess of one or both labia minora are candidates for labiaplasty, also called labioplasty. The most common concerns include discomfort when walking, engaging in sports, or wearing tight clothing, chronic irritation, pain during sexual activity, and aesthetic dissatisfaction. The excess can be upper, lower, symmetrical, asymmetrical, small, large, involve the clitoral hood (prepuce) -- the skin covering the clitoris -- or not, thin, thick, dark, or pink. There are various variations of the labia minora, and one of them may be bothering you. During the consultation, I assess whether it is a case that can be improved with surgery. The indication takes into account the overall condition of the intimate area and may require concurrent treatment of other aspects, such as excess clitoral hood tissue, excess mucosa in the vaginal fourchette, excess labia majora, excess fat in the mons pubis, among others.
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Pre-operative
The consultation
In the consultation for labiaplasty, I listen to your concerns and assess your intimate area. The labia minora are analysed regarding size, colour, thickness, symmetry, and shape. During the physical examination, I also assess the mons pubis, clitoral hood, clitoris, labia majora, and perineum, to outline the most suitable surgical plan for your case. I explain the details of the surgery and the techniques employed, as well as inform you about post-operative care and answer your questions.
Examinations
For your labiaplasty, I usually request the following examinations:
- Complete 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
I use a labiaplasty technique without infiltration of anaesthetic solution, to avoid distortions that may compromise the final result. For this reason, labiaplasty is performed under general anaesthesia in most cases, or under spinal anaesthesia occasionally. The general anaesthesia I employ is total intravenous anaesthesia (TIVA), where all medication is administered intravenously and only oxygen passes through the tube. At the end of the surgery, the infusion is stopped and the patient wakes within two to three minutes.
The surgery
I perform labiaplasty principally using two techniques: longitudinal resection -- trimming -- or the wedge technique (wedge excision). Both preserve the sensitivity of the labia minora, as the principal innervation (perineal nerve and posterior labial nerve) is respected. The choice depends on the anatomy, concerns, and objectives of each patient.
Longitudinal resection - trimming
This technique consists of removing the excess from top to bottom, aligning the labia minora with the labia majora, finishing with a continuous absorbable suture in the longitudinal direction of the labia minora. The scars remain along the anterior edge of the labia minora. It is one of the oldest techniques and was the first one I used.
Advantages
- Does not interfere with sensitivity;
- Corrects asymmetries;
- The scar is imperceptible when well executed;
- It is quicker, and can be performed in 30 to 40 minutes;
- Removes the dark and thicker part, if that is the patient's wish.
Disadvantages
- Does not reduce the length of the labia minora;
- Some patients wish to preserve the original colour pattern of the labia minora, and this technique does not allow for that;
- Needs to be very well executed by the surgeon, to avoid leaving excess or removing too much.
Wedge resection - wedge excision
The wedge technique was developed in the United States by plastic surgeon and urologist Dr. Gary Alter. It consists of removing a wedge, or "pizza slice", as well as removing tissue more superiorly, laterally to the clitoris. I travelled to the United States to learn this technique directly from Dr. Alter, to execute it perfectly. This is my preferred approach for most labia reduction cases.
Advantages
- Also does not interfere with sensitivity;
- Corrects asymmetries;
- The scar is also imperceptible when well executed;
- Preserves the original colour and shape of the labia minora
- Allows shortening of the labia minora.
Disadvantages
- Does not completely remove the dark and thickened part, if desired;
- Takes longer to execute due to more details and more suture points - about two hours -.
Which technique to use?
Based on your desires and your physical examination, I discuss with you the most suitable technique for your case. In some cases, I may combine elements of both techniques to achieve the best possible result.
Post-operative
Labiaplasty, in summary, is a virtually painless procedure with a very smooth recovery. I recommend the use of silver sulphadiazine ointment for one week, to prevent infection, as it is a moist area. Other recommendations include one month without physical activity and six weeks without sexual activity. Bleeding is minimal and most patients resume light activities within a few days.
Sutures
The sutures I use in labiaplasty are absorbable. This means there is no need to remove them -- they dissolve naturally over the following weeks, providing greater comfort throughout recovery.
Final result
Initially, the labia minora may be slightly swollen, and will progressively decrease in volume. After one to two months, they will have significantly reduced swelling, but healing will not yet be complete. I consider the final result to be around six months to a year. The scars remain in the natural folds and become practically imperceptible.
Combined intimate surgeries
It is very common to combine other female intimate surgery procedures with labiaplasty. Treatment of the intimate area should be comprehensive, to achieve the most natural balance. As an intimate surgery specialist, I have the knowledge, experience, and skill to offer you a complete and individualised treatment.
The intimate surgeries most commonly performed alongside labiaplasty are:
Clitoral hood reduction
The skin surrounding the clitoris, also referred to as the clitoral hood or prepuce, may be excessive. During the assessment for labiaplasty, it is very important to evaluate this area, as an excess of hooding can make the clitoris overly prominent, making the result of the labiaplasty less aesthetically pleasing. The wedge technique typically includes reduction of the skin along the clitoral hood. For patients undergoing the trimming technique, I assess and remove any excess hood tissue if present. This excess can be removed with longitudinal incisions parallel to the clitoris, as in the wedge technique, or through a crescent-shaped excision just above the clitoris, increasing its exposure, as in male circumcision surgery.
