-In consultation, surgeon must determine whether patient's anatomic goal is achievable
-Be cautious regarding aggressiveness of reduction
-Careful technique critical for avoiding complications when performing linear resection
ATLANTA — Success in labiaplasty requires understanding of the patient's motivations and outcome goals along with good surgical technique. While these principles seem obvious, the frequency of women presenting for revision labiaplasty suggests they are too often being overlooked, says John R. Miklos, M.D.
"Avoiding complications in any surgery involves choosing the right procedure and performing it correctly. However, the first step depends on obtaining a good history to determine the patient's indication for seeking surgery and postoperative expectations, and then one must have proper training and skills," says Dr. Miklos, a private practitioner in Atlanta with fellowship training in urogynecology and laparoscopic reconstructive vaginal surgery. "Considering the number of women I see who are devastated by the results of their labiaplasty, not all surgeons are following these basic rules."
"Only about one one-third of women wanted labiaplasty solely for cosmesis. For the majority, there was a functional quality of life issue involved," he says.
With the patient's anatomic goal in mind, surgeons must first determine whether it is achievable and inform the patient of their determination. In some women, the labia majora are so flat because of changes in weight and/or age-related fat atrophy that it is not possible to get the labia minora below the level of the labia majora, Dr. Miklos says.
"However, lowering of the labia minora will still relieve discomfort because the tissue will be less pedunculated. Therefore, the outcome may be acceptable to women seeking surgery for functional reasons," he says.
Dr. Miklos says it is important to be cautious about the aggressiveness of the reduction performed, taking into account whether the patient wants or is willing to have the tissue completely removed.
"One recurring problem among women who come to me for postlabiaplasty revision is a desire to have the labia minora rebuilt because the tissue was totally amputated by their previous surgeon," Dr. Miklos says.
"It is widely written throughout the literature that labiaplasty should maintain the natural skin color and border, and for that reason, the procedure is usually performed with a V-wedge resection," Dr. Miklos says. "However, to meet the expectations of the majority of patients, a linear-contouring resection should be done instead. Even then, depending on the anatomy, it is sometimes not possible to provide the desired skin color, and patients need to be told that preoperatively."
Careful technique is also critical for avoiding complications when performing a linear resection. Cutting the labia while pulling the tissue with excessive tension is one mistake that results in over-shortening to the point of near complete amputation, Dr. Miklos says.
"Though all cosmetic surgeries have their potential financial incentive, the ultimate physician reward is an elated patient with an improved quality of life. Therefore, I would caution surgeons to be slow to adapt new surgical procedures and techniques and to address patients' cosmetic labia requests with the same intensity and concern as he/she would for themselves or a family member," he says.