Clitoral Hood Reduction
Designer Laser Labiaplasty
A labiaplasty is the removal of the stretched and redundant labia minora by surgical means. The labia minora shows a high degree of variability with congenital factors playing a role on these variations. The anatomy of the labia minora influences the functional and aesthetic factors leading to a request to have the labia remodeled or reduced. Common complaints are discomfort and tearing during intercourse, rubbing and pain with tight-fitting clothing such as jeans and sport leggings, pain on the labia with sport activities and a dissatisfaction with the appearance of the labia leading to impaired sexual activity and even embarrassment with the use of a swimsuit. A Designer Laser Labiaplasty (DLL) involves the use of an operative laser CO2 with a small spot of energy and the use of small caliber absorbable sutures leading to a lower frequency of wound complications and optimal cosmetic results. The use of this type of laser does not require the use of deepithelialization. A DLL goes beyond the traditional labiaplasty by integrating sound surgical methods with established safety, the lowest degree of tissue trauma, decreased blood loss, decreased postoperative swelling, decreased pain and an aesthetically pleasing smooth contour at the edges.
Are there different looks for a labiaplasty?
Yes. The results of a labiaplasty are categorized in three different looks or final appearance. Medical literature have described three main looks. These are the Barbie, the Rim and the Hybrid. The Barbie look consist on the removal of all or almost all of the labia minora. Currently, a preference for the Barbie Look has been reported at a rate of 98%. The Rim Look consists of of excision of the rugose hyper pigmented edge preserving a protrusion beyond the labia majora to a maximum of one centimeter. The Hybrid Look has been defined as a middle of the road approach in which a small labia minora is seen below or at the level of the labia majora. None of these procedures preserve the full extent of the darkened edges of the labia minora. Literature on the specific area of preservation of the pigmented edges show that 97% of the patient requesting labiaplasty do not desire preservation of the pigmented or rugose edge.
How do I decide which approach is for me?
At consultation with the surgeon. A handheld mirror is provided and the anatomy is reviewed with you. A consent for photo-documentations will be presented before taking the first photographs. The photographs obtained become part of the patient electronic medical record in a digital format. Once the first set of photographs are obtained and reviewed with you the area of desired excision is marked with a removable ink surgical pen. Once marked a second set of pictures is taken and reviewed with you along with answering all procedural questions and reviewing the recovery. The aesthetic goals and expectations are then summarized for you. You will leave with clear and detailed knowledge of the chosen look.
How is the recovery?
This is an outpatient procedure. In some instances it can be done at the office but most commonly at a surgery center. Expect swelling and pain in the surgical are for the first ten days. Specific postoperative instructions will be provided to you. You are expected to avoid intercourse for six weeks. A downtime of 10-14 days will allow for the swelling to subside and will advance your recovery. Routine postoperative appointments are at 2 and 6 weeks. After six weeks prepare to enjoy the results, wear a beautiful bikini and enjoy the looks of your surgery.
A laser hymenoplasty is an office procedure typically requested by a young woman with a partially torn hymeneal ring. The procedure treats the appearance of the entrance to the vagina (introitus). This is not a procedure to restore “virginity”. It is used to addressed torn areas, vaginal skin tags and redundant tissue that have become torn during sexual encounters, trauma, vaginal surgery or vaginal deliveries. A hymenoplasty is done at the office under local anesthesia with an operative CO2 laser and microsurgical technique. The goal of surgery is to eliminate the tags of tissue protruding through the opening of the vagina and interfering with intercourse, wearing a tampon or being aesthetically unpleasant to the patient. The recovery includes no intercourse for six weeks with resumption of moderate physical activity in three days.
Designer Laser Vaginoplasty
A vaginoplasty is the repair of the laxity of the vagina. It addresses the increased vaginal caliber which results in decreased sensation during penetration and intercourse. The procedure is a modification of a long used technique to treat vaginal relaxation, specifically an anterior and posterior repair. The modification consist on the plane of operation which concentrates in the fibromuscular layer of the vagina and its lateral attachment instead of the deepithelialization used in anterior and posterior repairs. A plastic repair with small caliber delayed absorbable sutures serves the approximation of the vaginal tissue decreasing the formation of scar bumps and nodularities. The extent of dissection requires meticulous hemostasis as the postoperative results are affected by the formation of hematoma and inflammatory fluid collection.
The addition of an operative CO2 laser facilitates an operation with precise dissection of tissue planes, decreased tissue damage, decreased rates of wound separation and allows for a procedure with minimal blood loss. These factors translate in restoration of the vaginal caliber to a degree of physiological tightness which translates in an enhanced sexual gratification.
How do I know if I will benefit from a vaginoplasty?
Almost all of the patients requesting a vaginoplasty do it after childbirth. The most prevalent complaint is decreased sensation in the vagina during intercourse, decreased feeling of thrust, a sensation of vaginal widening, vaginal flatus (gas) during or after intercourse and dislodgment of the penis. These symptoms of vaginal relaxation frequently result on decrease desire, impaired arousal and decrease frequency of orgasm leading to avoidance of sexual interactions. A common complaint is “it does not feel the same after my vaginal delivery”.
Is there a preparation for this procedure?
