“It’s okay to look good down there,” declares Austin-based plastic surgeon, Dr. Jennifer Walden, referring to a type of cosmetic surgery becoming increasingly popular — labiaplasty.
According to The Aesthetic Society, there were 36% more labiaplasties performed in the US in 2021 than in 2020. Usually undertaken to minimize the size of the inner or outer vaginal lips (labia minora and labia majora respectively), this procedure addresses functional as well as aesthetic concerns.
There are significant psychological benefits that accrue with this surgery too, particularly when it comes to reconstruction in the aftermath of female genital mutilation (FGM).
So what is a labiaplasty and what’s behind the increase in demand?
Labiaplasty — not to be confused with vaginoplasty which is a surgical procedure for vaginal tightening — is an outpatient procedure typically performed on the labia minora to restore symmetry or reduce excess bulk. If, for instance, the labia minora hangs below the labia majora or one labia is significantly longer or misshapen relative to the other, the excess is trimmed and a new contour of the labia is designed.
Labiaplasty can also address cosmetic deformities of the labia majora. “With time,” explains New York City plastic surgeon, Dr. Olivia Hutchinson, “older patients lose some of the structural support within the labia majora, so in those patients, we would either remove excess tissue or actually use fat or filler to restore the volume that was lost. It can be something that’s part of a mommy makeover.”
A third component involves the clitoral hood — the skin overlying the clitoris. Sometimes there’s excess bulk causing irritation and decreased sexual pleasure and that can be removed, says Dr. Hutchinson. Or, patients have experienced some type of trauma.
“I had a young patient who was on an ATV vehicle that crashed and her genitalia were injured in a very traumatic manner from the controls of the ATV,” shares Philadelphia-based plastic surgeon, Dr. Ivona Percec.
Deformities and scar tissue caused by piercings and the removal of cancerous lesions can also be addressed with labiaplasty.
As for the increase in demand for this procedure, modern life in general appears to be the driving force. Today’s form-fitting fashion trends, like athleisure, accelerated during COVID, can create a visible bulge or be uncomfortable to wear. “A lot of patients, especially the younger ones, feel ill at ease in certain types of clothing like gym clothes and yoga pants,” says Dr. Hutchinson, adding that patients under the age of 18 are carefully evaluated over the course of several months. “There’s not much coverage of the area, and if you have a lot of excess tissue, it really shows through clothing and in gym outfits. So, they come to us because they’re embarrassed and self-conscious and also because the excess bulk can cause irritation, so it becomes a functional problem as much as an aesthetic one.”
Our collective image consciousness is another factor. “The fact is that we as a society for better or for worse, are very in tune with our external appearance and that probably has to do with the internet and access to imagery, some of it pornographic,” says Dr. Walden.
In addition, dissemination of and access to information has reduced the stigma associated with labiaplasty, thereby contributing to the rise in demand. “We definitely saw an increase in the past 10 years,” says Dr. Hutchinson. “It was not as well-known prior to that. We see a rise in requests for procedures when there have been articles written about it or when it becomes more commonly discussed.”
“Women now know this is a procedure that can be performed and can help them and it’s not taboo,” says Dr. Walden. “It’s an acceptance of a procedure that restores natural anatomy just as if you had a breast reduction or a facelift. It can help you restore to what it used to look like.”
Popular across a wide age range
Something that sets labiaplasty apart from other plastic surgery is that it is performed across a wide age range of patients. Whereas breast augmentation, for instance, is usually carried out in younger to middle-aged women and facelifts are typically performed on middle-aged to older women, labiaplasty runs the gamut. “I’ll perform a labiaplasty on an 18- or 19-year-old who’s developed an enlarged labia and wearing a bathing suit is embarrassing and painful for her and on someone who’s middle aged who’s had children and wants to restore pleasurable intercourse,” says Dr. Walden who has also “done a large amount of labiaplasties on women in their 60s and some in their 70s and cheers to them! Women are dating at older ages and they’re empowered to do that.”
