Labiaplasty Surgery in Mumbai

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Labiaplasty · Applications, areas, treatment and effects

The  labiaplasty  is one of the intimate surgeries par excellence. The patients who demand it intend to return the lost turgor to this area or to give a less childish appearance in the event that there is little development.

There are surgical procedures that help solve these problems by returning the appearance of this anatomical region to normal; one of them is labiaplasty .

Hypertrophy or enlargement of the labia minora can lead to an aesthetic and functional problem. Difficulty in hygiene or in sexual relations that can affect the lives of some patients.

Labiaplasty · Reduction of labia minora and majora

There are several types of  labiaplasty or genital lip surgery. One of them is labiaplasty for the reduction of the labia minora and majora . This type of surgery is carried out through a laser that cuts the hypertrophic part that is left over from both the labia majora and the labia minora.

The consequences of a hypertrophy of the lips can be very annoying for patients, such as irritation due to friction with intimate clothing.

The procedure is normally performed in just 60 minutes, under general anesthesia. For this reason, the patient does not feel pain and it is not necessary for her to be admitted to the hospital.

How is the diagnostic appointment?

In the first consultation, you will receive information about the intervention, and the surgeon will take your medical history. In the consultations prior to the labiaplasty intervention, a   genital examination is necessary, the measurement of certain parameters such as the general state of health, and the taking of photographs that will later be used to evaluate the results.

The genital examination, together with the age and history, will serve to request other complementary tests before the operation (analytical, electrocardiogram, ultrasound, etc.) that will help us decide the technique to use. It is important that you say if you suffer from any important disease, if you are a smoker, if you take any medication, or if you are allergic to any medication or product, and that you ask anything you doubt.

The plastic or gynecosesthetic specialist will assess with you if the best option is surgical or CO2 laser.

Non-ablative labiaplasty

Today it is no longer a taboo to talk, both among friends and in the media, about the characteristics of the female genital area.

Some women have recognized that the exaggerated length of the labia minora or the marked thinness of the elders is not a condition to suffer but a situation that can be remedied.

In this way, we have designed a treatment with non-surgical techniques that combines the infiltration of hyaluronic acid in the labia majora with plasma excision (PLEXR) of the labia minora to provide a solution to these very intimate problems ( non-ablative labiaplasty ).

Where can we apply pressure therapy?

After an outpatient labiaplasty surgery, the normal thing, during the first days, is to suffer a little pain, which will decrease as time goes by and thanks to the medications prescribed by the doctor.

Small bruises and inflammation may appear. As for the infection of the scar, it does not usually occur, since the area is quite vascular, which means that there are hardly any complications.

LabiaplastyBest in DELHI

For us, the fundamental thing after your labiaplasty operation is to achieve a natural result and your maximum satisfaction. In order to use a safe technique and maximum safety, at  DELHI  the operation is performed exclusively by doctors with the appropriate qualifications and experience for this procedure.

Our main advice is that, in the diagnostic consultation, ask anything you doubt about labiaplasty . It is very important to use quality and reliable products, so we always use machines approved by the health authorities.

It is important that you let us know what your expectations are, so that we can explain if they can be met or if there are any limitations. We will explain the most appropriate correct operation in your case. Likewise, we will inform you about the price, the different forms of payment and the financing possibilities  .

How is the labiaplasty operation?

We currently perform the labiaplasty operation under general anesthesia. Although it is a short-term operation, it is advisable to perform labiaplasty in a hospital center that has all the security measures, such as having an intensive care unit and always under the strict control of the anesthetist in the operating room. Once the patient to whom the labiaplasty will be performed is asleep , the surgical field is sterilized and the operation proceeds. Your surgeon will inform you of the usual and extraordinary measures taken into account for your safety during the labiaplasty intervention., as well as during the postoperative in the medium and long term. The surgeon will choose the product and the technical and human resources that he considers best for you. In less than an hour the labiaplasty operation is finished.

