Vaginal Rejuvenation – Labiaplasty and beyond

My Dearest Patient

Vaginal rejuvenation has been on the rise over the past 10 years. Reasons for the increase seem to be multifactorial. Media hype, reality television shows, free internet access to pornography and the advances in hair removal techniques with complete exposure of the female genitalia has lead women desiring a youthful appearance of their genitalia. It is with this goal in mind that I have been able to help women achieve a cosmetically pleasing appearance to their genitalia.

Indications for Vaginal Rejuvenation

Requests for labiaplasty are largely cosmetic in nature, but complaints of rubbing with exercise, pinching with walking or sitting, discomfort in tighter clothing and invagination with intercourse are not uncommon. Or just merely sagging, stretching and decolourisation from age or gravity.

Patients may also show evidence of chronic irritation, rashes and scarring.

The majority of my patients however would like a more youthful look to the external appearance of the vagina.

Areas and Concerns

The approach to vaginal rejuvenations requires the evaluation of the different parts. Ideally women seem to prefer no pubic hair and minimal if any labia minora (inner lips) hanging beyond the labia majora (outer lips).

The following areas are areas addressed:

Mons Pubis– The mons should be a gentle curve onto the labia majora on either side. Abnormalities often seen here would either be excessive hollowness and laxity, especially seen in patients after massive weight loss or a fatty protuberant area with undue bulkiness. In cases of hollowness and skin laxity fat fills allows for adequate rejuvenation on the basis of volume restoration, elevation and stem cell activity improving the overall skin appearances and softening the look.

Intervulval Cleft – Ideally the cleft shot be short and full and not elongated and hollow. Addressing the deformities in the surrounding areas greatly improves the intervulval cleft. In rare instances shorting and reduction may be performed by excision and suture techniques.

Labia Majora– The outer lips should ideally be symmetrical, full, smooth and nearly approximate in the midline. Surgery aims to reduce excess fattiness and laxity and restore a more youthful appearance by excision of excess skin and hair baring areas. Liposuction may also be used to decrease fatty areas. In cases where deflation is excessive fat filling may greatly improve the result.

Labia Minora- inner lips. Inner lip reduction or labiaplasty is by far the most common procedure performed for vaginal rejuvenation. The inner lips should be concealed and hidden by the outer lips with minimal protrusion beyond the outer lips.

Surgical excision by various methods allows the removal of the extra skin and closure with absorbable sutures.

Clitoral hood – May be wide and enlarged with accordion-like folds of the hood and widening of the intervulval commissure. Abnormalities here are also address by excising (cutting) of the excess and closure in an aesthetically pleasing manner.

Clitoris – May be large and protruding and may require a reduction by surgical excision.

Internal vaginal muscular wall – as the internal vagina is largely a cylindrical muscular wall this area responds well to strenuous pelvic floor exercises rather than surgical intervention which may result in permeant scaring and contracture formation. However in cases of vaginal prolapse the patient requires a pelvic floor lift performed by a gynaecological surgeon.

When considering vaginal rejuvenation I would recommend that you consider the above mentioned structures on your own genitalia and assess which areas concern you most. As mentioned previously labiaplasty is the most commonly performed procedure. You may however feel that you have multiple areas of concern. I would however recommend that we do not address all areas at once as multiple cuts leads to prolonged healing and swelling, delay in returning to sexual intercourse and increase complication rates.

It is important to realise that vaginal rejuvenation improves the outer cosmetic appearance of the vagina the so called designer vagina but has no effect or improvement on sexual function.

Surgical Procedure

The surgical procedure is performed under general anaesthetic in theatre or under local with sedation in our procedure room. The procedure may take anything from 30 min to 3 hours depending on the amount of rejuvenation that needs to be done. The procedure can be done as a day case or the patient may desire to remain in hospital for one night.

The desired areas are addressed usually with a combination of liposuction, fat filling, surgical excision (cutting) and stitching with absorbable sutures.

After the operation the area would be injected with a long acting local anaesthetic to provide prolonged pain relieved.