Labiaplasty - reduction of labia

Genital Surgery

Both men and women occasionally wish to have their genitals altered through surgical means. In women it is usually vaginal surgery, surgery of labia minora or majora or hymen reconstruction surgery. Men usually wish to have the size and volume of their penis changed, or perhaps circumcision.

Female Genital Surgery

Vaginoplasty

Generally speaking vaginoplasty is the modification of the female vagina. The most frequent procedure is the narrowing of the vaginal opening. This specific narrowing of the vagina can lead to it becoming more firm.

The goal of this surgical procedure is to provide the patient with a better sex life.

This surgery is usually performed in middle-aged women who have given birth. The vagina and vaginal opening has loosened because of the birthing process and increasing age.  

The procedure is performed under general anesthesia and usually lasts 45 minutes. It is performed using the following technique: In the area of the vaginal opening, on its back side, an excision of tissue in various sizes (according to the wish of the patient, anatomical findings, etc.) is made. Then the wound is sutured. It is better to make the extent of the excision bigger and therefore narrow the opening more because it is common that the vaginal opening will widen slightly again.

If the incision is expanded even to the back of the vaginal wall and in different lengths, we can contract the whole vagina in this way. This surgery is also performed under general anesthesia, it takes about 1.5 hours.

The surgery does not only involve the mucosa, but it enters into the muscular layer of the vaginal wall. First, the vaginal mucosa is excided in the needed (chosen) extent; next, the muscular layer of the vagina is firmed and shortened. The last phase of the surgery is to suture the vaginal mucosa. The same procedure is valid regarding the extent of the excision as is mentioned in the correction of the vaginal opening. During this surgery, the prudence and experience of the surgeon is critical because of the vagina's proximity to the terminal part of colon. This is necessary to prevent the creation of a so-called rectovaginal pouch.

Both methods of surgeries use absorbable suturing material. Following the surgery, it is recommended to avoid sexual intercourse for up to six weeks. More information about vaginoplasty abroad can be found here.

Labiaplasty

Labia minora

This term refers to the surgical modification of the inner and outer lips of a woman's vagina.

The labia minora in women often protrudes between the labia majora and may reach an unbelievable size. The goal of this surgery is to reduce the protruding inner lips, and in severe cases, sometimes even almost completely remove them. Because of their function we do not recommend their total removal.

The surgery is not especially difficult; it can be performed under local anesthesia, analgosedation, or if needed, under general anesthesia. We use absorbable material for the sutures and don't recommend sexual intercourse for about one month.

Labia majora

Atrophic labia majora is when the fat tissue and elasticity have been reduced over time and therefore the labia looses its fullness.

There are several solutions:

  • Filling of the labia with a person's own fat. This procedure usually must be repeated because your own fat can be quickly absorbed; usually due to frequent sexual intercourse.  

  • Another method is the skin reduction of the labia majora. Here, the incision is usually made in the inner side of the labia minora.

  • A combination of both methods.

It is possible to perform all the above surgeries under local anesthesia, although it is better under analgosedation or general anesthesia. More information about labiaplasty abroad can be found here.

Hypertrophic (excessively large) labia majora

This most often occurs in young women. There are also several solutions:

  • Liposuction

  • A surgical reduction, when the incision is done the same way as in the skin reduction of an atrophic labia

  • A combination of both methods.

Hymenoplasty – Hymen reconstruction surgery

Much could be written about the reasons women decide to undergo this surgery.

There are several methods, although it is impossible to fully reconstruct the real hymen. The only goal of this surgery is bleeding during sexual intercourse so the man believes he was the first man for his partner.

Usually, a thin, short and small flap of mucosa is separated from the vaginal wall (approximately 1/3 of vaginal width.) It is then sewed very gently to the opposite vaginal wall. In this way, the vagina is not blocked too much to interfere with menstruation; but at the same time, the woman will bleed during sexual intercourse.

The surgery is not difficult for an experienced surgeon. It is better to perform the surgery under general anesthesia. More information about hymenoplasty abroad can be found here.

Male Genital Surgery

Foreskin

Circumcision

- Total (complete) removal of the penis' foreskin; the foreskin is removed to the extent that the glans penis is uncovered. The sutured surgical wound is under the glans penis. More information about circumcision abroad can be found here.

Common reasons for this surgery include:

  • ritual – religious (Jews)

  • medical – the need for a circumsion for medical reasons is rare

So-called Burian Plastic Surgery

- An incomplete foreskin removal that is combined with the enlargement of the opening of the foreskin flap for the glans penis.

This type of procedure is usually done for medical reasons:

  • Phimosis (the foreskin of the penis cannot be fully retracted over the glans penis – the narrow opening may occur for different reasons – injury, chronic inflammation, congenital)

  • Paraphimosis (the foreskin becomes trapped behind the glans penis and cannot be pulled back)

It is possible to perform both types of surgeries under general anesthesia with several hours or a one day stay in hospital. It can also be performed under local anesthesia as an out-patient procedure, when the patient goes home after surgery. The sutures are not removed as they are from an absorbable material. Sexual abstinence is necessary for approximately 3 to 4 weeks.

Many men have questions relating to the possibility of a penis enlargement or extension. It is necessary to keep in mind that this surgical procedure has its difficulties; and the risk for complications is great. If complications do occur, they can lead to irredeemable penis damage, not only anatomically but also functionally (penis deformation, erection defects, etc.)

Penis Enlargement

Extension

- And perhaps even enlargement of the penis in volume. It involves several procedures; usually a combination is best.

  • The least penetrative is a simple liposuction in the area of the penis root to achieve a satisfying result. The risk of complications is minimal in this method, almost none.

  • The separation of columns of erectile tissue in the penis from the pubic bone is another method. This is much more penetrative; the incision is made above the penis root. The separation of erectile tissue in the penis is not totally without risks though and it can lead to an increased danger of penis injury during sexual intercourse. The erection itself can also be negatively influenced by this procedure, which is an additional complication of this surgery.

It is necessary to wear a special weighted bandage to retain the achieved state for several weeks after this procedure. If this bandage is not worn, the penis could shorten back to its original size during the healing process.

 Size enhancement

The most advantageous method is to use one's own tissue – usually a fat tissue:

  • Lipofilling – the most gentle, a method with the least amount of complications, but also with the smallest and shortest lasting effect

The tissue is taken from the lower abdomen (for example) and is injected with subcutaneous injections into the penis.

  • Corium Fat Implants – skin with subcutaneous fat is inserted through small incisions without the top layer epidermis into the hypodermis of the penis, along its sides.

This tissue is taken from the area of the lower border of the buttocks – elliptic tissue excision from both sides. The wound is sewn; the resulting scar is hidden in the fold under the buttocks.

This method comes with a high risk of necrosis of implanted tissue, purulence and so on; on one or both sides. An adequate cool and calm mode is necessary for 4 to 8 weeks. The effect is more visible and longer lasting. More information about penis enlargement abroad can be found here.

  • Other methods are various penile implants that enhance the volume but also the penis function however this is more urologic than cosmetic.

It is always necessary for doctors to know precisely what the patient has in mind; regarding both the result and the reasons for the desired surgery. Knowing this, we can hopefully meet the patient's expectations; or inform them of the true possibilities. This is true for all cosmetic procedures.

Author: Josef Hrbaty, M.D.

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