Frequently Asked Questions

Do I Need Labiaplasty or Labia Majora Fat Transfer, or Both?

Posted on June 8, 2017 in Frequently Asked Questions

Recently, a 20-year-old woman asked Dr. Dimitri Koumanis if she would benefit most from either a labiaplasty and clitoral hood reduction, or simply a fat transfer to her labia majora. Based on several photographs accompanying the inquiry, Dr. Koumanis was able to determine that she was showing signs of labia majora deflation, paired with the presence of prominent clitoral hood and labia minora skin. His recommendations for addressing these concerns included a combined double wedge labiaplasty, in addition to application of a dermal filler or transferred fat to the labia majora to add volume or “puff” its appearance. Ultimately, he outlined that her next step should be to carefully choose and visit a board certified plastic surgeon who can perform a full, in-person examination and provide the most informed treatment recommendations.

In addition to her cosmetic questions, she expressed that insecurity about the appearance of her labia and vagina was holding her back from sexual intimacy. Ultimately, she believed that achieving a more “ideal look” through female intimate surgery procedures would give her the confidence to engage in a sexual relationship. Dr. Koumanis found it important to emphasize that, though he did highlight cosmetic concerns she may want to remedy with surgery, he found nothing inherently “abnormal” about her appearance in the photos. He went on to impart some helpful wisdom to consider when evaluating one’s own female genitalia:

• There is broad variation in the natural appearance of womens’ labias and vaginas, and no one particular standard of beauty must set the bar for everyone.
• Men are not as attuned to the cosmetic details of the labia and vagina as many women may think.
• The beauty of the female genitalia is in the eye of the beholder.

In conclusion, Dr. Koumanis reiterated that if she desires to change the appearance of her labia for her own personal satisfaction, confidence, and comfort, plastic surgery techniques can provide a solution.

If you are considering female intimate surgery and want to learn more about which options may provide you with the results you desire, please contact Saratoga Springs Plastic Surgery to schedule a consultation with Dr. Koumanis.

Where Do I Begin if I am Considering Labiaplasty?

Posted on May 8, 2017 in Frequently Asked Questions

For women at the very beginning of their labiaplasty journey, plastic surgeon Dimitri Koumanis, MD, has quite a bit of helpful advice. Most importantly, he emphasizes thoroughly researching a plastic surgeon who has the education, certifications, and experience necessary to provide you with top-quality care. He specifically recommends selecting a surgeon who is both board certified and a member of The Aesthetic Society.

Dr. Koumanis advises that women who are interested in reduction of their labia minora and/or clitoral hood skin should research surgeons who offer the double wedge labiaplasty technique. In his expert opinion, the double wedge method yields the best possible results. He says women should be careful to avoid the “edge trim” labiaplasty technique, which can cause many uncomfortable physical side-effects and disappointing results. As far as the cost for surgery, he informs women considering the procedure that labiaplasty is considered a “self-pay” procedure and is not typically covered by medical insurance.

If you are interested in learning more about labiaplasty and other female intimate surgery options, we encourage you to contact our office to schedule an appointment with Dr. Koumanis.

Can a Torn Labia After Childbirth be Repaired?

Posted on February 24, 2017 in Frequently Asked Questions, News

I have helped many women who have had their labia minora torn during childbirth with repair. Sometimes the tear is due to a failed episiotomy, a surgical cut made at the opening of the vagina during childbirth which helps aid a difficult delivery and ideally prevents rupture of tissues. Other times, the labia minora may tear spontaneously during delivery, causing a jagged edge or even a separation anteriorly from the frenulum (skin attachment) of the clitoris. All of these tears can be repaired, but I recommend waiting at least 3-6 months after delivery for the scars to soften before proceeding with surgical repair. The repair can be done with local anesthesia or general anesthesia (while asleep). When performed by a well-trained and experienced labiaplasty surgeon, the repair is often successful. Since the best time to get a proper repair is the first time, be sure to consult with an experienced labiaplasty plastic surgeon before proceeding.

When Can I Have Sex Again After Labiaplasty?

Posted on January 23, 2017 in Frequently Asked Questions

When it comes to wound healing, you can’t fool “mother nature.” After labiaplasty (or any cosmetic surgery for that matter) with optimum healing it takes at least 6 weeks to reach the 90% point of the end result and up to a year to see the final result. Despite claims of other plastic surgeons and gynecologists to the contrary, there is no magical way to promote faster healing. Since vaginal intercourse, or inserting anything in the vaginal opening, can physically stress delicately healing labia minora, I recommend waiting to resume relations and avoid using tampons or vibrators for at least 8-10 weeks. A patient of mine ignored my advice having sex at 6 weeks after surgery which caused a painful tear. While her labia eventually healed, this problem was avoidable if she had waited another few weeks for the scars to mature and skin to toughen. To be safest, use added lubrication when resuming relations (we recommend Astroglide^®), be very gentle at first and let comfort be your guide.

Painful Scars After Labiaplasty—What Should I Do?

Posted on December 20, 2016 in Frequently Asked Questions

Some women who I’ve seen in referral after having labiaplasty by another physician using an edge-trim technique have complained of painful scars which have deterred them from resuming comfortable relations.

