Sagging or enlarged labia majora showing in a bikini?
Most of the time, the labia minora are the focus of attention, but I believe the labia majora play a crucial role in the overall aesthetics of the intimate area. Labia majora reduction (labia majoraplasty) addresses excess tissue in this region that can compromise the entire treatment if not addressed properly. That is why I always evaluate the labia majora carefully and diagnose any possible excess. I have international specialization in intimate surgery -- including training with Dr. Gary Alter in the USA -- and use the most advanced techniques to treat hypertrophy, laxity, and asymmetry of the labia majora, safely and with excellent results. This procedure is often combined with labiaplasty for a balanced, natural outcome.
Indications
I assess the labia majora with the patient standing, a position in which laxity and volume become more apparent. The labia majora may have excess skin, fat, or both -- caused by genetic factors, aging, hormonal changes, pregnancies, or weight loss. Many patients report discomfort when wearing tight clothing, swimwear, or during physical activities and sexual intercourse. Both skin and fat can be surgically reduced in a straightforward, painless procedure that can complement labiaplasty exceptionally well.
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Pre-operative preparation
The consultation
During the consultation, I evaluate you in a standing position to check for excess skin or volume in the labia majora. Then, with you lying down, I analyze the relationship between the labia majora and minora and outline the most appropriate surgical plan for your case. I explain whether skin or fat removal is needed, how the procedure will be performed, and what post-operative care is required.
Pre-operative tests
For labia majora reduction surgery, I request the following tests:
- Complete blood count;
- PT with INR + aPTT;
- BUN (blood urea nitrogen);
- Creatinine;
- Fasting blood glucose;
- Total protein and albumin;
- Vitamin D;
- Vitamin C;
- Urinalysis;
- Electrocardiogram;
- Pre-operative cardiac clearance.
Anesthesia
My preference is general anesthesia (TIVA) in most cases. This approach allows proper treatment of the intimate area without the need for local infiltration, which could distort the anatomy, while also enabling a very quick recovery after surgery. For patients who have difficulty with this type of anesthesia, such as those with cervical disc herniation, I perform the procedure under spinal anesthesia.
The surgical procedure
Labia majora reduction can be performed together with labiaplasty. I begin by marking the tissue to be removed on both the labia minora and majora when both are being addressed. I operate on the labia minora first and finish with the labia majora reduction.
The marking on the labia majora is crescent-shaped, with the concavity facing the midline, so that the final scar falls exactly in the fold between the labia majora and minora -- becoming very well-concealed as it heals. Both skin and fat can be removed at this stage. In cases of significant fat accumulation, I also remove subfascial (deep) fat. I take special care with hemostasis during this procedure to prevent postoperative hematoma. The tissues are closed in layers, and the sulcus is reconstructed. The surgery preserves local innervation, maintaining full sensitivity in the area.
Post-operative recovery
Labia majora reduction, like labiaplasty, is virtually painless with a very smooth recovery. I recommend applying silver sulfadiazine ointment for one week to protect against infection, and I advise one month without physical activity and six weeks without sexual intercourse -- the same protocol as for labiaplasty. The patient is discharged the same day.
Sutures
I use Vicryl sutures, which are absorbable. These sutures do not poke during the post-operative period and leave no residual material that could cause discomfort later, as can happen with nylon sutures, for example.
Final results
A significant improvement is visible immediately, even with swelling. About 80% of the result is apparent within two months, but the final outcome is achieved between six months and one year, once 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 main factors are aging, significant weight loss, genetic predisposition, pregnancies, and hormonal changes such as menopause. These factors can lead to laxity, excess skin, or fat accumulation in the labia majora, causing both aesthetic and functional discomfort.
How is the evaluation for this surgery performed?
I evaluate the patient in a standing position, where laxity and volume are most apparent. Then, with the patient lying down, I analyze the relationship between the labia majora and minora and determine the most appropriate surgical plan -- whether skin, fat, or both need to be removed.
Does labia majora reduction leave a visible scar?
The incision I use is crescent-shaped, positioned precisely in the natural fold between the labia majora and minora. As a result, the final scar is very well-concealed and virtually imperceptible once healing is complete.
What type of anesthesia is used?
My preference is general anesthesia (TIVA), which allows me to treat the area without local infiltration -- which could distort the anatomy. In cases where the patient has a contraindication, such as cervical disc herniation, I perform the procedure under spinal anesthesia.
Can labia majora reduction be combined with labiaplasty?
Yes, I frequently combine the two procedures. I begin with the labiaplasty and finish with the labia majora reduction, achieving a more balanced and comprehensive result for the intimate area.
Does the surgery affect sensitivity?
No. The technique I use preserves local innervation, keeping sensitivity in the intimate area fully intact. I pay careful attention to this aspect throughout the entire procedure.
What is the recovery like?
Recovery is very smooth and virtually painless. I recommend applying silver sulfadiazine ointment for one week, avoiding physical activity for one month, and refraining from sexual intercourse for six weeks. The patient is discharged the same day as the surgery.
What type of sutures are used?
I use Vicryl sutures, which are absorbable. These sutures do not poke during the recovery period and leave no residual material that could cause discomfort, unlike nylon sutures, for example.
When will I see the final results?
A noticeable improvement is visible right away, even with swelling. About 80% of the result is apparent within two months, but the definitive outcome takes shape between six months and one year, once healing is complete and the tissues have fully settled.
When can I wear a swimsuit after the surgery?
After initial healing, around two to three weeks, you can comfortably wear a swimsuit. I recommend that my patients wait this period to ensure proper healing.
Schedule Your Labia Majora Reduction in Brazil
Get in touch with my clinic in Londrina, Brazil and schedule your consultation for labia majora reduction. I am a board-certified plastic surgeon in Brazil (CRM-PR 17,388 / RQE 15,688) with over 20 years of experience in intimate surgery. International patients seeking medical tourism in Brazil for intimate procedures can count on my expertise and discretion. I also offer online consultations for international patients. Often combined with labiaplasty, labia majora fat grafting, or pubic liposuction.
Labia majora reduction is often combined with labiaplasty for a more balanced, natural result. Also learn about labia majora fat grafting for volume restoration, pubic liposuction, perineoplasty, and vaginoplasty. Learn more about pricing and online consultation.
Dr. Walter Zamarian Jr.
Plastic Surgeon in Londrina, Brazil
Rua Engenheiro Omar Rupp, 186
Londrina, Brazil
ZIP 86015-360
Brazil
YouTube Channel: Dr. Walter Zamarian Jr.
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