Yes. A consultation to address goals and expectations is required. At consultation the degree of relaxation is used to decide on the type of procedure. A healthy vaginal epithelium is required therefore premenopausal women need to heal from previous deliveries and menopausal woman frequently need to use a short course of transvaginal estrogen before surgery.
How long is the surgery?
This is an outpatient procedure done under anesthesia, not general anesthesia. The procedure time is 45 minutes to one hour. The procedure is done at a surgery center with anesthesia provided by an anesthesiologist and a nurse anesthetist.
How long does it take to recover?
Detailed written instructions are provided ahead of the surgery. Walking and activity is encouraged immediately after surgery. No exercise is recommended for the first three weeks and no biking or strenuous exercise for six weeks. Intercourse can be resumed six weeks after surgery.
How soon before I can enjoy the results of a vaginoplasty?
Six weeks. Some patients require one or two extra weeks without intercourse.
Will intercourse hurt afterwards?
Complete healing may take up to six months. Painful intercourse is less frequent after a repair than before as vaginal relaxation interferes with the shape of the vaginal canal. Data from vaginal repairs in general show that painful intercourse is less frequent after a vaginal repair. The rate of painful intercourse in our practice is less than one percent.
I this procedure covered by insurance?
No. DLV is a reconstructive/cosmetic procedure not covered by insurance.
The G-Spot enhancement is a procedure intended to enhance awareness and sensation to a small area in the anterior vagina. The results are an increased sensitivity during sexual stimulation which leads to an increased intensity of orgasm in a woman that is able to achieve adequate arousal. Classically performed with a hyaluronic acid filler the procedure may be done at the time of an O-Shot. The procedure increases the intensity of the orgasmic experience in a woman able to achieve vaginal or clitoral orgasm.
Enhancement of Labia Majora with Fat Transfer
The procedure is primarily elected by patients having a liposuction with your plastic surgeon, primarily from the abdominal area. A small portion of the processed or decanted fat is injected in the labia majora to treat the laxity of the outer vulva caused by the atrophy of the subcutaneous genital fat. The procedure is intended to restore the youthful appearance of the labia majora by treating the tissue laxity caused by the atrophy of the subcutaneous tissue. A prominent and smooth labia majora serves to conceal the labia minora, a desired look by most women. The procedure is also requested by younger women with congenital relaxation of the labial skin, minimal subcutaneous labia majora tissue and a desire for a fuller vulva. A special group of patients is the post-vulvar surgery group including excision of vulvar tumors and patients with previous Martius graft for fistula repair. The level of disfigurement is significant in the patients with previous vulvar surgery requiring the use of labial skin reduction to achieve optimal results. The use of a fat graft does not preclude the use of platelet rich plasma if required in the future.
Labia Augmentation with Fat Transfer
Our most popular cosmetic procedure, a laser perineoplasty remodels the lower portion of the vulva (external) and lower third of the vagina which becomes scarred and stretched after a vaginal delivery. The procedure is done as a stand alone procedure or in combinations with a larger repair of a prolapse, a continence procedure, a vaginoplasty or a labiaplasty. A hymeneoplasty is opted by half of the patients undergoing a perineoplasty. Classically, a perineoplasty was done with standard surgical technique resulting in a high rate of wound separation and pain. A Laser perineoplasty takes advantage of an operative CO2 operative laser with a millimetric area of tissue damage resulting in minimal bleeding, optimal healing and less pain. The procedure has an approximate operative time of 30-40 minutes. In some cases it can be done under local anesthesia.
A Vampire Winglift procedure uses the injection of a proven cellular therapy, platelet rich plasma from the patients own blood (autologous PRP) and a hyaluronic acid filler to augment the labia majora. The procedure is intended to restore the youthful appearance of the labia majora by treating the tissue laxity caused by the atrophy of the subcutaneous tissue. A prominent and smooth labia majora serves to conceal the labia minora, a desired look by most women. The procedure is also requested by younger women with congenital relaxation of the labial skin, minimal subcutaneous labia majora tissue and a desire for a fuller vulva. This a procedure done at the office. It does not include an excision of the excess skin as in a labia majora reduction. There is no down time. The only limitation is to not use tight clothing for the first ten days after the procedure.
What causes a lax and wrinkled labia majora?
There are congenital and acquired factors. Common causes are menopause, pregnancy, childbirth, weight loss and aging. The effect of these conditions produce a lax and baggy labia majora. A special group of patients is the post-vulvar surgery group including excision of vulvar tumors and patients with previous Martius graft for fistula repair. The level of disfigurement is significant in this group which have shown a high rate of satisfaction with the procedure.
Is there a difference between a Vampire Winglift and an augmentation of the labia majora using autologous fat graft?
The cosmetic results with a fat graft are noticed immediately. A Vampire Winglift uses high density platelet rich plasma, although results are seen in the first few weeks the full result is seen from 6-12 weeks. The addition of a hyaluronic acid filler is an option for patients with deep labial folds, an area with minimal tissue underneath. Contrary to fat graft, fat necrosis and pseudocysts have not been reported with PRP on the vulva. Minimal swelling and tenderness are expected with the Vampire Winglift and the labia majora augmentation using fat graft in a lesser extent with the Vampire Winglift.