Labiaplasty Before and after photos

Viewing the before and after photos will help you complete this information about the process and possible results of labiaplasty surgery interventions .

For almost two decades, a series of procedures that are included within what has been called cosmetogynecology or female genital cosmetic surgery have been added to the knowledge and practice of gynecology (1). However, to date there are few studies and reviews in this regard that allow us to judge their results (2-4).

In the case of labiaplasty, or surgical reduction of the labia minora (and, frequently, part of the clitoral foreskin), this was performed in exceptional cases, mainly in girls and adolescents with hypertrophy of nymphs. Labiaplasty is indicated for hypertrophy of the labia minora; that is, when they measure more than 4 cm in extension and when faced with functional and / or aesthetic discomfort (2). Its causes are not clearly defined, but are associated with factors such as: use of androgenic hormones, hormonal imbalances, chronic local irritation, congenital or idiopathic condition that corresponds to the majority of cases (5-7).

Women generally consult motivated by an aesthetic condition, but also a functional and psychological one. There are no measurements for each particular reason, but they are often found in combination (8,9). In the case of psychological conditions, it is common to find women who reject certain sexual practices (such as cunni-lingus), due to the appearance of their external genitalia (1). In our experience, it is not uncommon for women over 25 years to confess that their virginity is related to a self-esteem problem due to the size of their labia minora.

There are many techniques used to perform labiaplasty, ranging from the method of cutting to the design of the cutting lines. Labiaplasties performed with a scalpel, scissors, laser, and an electrosurgical unit have been reported. Also, the cutting lines vary from labiaplasties in "Z", lateral or triangle resections. There are no randomized communications that allow to show advantages of an instrument and / or cutting lines and these vary according to the author.

In 2003 we started an experience in laser labiaplasty, reported in 2005 with 55 cases (4). The objective of this work is to communicate the results of 500 labiaplasties performed in the course of more than 10 years of experience.

PATIENTS AND METHODS

A descriptive study was carried out of the results obtained in the universe of labiobioplasties performed by two surgeons (JP and VS), with 386 and 114 interventions, respectively, between October 2003 and April 2014, in 5 clinics in Santiago , Chile. In more than half of the cases, the surgery was performed by both doctors, but having gained more experience, they began to be performed by a single surgeon and without an assistant.

Despite the fact that in a previous communication the authors established a classification of hypertrophy of the labia minora, on this occasion it was not considered necessary to measure the lips to justify the intervention, but the reasons why surgery was decided were recorded. These were classified as: aesthetic, functional and psychological reasons.

Aesthetic reasons were defined when there were no local or psychological / sexual complaints. Functional causes were considered: nonspecific local discomfort, inappropriate and annoying rubbing in sports activities or with clothing.

The exclusion criteria for surgery were: i. Not having reached at least two years post menarche, ii. Acute vulvitis and iii. Have a body self-image disorder. Regarding the selection to use electrosurgery or laser, this was related to the availability of the laser equipment and not to other types of criteria.

All patients received detailed information about the procedure and possible complications, in the consultation prior to surgery, and signed a specific informed consent.

Finally, to assess satisfaction with the results obtained, all patients were questioned within three months after surgery, where they were asked to answer about their degree of satisfaction in relation to their expectations prior to surgery, of according to an ordinal scale that categorizes the response options as: Very satisfied, Satisfied or Dissatisfied.

