Labiaplasty Orlando

Dr. Oppenheimer — @RealdrOPP

Each vagina is different, and therefore, each labiaplasty is different.

Just like there is no "normal penis," there's a wide range of normal-appearing vaginas. Some labia are long and narrow. Some labia have one side enlarged and one side short. Some labia are very rough and dark, while some are thin and smooth. Just like a fingerprint or a snowflake, no two labia are alike, even on the same person.

There is no such thing as a "normal" vagina. Each vagina is different. Each of these patients presented to my clinic for a labiaplasty.

Do I need a Labiaplasty?

I'd like to take a moment here to pause and state the following: Plastic Surgery is only ONE way to achieve empowerment. It is not THE way and it is certainly not the ONLY way. Whenever we are bothered by our appearance we have a choice: To accept how we are, or to change it with plastic surgery. Each option is empowered and each option is equally valid.

Most women seek labiaplasty for appearance reasons. Specifically because of labia minora "show," where the inner labia (the labia minora) protrude beyond the outer labia (the labia majora). The labia minora are reduced--not removed--so that there is a more "tucked in" look to the vagina, especially when standing.

Large labia minora can also be symptomatic, in that they can get in the way of activities, clothing, and intercourse. A labiaplasty reduces the labia minora to alleviate these symptoms.

Labiaplasty is Liberating

We wear nice clothes, we exercise, and we present our best selves to the world. When intimate, in our own private world, we endeavor to feel that same degree of confidence. A labiaplasty is a freeing and empowering procedure for many women, providing confidence, alleviating self-consciousness, and aiding in body positivity.

Women seek labiaplasty--reduction of the inner labia, the labia minora--for two main reasons:

  1. They don't like the way the labia look.
  2. They don't like the way the labia feel.

A Labiaplasty Reduces the Labia Minora

In simplest terms, a labiaplasty is a procedure for the reduction of the inner labia, the labia minora. Of course, expert plastic surgery is never simple. There is an amazing number of nuances involved in making the labia minora reduced in the most aesthetic--and safest--way possible. Much like an upper eyelid surgery isn't just removing eyelid skin, there are nerves, vessels, lymphatics and many other critical structures that are involved with performing expert labiaplasty surgery.

Labiaplasty can reduce long hanging labia.

Is my vagina normal? Why do I have long labia?

Labiaplasty can reduce long hanging labia.

While large inner "lips" or inner labia can be seen as attractive by some, most women want a "tucked in" look to the labia minora; where they are mostly or completely hidden by the outer labia, the labia majora. A labiaplasty reduces the inner labia so that the outer labia cover them when standing.

Large labia can cause a large number of functional issues. For example:

  • Long inner labia get in the way of clothing, exercise and intercourse. Yoga pants, tight jeans, bikini bottoms and thong underwear can be a problem for women with large labia. Not only do the labia pinch and pull in certain clothes, but they can become visible in certain clothing. This leads women with large labia to avoid certain clothing.
  • Large labia can interfere with exercise. Women often will tell me that they have to adjust themselves while running or doing yoga, which is a source of distress and discomfort.
  • Long labia can get physically in the way of sex. Sometimes the inner labia will get pulled into the vagina during intercourse, leading to injury, tearing, and pain. 
  • Large labia can actually cause yeast infections. Because of infolding of the labia, fungal infections can become more common, resulting in chronic yeast infections.
  • Long inner lips can cause challenges with hygiene. Urination can be a problem because the urine stream can be affected by labia. In addition, toilet paper can get caught in larger labia, making cleanliness a challenge.

Is my vagina normal? Why do I have long labia?

We’ve all wondered at some point in our lives if our bodies are normal. For most of us, these questions begin at the time of puberty when we rapidly experience changes in our bodies. Enlargement of the genitalia in women, specifically the labia minora, can be perceived as a masculine trait. As such, large inner labia can be distressing to young women and is homologous to breast development in men (gynecomastia)

That said, all of these changes are actually normal. And by "normal" I mean that an estimated 20% of young adults of both sexes experience these types of changes with puberty. But the question isn’t really a question of "normal." We know that we are all different! The question is really this: do my labia minora bother me? Do they bother me in a physical way? Do they bother me in an emotional way? Or is it a combination of both?