The edge-trim technique places a scar along the entire leading edge of the labia minora which can be tender as nerves regenerate. That is why I most commonly recommend a wedge type labia minora reduction which only rarely causes long-term pain. Painful scars after labiaplasty are most commonly managed with time, and it is likely that the pain will resolve over 3-6 months. I recommend that my patients avoid stressing the repair by waiting 8-10 weeks after surgery for sex and use of tampons or anything else that might be inserted into the vagina. With that said, if a painful scar remains after 5-6 months, touch-up surgery may be needed to improve the result of an edge-trim type of labiaplasty. This may include converting an edge-trim to a wedge type labiaplasty or creating skin flaps from the skin of the lateral clitoral hood to recreate a more natural appearing border of the labia minora. Scar revision or corrective surgery is rarely needed after a wedge type labiaplasty, however. It is best to allow scars to mature for at least 6 months after the wound completely closes before rushing into more surgery. Sometimes gentle massage or “desensitization exercises” can eliminate scar-related pain. Since it is not “normal” to have pain 6-8 weeks after a labiaplasty (and most patients state that pain or discomfort resolves within a few weeks of surgery), be sure to speak with your plastic surgeon if pain persists.

When Can I Have Labiaplasty Revision Surgery?

Posted on November 7, 2016 in Frequently Asked Questions

Female intimate surgery can be a complex surgery, and in order to reach your ideal outcome, it is crucial you seek a qualified plastic surgeon who is experienced at performing the procedure. With extensive experience performing labiaplasty, Dr. Dimitri Kumanis is considered a leading plastic surgeon in the specialty. In addition to performing different variations of female intimate surgery, Dr. Koumanis also performs revision surgery to help women who underwent labiaplasty from another surgeon and are unhappy with their results. To provide a better understanding of what a revision labiaplasty may entail, our board-certified plastic surgeon answered one woman’s questions on the online medical forum RealSelf.

This individual was five months into her recovery. She had expressed concerns to her surgeon about her results, which included excess skin and an uneven shape, but he disregarded her comments. This left the patient unhappy, saying she had a “‘mini lip’ on top of [her] labia minora,” which she described as looking worse than before the surgery. After seeing her doctor again for a follow-up, he told her not to worry and that he could make minor alterations to improve her results. This response left the concerned patient with more questions, which is when she decided to go online to ask for advice from other plastic surgeons.

After learning about her case, Dr. Koumanis provided his professional opinion for how the patient should move forward, based on the information she provided. He said it appeared she had an edge trim type labiaplasty that left excess labia minora and clitoral hood skin. To improve her outcome and provide the natural-looking appearance she desired, Dr. Koumanis recommended a revision with a double wedge type skin and clitoral hoods resection. By doing so, he explained this would help minimize the anterior prominence of the clitoris, which could also help eliminate associated irritation and sensitivity.

Since the patient was still recovering from her original labiaplasty, Dr. Koumanis recommended that she should let several months pass before undergoing reconstruction. This would allow enough time for the swelling to resolve and incisions to heal. During this waiting period, he advised the woman to seek a board-certified plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASPS). To get the best outcome from her revision, he further encouraged her to find a surgeon who specializes in wedge type labiaplasties and reconstruction after labiaplasty. When consulting with the surgeon, he stressed the importance of asking questions and viewing before and after pictures to make sure they can provide the results she is seeking.

Can My Period Affect the Healing Process?

Posted on September 27, 2016 in Frequently Asked Questions

Considering the intimate nature of labiaplasty, many patients have unique concerns related to healing after the surgery. From suture removal to scar visibility, Dr. Dimitri Koumanis has heard a wide variety of questions from his patients. In addition to addressing every concern they have, our board-certified plastic surgeon also offers his expertise by answering questions in the online medical forum Real Self.

One woman, in particular, had undergone labiaplasty and was inquiring whether her period would affect the healing process. She explained, “The labiaplasty wound is almost closed, but I am afraid that this could infect the tender area.” The woman also mentioned the burning sensation was minimal and questioned whether she should stop using her antibiotic cream.

Dr. Koumanis was happy to clarify that a woman’s menstrual period should have no effect on healing from labiaplasty and, therefore, should be no cause for concern. “Blood from your menses, or period, is not infected, and the vagina has a normal cleaning mechanism which requires little maintenance,” he said. Beyond using soap and water during a routine shower, Dr. Koumanis explained that there is typically no need for douches or irrigation of the area.

While the blood from a woman’s period should not cause any issues to the incision site, Dr. Koumanis emphasized that tub baths, swimming, and hot tub use should be avoided for three or more months following labiaplasty to prevent complications like infection and skin irritation or wound edge separation (showering is fine). In regards to applying prescription antibiotic ointment, Dr. Koumanis explained that this is usually recommended until the incision location heals and the sutures dissolve—about one to two months. In his conclusion, Dr. Koumanis suggested the woman check with her plastic surgeon to learn if she should continue use of her antibiotic cream or if she is safe to stop.