Surgical technique. The patient lies in a gynecological position. Preferably, the patient is shaved in the genital region to avoid the discomfort caused by genital hair when performing the sutures. After vulvope-rineovaginal aseptization, the surgeon makes a detailed evaluation of the anatomy of the lips in order to be clear about the different folds, thicknesses and particular variations. These are important, since in most cases a resection of part of the prepuce of the clitoris is required on the sides and, sometimes, in the center; what we have called the "harmonization of the clitoral foreskin". In other cases, excess skin that extends from the labia minora or that occurs independently in the region surrounding the perineum is frequently removed.After deciding the cutting lines, a drawing is made marking the internal and external or posterior area where the incisions will be made . Next, the inner side of the lip, marked with the pencil, is confronted with the contralateral side to mark the cut line. This is to seek as much symmetry as possible, since absolute symmetry is very difficult to achieve. The way of making the incision that has been used has varied with time and experience. During the first 100 cases, the lips were extended to the sides, securing them with sutures to two gauze that were between them and the inner thigh. Later, this technique was abandoned for a freer one that varies from patient to patient. Most commonly, the cut is currently made by assisting traction with a Hudson surgical forceps. As for the cutting instrument, it corresponds to a contact laser (CLMD 60 Contact Laser Nd YAG laser and sapphire scalpels ER2;Surgical Laser Technologies Inc., Montgomeryville, PA, USA) with an average cutting power of 10 W. During 2008, and with the experience of having operated on approximately 200 patients, the cutting instrument was changed to an electrosurgical blade with a tip. of tungsten, Stryker (Colorado Needle ®), with which the cutting and coagulation are performed, both with energies of 18 to 20 W. After removing the excess tissue, a careful hemostasis of the bed is performed by coagulating with the electrosurgical unit. Subsequently, the lips were closed with 5-0 polyglactin (4-0 was used in the first 250 cases). The suture of the lips has also varied over time and we do not have a standard, as we believe that this surgery is tailored to each patient. The closure has been made with separate points, intradermal or external continuous.In the last two cases, generally, some interrupted reinforcement points must be applied, with the same material. Another variant that is frequently applied is what we have called "memory" points, a term learned with Dr. David Matlock of the Laser Vaginal Rejuvenation Institute in Los Angeles, California and consisting of two or three points side by side on the base of the lips, which are intended to prevent retraction and maintain the lower lip at the chosen length.California and consisting of two or three points from side to side at the base of the lips, which are intended to prevent retraction and keep the lower lip at the chosen length.California and consisting of two or three points from side to side at the base of the lips, which are intended to prevent retraction and keep the lower lip at the chosen length.

During the operation a dose of Cefazolin is administered. In the postoperative period, ketoprofen 100 mg is administered intravenously and during the first two days local ice is applied, without direct contact with the skin and intermittently. Postoperative prophylactic antibiotics are not indicated in single labiaplasties.

Regarding post-surgery indications, the patient is allowed to shower after 24 hours. The local hygiene measures indicated emphasize the use of shampoo or shower soap, which runs off the area, then drying with a cotton towel and then a hair dryer. The use of a healing cream containing gotu kola for the first three weeks has been recommended in all cases. Relative bed rest is recommended for the first 48 hours and then getting up indoors. In general, return to work occurs 4 to 5 days after the operation, although in some patients in particular, it is feasible within 48 hours.

The first postoperative evaluation is performed a week after the surgery and then a month after the operation, when, in general, the patient is discharged permanently. During that month it is indicated to avoid sports activities that involve local friction, tight clothing, sexual intercourse and immersion baths of any kind, such as a bathtub, Jacuzzi, pool or sea.

RESULTS

The range of patients was from 10 to 72 years, 7% (n = 35) were less than 20 years old at the time of surgery. A 10-year-old patient had not been 2 years post-menarche, but the degree of hypertrophy was so significant that surgery was performed at the mother's request.

The indications for labiaplasty were aesthetic in 95.4% (n = 477), functional in 37.2% (n = 186) and psychological in 17.4% (n = 87). Several cases presented lip hypertrophy greater than 10 cm, with cases measuring 14-15 cm.

46.6% (n = 233) of the labiaplasties were associated with other gynecological surgery, such as: suburethral slings, colpoperineoplasties for symptomatic vaginal width (vaginal rejuvenation), prolapses, hysterectomies, myomectomies, laparoscopic tubal sterilizations (cosmetic lifting) labia majora and pubic liposuction). In 5.2% (n = 26), there were associated non-gynecological plastic surgeries such as: tummy tucks, liposuction, mammoplasties and breast implants, all performed by certified plastic surgeons not members of the gynecological team.