Standing view with labia minora "show" beyond the outer labia.

Large labia before and after showing toilet paper getting caught in the folds before treatment.

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This patient has a more prominent clitoral hood, as is shown by the thickened upside-down "V" at the very top of the vagina in the image at left. Shown after a labiaplasty and hood reduction, right.

The Clitoral Hood or Prepuce should also be reduced at the same time

The clitoral hood, or prepuce, should always be addressed at the time of a labiaplasty. In fact, a labiaplasty is incomplete in most cases unless a clitoral hood reduction (aka hoodectomy) is also performed. Naturally, sensation is completely preserved with hood reduction, because only the most superficial skin is removed, about the thickness of a skin graft.

If the clitoral hood is not reduced, the upper part of the vagina can stick out or be more prominent. Some women have described this to me as a "small penis". Needless to say, that is not the goal. A correct labiaplasty will result in a balanced look to the top, middle and bottom portions of the vulva (the outward appearing vagina). In the ideal, no single area of the vagina protrudes more than the other. In some cases, a perineoplasty is also performed at the time of a labiaplasty and hood reduction. The perineum is the space between the anus and vagina. In some women, this tissue can also be prominent and protrude. To get a balanced look tissue may also need to be removed from this area. Vaginal tightening can also be performed along with this procedure.

In over 200 labiaplasty surgeries, I've had only one emergency which was a hematoma: that's bleeding into the incision. While stressful for the patient, it was a very quick fix: we went right back into surgery and stopped the bleeding.

The patient did great and had no adverse problems whatsoever. I'm along for the journey, not just the surgery. Every one of my patients gets a special "medic-alert" bracelet with our on call hotline number. My nurses Yasi and Lae'l (as well as myself!) might pick up the phone to answer. We are on call 24/7 for you!

Change the appearance of the inner "lips"

Labiaplasty can smooth out the Rough labia edge that doesn't look "neat" to some women

Not only can folds on the labia minora edge look rough, but as mentioned above they can cause hygiene issues. Beyond that, many women want a smooth look to the outer labia. The best way to achieve this is with an edge labiaplasty to remove the rough edge, and replace it with a more smooth contour.

Labiaplasty can make the inner labia more symmetrical

Asymmetry, where one labia is larger than the other, is very common. Just like one testes hanging lower than the other in men, one labia is often longer than the other in women. While this is normal, the long labia can become folded and can pinch and pull, becoming irritated. Moreover, we all would love to think that we are a mirror image, and if surgery can bring us closer to that goal, then it can be a welcome solution.

Labiaplasty can remove Dark Pigment on the edge of the labia minora

A dark edge of the inner labia is the result of hormones, particularly estrogen. The more time that estrogen circulates in the body, the darker the labia minora can get. This is why the inner labia can become darker and darker over time. There is no safe way to lighten the inner labia. The best treatment is to remove the dark edge if this is bothersome to you. A wedge labiaplasty, does not remove the dark pigment or rough edge as well as my modified edge technique. (Of note, the outer labia anal area can be lightened with bleaching cream and pads, which can be found HERE.)

Labiaplasty can repair Trauma and Injury to the labia from Childbirth

While less common, women can experience tearing of the inner labia during childbirth. Much like a perineal tear occurs very characteristically at the bottom of the vagina, a labia minora tear during childbirth occurs right where the clitoris and labia meet. This is called the clitoral frenulum. A typical tear at the clitoral frenulum is a very thin and sensitive structure of the vagina. Many other related birth injuries can be repaired at the time of labiaplasty.

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The PreOPP Visit

The pre-operative visit is a chance to go over your aftercare instructions, and to have any questions answered that you may have about labiaplasty. Yasiria, my clinical nurse, will also take photographs for our records.

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Please know that your privacy is hugely important to me and my staff. We don't save your name with your photographs EVER, and we NEVER post or share photos without your direct written and verbal approval. That includes on this very website, and of course on social media.

