Over the past three years, through continuous refinement and modification, my technique has evolved based on invaluable experience gained from performing the procedure on hundreds of patients.
Here is a description of my technique, including preoperative, intraoperative and postoperative aspects, demonstrating significant advancements achieved.
Preoperative Considerations
The initial consultation is a crucial step in establishing open communication with the patient and allowing me to fully understand their concerns and goals. Equally important is ensuring that the patient genuinely desires the procedure for herself, devoid of any external pressures or shaming. It is imperative to create a supportive environment where the patient feels comfortable expressing her needs and expectations.
Furthermore, patients must be at least 18 years old and provide their own informed consent for a labiaplasty. This ensures that the decision is made with maturity and autonomy.
Prior to the procedure, I want patients to be in the best of health. For individuals who smoke or vape, a comprehensive consent form is signed, acknowledging the increased risk of wound-healing complications associated with nicotine use. These patients also undergo nicotine testing before the procedure is scheduled. To minimize the risk of bleeding during the procedure, patients are advised to discontinue multivitamins and blood-thinning medications before the scheduled surgery.
Intraoperative Technique
 My technique focuses on achieving desired outcomes while optimizing patient comfort throughout the surgical process. With this goal in mind, a topical numbing cream is applied to the labia and inner thighs, ensuring local anesthesia and minimizing discomfort. After 15 minutes, the cream is removed, and the area is carefully iced, which enhances numbness and further reduces discomfort.
Next, each side of the labial area is injected with a mixture of 8 cc – 10 cc of 0.5% marcaine and 1% lidocaine with epinephrine. This combination serves two essential purposes: it provides extended pain control and simultaneously reduces bleeding during the surgery.
Using a meticulous approach, I utilize a 10-blade to create a medial wedge and lateral hockey-stick incision, ensuring optimal aesthetic results while preserving the underlying mucosa and delicate blood vessels. To maintain hemostasis, an ocular cautery is employed to coagulate any actively bleeding vessels. To achieve precise and secure wound closure, the incisions are closed in two layers.
The first layer involves interrupted 5-0 monocryl sutures, which provide excellent tissue approximation. Subsequently, an overlaying running 5-0 chromic suture further reinforces the closure. As part of my technique, I also administer 1 cc of long-acting local anesthetic into each labia. This additional step has demonstrated positive outcomes in terms of long-lasting pain control, facilitating a smoother postoperative recovery.
It is important to safeguard the glans and reduce the risk of injury to the nerves, blood vessels and other surrounding structures that contribute to sexual function so I do not routinely perform a clitoral hood reduction. The majority of my patients agree with this strategy.
Postoperative Care
 Postoperatively, my approach centers on promoting patient comfort and ensuring a smooth recovery process. Patients are advised to ice the surgical area on and off for 20 minutes at a time, continuously for two to three days. This application of cold therapy effectively reduces swelling and discomfort. While maintaining an active approach to recovery, patients are encouraged to engage in hip elevation whenever possible, as it can further aid in reducing swelling. However, it is important to note that prolonged bed rest should be avoided to prevent other potential complications.
On the first postoperative day, patients are instructed to take a shower after a virtual followup examination. This allows me to remotely assess the healing progress and address any immediate concerns. Additionally, a three-day course of an antifungal medication, is prescribed to proactively prevent yeast infections, which can occasionally occur as a result of changes in the vaginal environment following surgery. We discourage tampon and menstrual-cup use and recommend maxi-pads for the first menstrual cycle after labiaplasty. Patients should avoid strenuous exercise, including sex, for four to six weeks. Additionally, it is important to avoid foreign bodies of water, such as pools and hot tubs, for this period of time to decrease the risk of infection.
Postoperative care does not conclude with the surgery itself. Routine follow-up appointments are scheduled in our office approximately one month after the procedure. These appointments are integral in evaluating the progress of healing, addressing any potential concerns, and providing ongoing support to ensure optimal results and patient satisfaction. It is through this comprehensive follow-up that we maintain our commitment to the well-being of our patients beyond the immediate postoperative period.
Conclusion
As a board-certified plastic surgeon, my dedication to patient safety, comfort and satisfaction has driven the development of this advanced labiaplasty technique. As the field of plastic surgery continues to evolve, it is vital to embrace innovative techniques that prioritize patient well-being and consistently deliver superior outcomes in cosmetic procedures.
