Lara Devgan, MD, MPH, is a Yale-educated, Hopkins-instructed, and Columbia-trained plastic and reconstructive surgeon in private practice in New York City. For more information, please visit

BLOG: A systematic approach for superb labiaplasty results

Labiaplasty, or cosmetic rejuvenation of the female genitalia, is the fastest growing plastic surgery procedure in America. The most recent set of statistics published by the Amercian Society of Plastic Surgeons reveals that the number of labiaplasties performed has nearly doubled over the past year, with a 44% increase compared with the previous year.

What is labiaplasty ?

Labiaplasty is, in short, any plastic surgery procedure designed to improve the cosmetic appearance of the female private parts. Areas of concern include the labia minora, the labia majora, the clitoral hood, the perineum, the mons pubis, or any combination of the above.

The most common complaint for women in my practice is hypertrophy or excess tissue of the labia minora. This area can hang down and create uncomfortable and unsightly bulging in the genital region. Not only does this frequently make a woman feel self-conscious about her physical appearance, but it can also make exercise, sexual intercourse and activities of daily living uncomfortable. In severe cases, women experience chafing, skin irritation and rashes in the affected regions. Generally speaking, labia minora hypertrophy is something that a woman is born with, though it can certainly be exacerbated by hormonal changes or the trauma of childbirth.

Another common concern is redundancy of tissue in the perineum. This is frequently related to injuries and tissue tears that occur during vaginal deliveries, including episiotomies.

As women age, they also experience atrophy of the labia majora. This creates a droopy or saggy appearance of the outer, more visible tissues of the female genitalia. Most women with atrophy of the labia majora are perimenopausal or postmenopausal, lthough it can also occur in women who have lost a significant amount of weight or who have poor tissue elasticity.

Mons pubis bulkiness is a less common complaint related to female genital rejuvenation. Puffiness in this an atomic region is generally associated with excess fat deposition in the area. It can also be seen in patients who have lost a significant amount of weight.

Prominence of the clitoral hood is a less common complaint related to cosmetic improvement of the female genitalia. Women who have clitoral hood hypertrophy have often been exposed to higher than typical amounts of testosterone or other male hormones, either during in utero growth, pubertal development, or later in life.

How should a plastic surgeon analyze a labiaplasty patient?

A full history and physical examination are essential in evaluating a labiaplasty patient. This includes a detailed account of menarche, puberty, pregnancies, types of delivery and menopause. It also includes a history of any exposure to hormones or hormonally mediated medications.

Physical examination should include a systematic analysis of the labia majora, labia minora, clitoral hood, perineum and mons pubis. It must also include an analysis of tissue type and quality. This includes assessing a patient's subcutaneous fat deposition as well as the elastic recoil of the skin and soft tissue.

Preoperative photographs are important to document the patient's anatomical concerns. These are taken with the patient in both standing and frogleg positions. A gloved hand can be used to splay the tissues apart to document particular areas of concern, as needed.

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