Laguna Beach, CA
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January 21, 2013 3:07 PM
All the surgeons have made valid and important points and I agree with just about all that has been previously written. The most important recurring statement is that perfect symmetry is
All the surgeons have made valid and important points and I agree with just about all that has been previously written. The most important recurring statement is that perfect symmetry is impossible to achieve and that expectations should be reasonable. However, most who have laibiaplasty done have an image or look they are trying to achieve. If it is not achieved on the first try then revision can be considered. Some with be able to live comfortably with the results and some will want a revision. The patient is the final decision maker on the need for revision. Once that decision is made for revision then the options open up. Looking at your pictures shows me a fairly normal and typical looking labia minora that does not strictly need a revision. In other words, it is within the normal range of normal results. But not perfect.
For irregular and discolored edges, dog ears of the frenulum or clitoral hood, notches from sutures, size discrepancy, irritating flaps of introital skin, even just bumpiness of labia, revision can be done. In your case, smoothing of tissues and matching sizes is best done, in my opinion, using radiosurgical resurfacing. You can see some examples at http://urogyn.org/labiaplasty_revisions.html. The radiosurgical tool I use is an Ellman Pelleve or Surgitron. It is exceptionally precise in work near or around the clitoris. It is able to smoothen and shrink tissues to a very refined look if wanted. Recovery takes six weeks and is uncomfortable because you are basically healing from a second degree burn. However, the results are quite amazing and gratifying. No sutures are needed in most cases. Similar results can be obtained with a CO2 laser with even greater shrinkage of tissues but the precision is lacking for work around the clitoris. Can revision be achieved without the Ellman? Yes, of course. Knives and excisions can be done but sutures will be needed. Standard cautery can be used but the burn is even greater. 980 Diode lasers can also be used but the lateral burn spread and precision around the clitoris and frenulum are a distinct issue requiring great care. Go to someone who does a million revisions for this type of surgery requires the right tools, the right choice of surgery, and experience. In most cases, revision labiaplasty is more difficult than a primary labiaplasty and requires more advanced planning and forward thinking and an artistic eye. Lastly, question yourself well on the need and desire for revision surgery. Get input, get consults, and make a decision that is right for you.
Hope this helps.
Red Alinsod, MD