We use this infographic to go over the details of your care and the timeline of your labiaplasty healing, return to work, and other life highlights, including when you can have sex (6 weeks until intercourse please).

Large labia can make women self-conscious

The reasons for this are complex and deeply embedded in our biology. For example, why are large male genitalia sought after and seen as masculine in most cultures? The answers lie deep within our anthropology. Regardless, large genitalia is universally seen as a masculine trait. On the opposite side of masculinity is femininity. This is a simple truth: the Yin-and-Yang of our species. Because of these internalized, deep-seated sentiments, large hanging genitalia in women can be seen as undesirable and masculine.

This is not a hard and fast rule, and it is certainly not my rule, it is just my experience as a physician and labiaplasty specialist. Feelings of self-consciousness are a major reason why women pursue labiaplasty. Not only do some women feel that the appearance of the labia are not feminine, but they also are concerned about what their partners may think about their large labia. There are many misconceptions about the causes of large labia, and one of my missions is to dispel these myths about large labia minora. That said, if you are ever made to feel bad about the way your labia look, FIND A DIFFERENT PARTNER. NO one should ever make someone else feel bad about their appearance, not the appearance of their vagina, nor any other part of their body.

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This young woman complained that her large labia were not feminine to her. Before and after labiaplasty is shown.

Shaving and Labiaplasty

Similarly, some women feel uncomfortable with the idea of not shaving after their labiaplasty, or of being examined in follow up without having shaved.

Again, it is highly irrelevant to me and to my nurse Yasiria whether or not you have shaved. We don't notice. Promise. That said, in terms of the aftercare, we recommend against shaving for 6 weeks after labiaplasty. Trimming the pubic area, however, is recommend before surgery. Learn more about our pre-operative instructions HERE. Please don't shave for 6 weeks after labiaplasty surgery to be safe.

Your Period and Labiaplasty

There's no good time to have your period, as I am told. This is true in labiaplasty as in life. Many women are embarrassed by the idea of having their period at the time of medical examinations and procedures such as labiaplasty. From a medical perspective, it really doesn't matter. If you review my before and after labiaplasty photos, you will notice more than one woman wearing a tampon in the before OR after photo.

It may be uncomfortable to you, but to me it's a regular day and a regular part of examining my female patients. Since you're going to have your period at some point during your care with us, it is best to just schedule your consult, procedure, and follow-ups based on life. This process can be stressful, and there's no need to add to that by working around your period. But of course, whatever makes you feel the most comfortable is the right answer!

Wedge labiaplasty

Edge Labiaplasty

Wedge Labiaplasty

When I first started my practice I performed the wedge labiaplasty. I no longer do so. There are three main reasons why the edge labiaplasty, or as I call it, the modified edge labiaplasty, is superior to the wedge.

  1. The wedge labiaplasty can split causing a gap in the labia minora,
  2. The wedge labiaplasty does not remove the dark pigment or rough edge of the labia minora, and
  3. The wedge labiaplasty does not remove enough tissue in many cases.

Originally, I was performing only the wedge labiaplasty in my practice. To the right is a before and after of a wedge labiaplasty in the operating room of one of my patients. The problem with the wedge isn't necessarily how it looks right after surgery. The problem is what tends to happen with the labia over time.

Wedge labiaplasty. Less tissue is removed, the edge appears slightly rough, and there is a pigment transition between the upper and lower portions.

Before and right after wedge labiaplasty. There's nothing wrong with this technique, but to be critical, you can see that there is not quite enough tissue removed from the hood, the lower part has a rough appearance, and there is a color transition from the darker lower half of the labia to the upper half that is lighter.

Edge Labiaplasty

Even though my results with a wedge labiaplasty were OK, they were unpredictable. That's why the best technique in my experience is the modified edge labiaplasty.

For these reasons, the best technique in my experience is the modified edge labiaplasty. Compared to the wedge, the modified edge labiaplasty:

  • Allows removal of the rough edge and dark pigmentation
  • Allows a more even removal of the labia minora
  • Heals beautifully!