In 8 cases they corresponded to touch-ups or revision labiaplasties, of which 3 were team patients who had not been totally satisfied with the first surgery.

The anesthesia administered was regional in 88% (n = 440), general in 10.4% (n = 52) and local in 1.6% (n = 8). General anesthesia was used preferably when there were associated plastic surgeries or laparoscopic hysterectomies.

The mean operative time was 40 minutes (range: 24 to 67 minutes). There were no intraoperative complications in any case. Likewise, there was no significant bleeding in any labiaplasty. In 2 cases there was moderate postoperative bleeding that could not be controlled by pressure, which made it necessary to apply a suture point. In one case, the bleeding occurred in the room before discharge and the other, the next day at the consultation. In both cases, a local anesthetic (lidocaine) was used.

In all cases in which labiaplasty was the only procedure, discharge was indicated on average 6 hours after surgery. When labiaplasty was combined with another surgery, the latter was the one that led to medical discharge.

In the medium term, in 9% of the cases (n = 44) there was a mild to moderate dehiscence of the suture, which were managed conservatively, all of which closed spontaneously.

With these described measures, pain management was very successful. Only 2.8% of the patients (n = 14) reported moderate pain for more than a week, which resolved spontaneously. Only one case of prolonged postoperative pain was recorded, which corresponded to a patient with very thick labia minora in which connective-cellular tissue resection was performed in order to thin them. The case was resolved by increasing the days of analgesia and use of non-steroidal anti-inflammatory drugs.

The topic of gynecological "cosmetic" surgeries has been in vogue in recent years in the press and communication media. Although it has been a source of debate and controversy in the specialty, the evidence in recent years points to the successful results obtained in this area. Thus, an article published in the editorial of the Journal of the International Urogynecological Association (IUGA) in 2007, concluded that cosmetogynecology came to stay and that the role of the different societies and serious groups of the specialty should no longer be the to oppose, but to study and standardize it (10,11).

The present study shows the results obtained in the largest series of laser labiaplasties reported to date in the national and international literature. These results show the high satisfaction obtained in terms of the resolution of the hypertrophy of the labia minora and its implications in aesthetic, functional and psychological areas, fully complying with the expectations of the patients, which is consistent with other previously published results on this technique. Recently, Miklos et al (12), in a prospective study, showed that well-indicated labiaplasty provides excellent results, with a high degree of improvement in self-esteem and a decrease in local discomfort, without negatively affecting orgasm.

Regarding the surgical technique presented, in our opinion, the design of the cutting lines is the cardinal point. One of the main care we have in surgery is to avoid over correction. On the other hand, it seems relevant to us to explain why we do not perform the "Z" technique. This is because in most cases the remaining inner area of ​​the labia minora is lighter in color. Patients seek to have the lightest pink lips possible and with the Z technique the edge is usually still dark.

Regarding the use of lasers versus electrosurgery, so far we have not found categorical advantages with any of these procedures, in terms of complications, degrees of satisfaction and aesthetic final result.

Finally, we want to highlight that the association with other gynecological or cosmetic surgeries is a common practice not only in this experience, but also in another series reported by the authors (13).

We think that, just as it happened when 30 years ago women sought to increase their breast volume with implants and shortly after this surgery, initially rejected, ended up being accepted, taught and regulated, the same should happen with labiaplasty. Surgeons in the specialty should not object to the reduction of the labia minora of a psychologically healthy woman who feels a reduction in her self-esteem, body self-image or functional discomfort due to the size of her lips, whether they are minor or major (14). We believe that, as gynecologists, we have an obligation to empathize with the discomfort of these patients and, if we are not in a position to offer surgery based on experience, we must refer them to a professional specialized in the subject and who has sufficient surgical expertise. .