Many women are unhappy with the size of their Labia Minora (inner vaginal lips) which may cause insecurity or embarrassment with a sexual partner, discomfort in tight fitting pants or swim wear or other hygienic problems. When Labia Minora are enlarged or unequal in size, some women harbor feelings of deformity or being abnormal, with loss of self-esteem. Most women do not desire the smaller inner vaginal lips to project much beyond the larger outer lips. Many women desire the smaller inner lips not to extend beyond the outer lips at all.
Most Labia Minora Reductions are performed by excising the protuberant/excess tissue and oversewing the raw edge. This technique replaces the natural contour and normally darker pigmented labial border with an unnatural and irregular scar line of more lightly colored inner labial tissue. A newer technique preserves the normal contour and color of the labia minora edge.The protuberant labia are removed in such a way that allows re-approximation of the normal labia minora edges. After healing, a normal appearing labia minora remains with surgery essentially undetectable. 
Other procedures to enhance the appearance of the vaginal area include Augmentation Labioplasty, which allows aesthetic enhancement and youthful Labia Majora (outer vaginal lips) by fat transplant/injections. In addition, Liposuction can be used to remove fat from an overly large or protruding mons pubis and upper parts of the labia majora. Lipo-sculpturing can alleviate the unsightly fatty bulges of these areas and produce an aesthetically pleasing contour.
Labioplasty Consultation
The initial consultation is extremely important to review the patient’s medical history, goals and expectations, as well as build mutual trust and rapport. Before and after photos are reviewed, the procedure is carefully explained and alternatives are discussed. Any additional procedures are reviewed if requested. A complete evaluation and physical examination is performed for each individual patient, to ensure that expectations can be met, as well as to determine the best choice of procedures. The surgical plan is then reviewed. It is important to understand that the labia minora are not naturally symmetrical and every effort will be made to make the labia as symmetrical and as close as possible to the desired size. However, no surgeon can make guarantees as to the exact size, shape, or symmetry. Prospective patients are encouraged to speak with previous patients about their surgery and results.
Labioplasty Surgery
It is generally recommended to have this procedure performed just after one's period. After speaking with the anesthetist/anesthesiologist, the patient is brought to the operating room. After the patient is asleep (or sedated), local nerve blocks, combined with medication that shrinks blood vessels and capillaries to reduce bleeding, are instilled. The excess labia minora tissue is excised in a fashion that allows re-approximation of the normal labial edges, preserving natural color and contour. The incision is closed with sutures that are self-dissolving. Any additional procedures are next completed. Liposculpture of the mons pubis will require one or two tiny hidden incisions. The excess fatty tissue removed from the mons or a small amount of fat from the abdomen, thighs, or buttocks may be used to enhance and fill out a small area of the labia majora, if desired. Antibiotic ointment and a sanitary napkin are applied.
Recovery After Labioplasty
After surgery, patients will experience some mild swelling. The recovery is easily tolerated and patients generally report minimal to no discomfort. Sutures (stitches) are self-dissolving; hence, no sutures need be removed. The evening, or the following day, the patient should shower and use phisoderm/phisohex or baby shampoo to gently clean the area and then apply Bacitracin or Neosporin® antibiotic ointment to the incision lines. Most patients return to work in two to four days. Sexual relations may resume in about six weeks. Patients from out of town should plan to stay about two or three days after surgery.
Labioplasty Complications
As with most cosmetic surgical procedures, complications are unlikely when performed by a skilled and competent surgeon. Complications include, but are limited to, anesthesia risks, bleeding, infection, asymmetry, poor or delayed wound healing, incision separation, under- or over-correction, and need for revisional surgery.
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Content provided by Miami Board Certified Plastic Surgeon Sam Gershenbaum. Dr. Gershenbaum practices plastic surgery in Miami Florida