Labia majora reduction
The labia majora are the outer folds of the vulva. Often, the problem of enlarged labia minora is associated with laxity of the labia majora. It is possible to reduce the labia majora in conjunction with labiaplasty, and the resulting scar is imperceptible, sitting in the fold between the labia majora and labia minora on each side. Importantly, as Dr. Christine A. Hamori always reminds, during this combined procedure I first reduce the labia majora, as this usually decreases the projection of the labia minora, making the labiaplasty somewhat more conservative.
Pubic liposuction
Excess fat in the pubic area can be quite bothersome. During the labiaplasty consultation, many patients request mons pubis contouring through pubic liposuction. Through two small incisions concealed by the bikini line, it is possible to effectively remove fat and reduce the volume that previously protruded in swimwear and gym clothing. You may also consider labia majora fat grafting to restore volume to that area.
Non-surgical treatments
There are other treatments for the intimate area that do not involve surgery and can be performed as a complement to labiaplasty. These treatments depend on each case and may involve, for example:
- Laser;
- Lightening creams;
- Dermal filler with hyaluronic acid.
I assess your case and recommend the aesthetic treatment modalities that are necessary.
Frequently Asked Questions about Labiaplasty
Is labiaplasty painful?
I perform labiaplasty under total intravenous general anaesthesia, so the patient feels absolutely nothing during the procedure. In the post-operative period, in my experience, discomfort is minimal — most of my patients report much less pain than they expected. I prescribe analgesics that effectively manage any discomfort in the first few days.
What is the difference between the wedge technique and the trimming technique?
In my practice, I use both techniques according to each patient's needs. The trimming technique removes excess tissue along the edge of the labia minora, allowing for the elimination of the darkened and thicker part. The wedge technique removes a wedge-shaped section in a "V" shape, preserving the natural edge and original colour. I travelled to the United States to learn the wedge technique directly from its creator, Dr. Gary Alter, and I personally assess which approach will yield the best result for each case.
Does labiaplasty affect the sensitivity of the labia minora?
No. The techniques I use preserve the main innervation of the labia minora — the perineal nerve and the posterior labial nerve. In my experience, no patient has reported loss of sensitivity after surgery. This is one of my greatest concerns during surgical planning.
When can I return to normal activities after labiaplasty?
I recommend that my patients resume light activities within a few days. For intense physical activity, I advise waiting a month, and for sexual activity, six weeks. Each case is assessed individually during follow-up consultations.
Does labiaplasty leave a visible scar?
In my experience, the scars are practically imperceptible. In both the trimming and wedge techniques, I position the incisions in the natural folds of the labia minora. With complete healing, around six months to a year, the marks become almost invisible.
Is it possible to combine labiaplasty with other intimate surgeries?
Yes, and this is very common in my practice. I often combine labiaplasty with clitoral hood reduction, labia majora reduction, or pubic liposuction. As an intimate surgery specialist, I assess the entire region to provide a complete and balanced result.
What type of anaesthesia is used in labiaplasty?
I use total intravenous general anaesthesia in most cases. In this technique, all medication is administered via the vein, and only oxygen passes through the tube. At the end of the surgery, the drip is turned off, and the patient wakes up in two to three minutes. Occasionally, I may use spinal anaesthesia. I choose not to infiltrate local anaesthetic solution to avoid distortions that could compromise the result.
Do the stitches from labiaplasty need to be removed?
No. I exclusively use absorbable sutures in labiaplasty, which dissolve naturally in the weeks following the surgery. This ensures more comfort for my patients, without the need for a return visit to remove stitches.
How long does it take to see the final result of labiaplasty?
In the first few days, it is normal to experience swelling in the labia minora. In my experience, after one to two months, there is already a significant reduction in swelling, but I consider the final result to be between six months and a year, when healing is fully complete.
Who is a candidate for labiaplasty?
I recommend labiaplasty for patients who have excess skin on one or both labia minora and who experience discomfort when walking, exercising, wearing tight clothing, or who have aesthetic dissatisfaction. During the consultation, I carefully assess the anatomy — size, colour, thickness, symmetry — and discuss expectations to determine if surgery is the best option.
Have your labiaplasty performed by an intimate surgery specialist
Get in touch with my clinic in Brazil, and book your consultation for labia reduction. As an intimate surgery specialist in Brazil, trained at the Ivo Pitanguy Institute and with the wedge technique learned from Dr. Gary Alter in the USA, I deliver excellent results with total respect, discretion, and professionalism. As a board-certified plastic surgeon, I welcome international patients from the United Kingdom and worldwide seeking cosmetic surgery abroad through medical tourism.
Labiaplasty is often combined with labia majora reduction, clitoral hood reduction, and clitoroplasty. Also learn about labia majora fat grafting, mons pubis lift, perineoplasty, vaginoplasty, and hymenoplasty. See information about pricing and online consultation.
Dr. Walter Zamarian Jr.
Consultant Plastic Surgeon in Brazil
Rua Engenheiro Omar Rupp, 186
Londrina, Brazil
ZIP 86015-360
Brazil
YouTube Channel: Dr. Walter Zamarian Jr.
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