Edge labiaplasty. Note the smooth edge and more aggressive reduction.

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This young woman complained that her large labia were not feminine to her. Before and after labiaplasty is shown.

The labia minora grow during puberty in response to estrogen.

This answers the most common question women have about labiaplasty: What causes large inner labia? Why does this happen to some women? Why did it happen to me? Since labia minora grow during puberty, it is worth noting what does NOT cause large labia:

  • Large inner labia are NOT caused by intercourse
  • Large inner labia are NOT caused by masturbation
  • Large inner labia are NOT caused by promiscuity

These are unfortunate misconceptions about the labia minora that have no basis in reality. My goal is to dispel these notions and to provide a safe place for women to discuss the issues they are having with their genital anatomy.

Preparing for your Labiaplasty Procedure

How the Consultation Works

Let's face it: Vaginal examinations are awkward. That's the facts. Doctors visits aren't really fun, and GYN visits--as I am told--are not exactly a picnic. Here are the ways I make a labiaplasty exam NOT AS AWKWARD AS YOU THINK:

  • I perform 2-4 labiaplasty exams every day and I'm a professional. Always.
  • There is NO SPECULUM
  • There is NO PAP SMEAR
  • It is a LOOKING ONLY exam, guided by you with a mirror
  • In fact, the only touching is with a Q-Tip
  • The exam takes 5-10 seconds. Yes, seconds.

Out of Town Patients

Out of town patients are about 1/3 of all of our labiaplasty patients. That means you're in good company, and we know exactly how to guide you through every step of the way. If you'd like to get things started, click HERE to set up a virtual consultation. Here you will get a chance to speak with me by phone and go over your concerns and goals for labiaplasty surgery. I will still meet you the day before your surgery, or the morning of, depending on your preference, where we can discuss things in more detail. We often request that our patients stay in town just one night after surgery to make sure that everything is OK before you travel. For general information on the out of town process, where to stay, and the location of our clinic, check HERE.

Type of Anesthesia: It's up to you

There are three options for anesthesia with a labiaplasty, and I offer them all:

  1. Local and topical anesthesia (numbing cream): You are awake
  2. Local and topical anesthesia with valium: You are a little sleepy
  3. Local and topical anesthesia with IV sedation ("twilight anesthesia"): You are asleep 

This part is entirely up to you. Some women feel that they want to be awake for the entire process, perhaps because they are nervous about anesthesia. Other women want to be asleep for the entire process, perhaps because they are nervous about surgery! It's up to you, but either way, I will make sure you are comfortable. I am very gentle with the needle and thread!

The Day of your Labiaplasty

Depending on your choice of anesthesia, you will either drive yourself or take an Uber (option 1), or you will have a family member, friend or spouse accompany you (options 2 and 3). You'll arrive to our private surgery center, the same place where you had your consult, and we will put you in a gown. You'll have topical numbing cream applied, as well as a urine pregnancy test. From there, we'll give you some oral medications or an IV if you're having twilight anesthesia for your labiaplasty. We will handle the rest! The surgery takes about 1.5 hours, and adding another half an hour of recovery, you'll be on your way!

The Labiaplasty Recovery

Scars are invisible after labiaplasty

I use a 5-0 buried monocryl suture for my labiaplasty procedures. This is totally absorbable suture and there is no "baseball" stitching. This means that the scars are imperceptible. Like the inside of the mouth, the vagina doesn't scar in the same way as skin. The most you will see from your labiaplasty scar is a shiny area, and your partner will never be able to tell you had a labiaplasty performed.

Liberation Awaits.

While it seems hard to believe, there's really only one tough day in the labiaplasty recovery: the first night. We often hear from patients that once the numbing medicine wears off, approximately 3-6 hours after the surgery, there is a stinging, throbbing or burning pain.

Much like a burn on the roof of your mouth, or a bite on the inside of your cheek, this can be a miserable feeling. ICE IS THE KEY. Icing the area with our ice packs is the best way to provide both analgesia (pain relief) as well as swelling reduction (which in turn will also decrease pain).

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