Female Genital Rejuvenation
It seems as if one of the latest trends in plastic surgery is the cosmetic enhancement of the female genital area. In fact this type of surgery has always been performed, as it has always been demanded, yet it was historically not talked about. Patients were embarrassed to talk about this type of surgery with others, and surgeons were not apt to promote these procedures in their practice. That has all changed now. Women are increasingly seeking aesthetic enhancement of their vulva and genital areas, much as men have done for years.
The female genital procedures can be divided into five areas where surgeries are performed;
Labia majora and Mons pubis, labiaplasty/ labioplasty (labia minora reduction), vaginoplasty, clitoral de-hooding, and hymen reconstruction.
Labia majora and Mons pubis
The labia majora are the two outermost bands of female genital tissue directly next to the thighs. The Mons pubis is the collection of fatty tissues directly over the pubic bone above the vulva. The functions of the Mons and the Labia majora are to enclose and protect the genital organs The Labia majora As with other areas of the body, with age, weight loss or child bearing, there is a reduction in the amount of fatty tissues in these areas leading to a more wrinkled and deflated appearance. Although laser resurfacing of the labial majora has been advocated by some, my preference for rejuvenation of this area is for fat injection into the labial majora and Mons pubis in order to replenish the lost fat and to ”plump“ up the skin wrinkles. Simply removing the wrinkles still leaves the patient with a flat and abnormal looking labial majora. Like fat injection in other body parts, some of the fat may resorb after the first surgery and a repeat fat injection may need to be performed.
The Mons pubis may on the other hand be too large and fatty. In such cases liposuction of the fat from the Mons can be performed to reduce its size.
These procedures are typically carried out in the office under local anesthesia as an outpatient procedure.
Labiaplasty
The term labiaplasty (or labioplasty) refers to the reduction in size of the Labia minora. The Labia minora are the bands of tissue on either side of the vagina that are directly inside the Labia majora. These two flaps of skin extend down from the clitoris. Hormonal changes in the body brought on by pregnancy, puberty, menopause and age, enlarge and darken the color of these tissues.. Many women find these changes particularly disturbing as they are the most obvious to them and their sexual partners. In some cases the labia minora can become so large that they will interfere with sexual intercourse.
Labiaplasty is one of the most common of the genital rejuvenation procedures performed. Typically performed under local anesthesia in the office, the procedure involves cutting away the excess tissue and closing the wound. The aim of the surgery is to reduce the labia minora and not to totally remove them. The patient must refrain from sex for several weeks until the wounds are healed, but is otherwise walking directly after the surgery and has minimal discomfort.
Vaginoplasty
This procedure refers to the reduction in the size or tightening of the vagina that has become enlarged or lax following childbirth. The vagina is composed of three layers. An outermost fibrous layer that attaches it to the surrounding tissues, a muscle layer that contracts, and a redundant mucosal layer. In the vaginoplasty procedure, the aim is to reduce the volume of the vagina in the first 1-2 inches while maintaining its shape. This procedure is also performed under local anesthesia in the office, but is a little more involved than labioplasty or Labia majora and Mons pubis enhancement. The mucosa is removed in several locations around the vagina with care being taken not to injure or affect the urethral opening through which urine flows out. The muscle layers is then folded over itself, and the wounds closed. This tightens the entrance to the vagina. In some cases another suture is placed around the vaginal opening to tighten it further. Patients need to refrain from sexual relations for at least 6 weeks until healing is complete. Patients are ambulatory as of the first day.
Clitoral de-hooding.
The clitoris is the tissue at the top of the labia minora which is involved in conveying sensations associated with sexual pleasure. There is a fold of tissue, or ”hood“, which covers part of this cylinder shaped organ. In some cases, to allow for increased sexual arousal, patients request removal of the hood. This is a small but delicate procedure is performed under local anesthesia in the office.
Hymen reconstruction
The hymen is a thin fold of mucosa covering the opening of the vagina. This is typically associated with sexual virginity in females, and throughout history the finding of blood on the sheets of the newlyweds was a testament to the hymen no longer being intact. In many cultures the intactness of the hymen is of profound importance in cases of marriage and its lack not associated with a happy outcome. There are women that are born without a hymen and others where the fold is so thick that it must be surgically excised (imperforate hymen).
The reconstruction of the hymen involves forming a fold of mucosa to cover the vaginal opening. The procedure is performed under local anesthesia in an office setting and the patient is ambulatory immediately. Full healing can take about one month.
The above procedures share a common thread with other cosmetic plastic surgery procedures. They enhance the quality of life of the patients by giving them self-confidence, a feeling of well- being, and a return to normal in the shape and contour of their genital areas. The surgeries are performed under local anesthesia in an outpatient setting, have quick recoveries and are associated with low risks of complications.