“This is a good message in this day and age with Roe v. Wade,” continues Dr. Walden. “I think women should have the autonomy to do whatever they want with their bodies. If they want to get a surgical procedure to look better or younger down there, then more power to them.”
Reconstruction after FGM
A woman’s agency over her own body is at the core of reconstructive surgery — which borrows heavily from labiaplasty techniques — for female genital mutilation which leaves deep emotional as well as physical scars.
Some 200 million women and girls alive today, living in 31 different countries across Africa, the Middle East and Asia, have undergone FGM. As more women who have been genitally cut move to Western nations with advanced medical methods, demand for such operations is growing. Enter Dr. Percec, who performs both labiaplasty and reconstruction surgery.
There are multiple classifications of FGM by the World Health Organization, explains Dr. Percec. Class 1 is more like a nicking or a symbolic scratch of the clitoris. That’s very rare according to the surgeon. Much more prevalent is Class 2 where the superficial aspects of the clitoris and the labia minora are removed. Lastly, Class 3, the most severe, whereby in addition to removing the clitoris and the labia minora, “everything gets closed up, leaving such a small opening to the vagina that you have a hard time menstruating or urinating and there are infections and cysts and a lot more medical complications.” Class 2 is what Dr. Percec most commonly treats.
Most of Dr. Percec’s FGM patients are in their mid to late 20s — women who were born and had their childhoods in Africa or Asia. The goal of reconstruction is to restore the appearance and sensation as much as possible: “I take out the scar tissue, then I find the clitoris that remains and I reconstruct it and resurface it with natural tissue from inside the mouth. Afterwards,” continues Dr. Percec, “I typically reconstruct the inner lips using plastic surgery techniques by creating a new flap and then using additional tissue from inside the mouth to strengthen and enlarge those flaps. Then I take fat from the belly or the thighs to graft all around the region because we think the stem cells from the fat help stimulate the nerve and tissue regeneration of the region.”
It’s difficult to overstate the impact of this surgery: “These are women who thought about the process for a long time — and I do have patients who come to me in their 40s and 50s who are past childbearing years and this is their life’s dream. They’re just extremely grateful. I have one patient who flew in from Canada to see me last week and she got on her knees and tried to kiss my feet and I hadn’t even operated on her! She was just so grateful for even the option to have help. So, I think the benefits are just spectacular even though I warn them that they’re not going to look and feel 100% normal. I explain to them that what I do is just a very small part of the iceberg because once the physical aspects are healed and we get to a point where we are happy with the aesthetics, now the hard work is the psychological healing, the trauma healing and also the sexual work.”
While the positive effect that reconstructive work can have on patients is undeniable, cosmetic labiaplasty has its detractors. Critics claim that it is an unnecessary procedure driven mainly by exposure to media images. And some physicians have opposed labiaplasty, despite evidence showing that it is effective in addressing functional and appearance-related symptoms with low complication rates. In a reaction against “designer vaginas” British artist Jamie McCartney took casts of 400 vulvas to create a ten-paneled wall sculpture — The Great Wall of Vagina.
Undeniably however, labiaplasty can have positive psychological effects. “It’s nice to perform these procedures,” says Dr. Hutchinson. “The improvement is immediate and patients feel so much better about it. It’s why we do this in the first place.” Dr. Walden echoes the sentiment: “This surgery improves my patients’ self-esteem and function/appearance so it is a positive for them psychologically. This procedure carries a very high patient satisfaction rate.”
“Many times people think of cosmetics and aesthetics as being very superficial,” concludes Dr. Percec. “But I think the FGM work that I do dovetails nicely with the importance of appearance to our psychological health and so even for those patients with a very small visible deficit, it’s linked to some kind of trauma — the trauma could be aging or childbirth — I’ve reconstructed patients after that. So from the standpoint of healing, it’s really important. Just like our face is our identity, and we should treat it with the utmost respect, our sexual organs deserve the same respect.”