Asking For A Friend
Hormonal mood swings. Uncomfortable digestive issues. The delicate balance of work, motherhood and sanity. Each episode of Asking For A Friend uses real-world experience and expert insight to tackle the struggles women don't get to openly talk about enough.
No question is off the table once host Jillian Birkle uncorks the cabernet with her cast of healthcare professionals, including Dr. Marguerite Weston, Paige Brudzinski, MSN and Dr. Michelle Sieffert!
A women's health podcast, powered by DONALDSON in Columbus, Ohio.
Asking For A Friend
Labiaplasty Explained: Recovery, Technique & When To Consider It For Yourself | Asking For A Friend
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Transparent Answers to the Very Real Questions Women Ask About This Procedure
"Is what I'm seeing ... normal?"
Asking yourself this question is a near-universal experience among women. Many resort to a midnight Google search, close the tab and never tell a soul. Turns out there's no such thing as "normal!"
And trust us: there's a lot more to know than the internet (or that outdated sex ed class you took in high school) usually offers.
In this episode, host Jillian Birkle sits down one-on-one with board-certified plastic surgeon Dr. Michelle Sieffert for a candid, no-judgment conversation about labiaplasty surgery:
- What causes changes in anatomy
- How the procedure actually works
- What recovery looks like
- How it connects to the rest of women's health
This one is for anyone who has ever had a question about their body but didn't feel comfortable enough to ask a doctor, a friend or even a search bar.
Everything We're Covering:
- Why labiaplasty is still considered a taboo topic, & why it shouldn't be
- What "normal" actually means when it comes to labia (there isn't just one)
- What causes labia to change: puberty, hormones, childbirth & aging
- Wedge Technique vs. Edge Trim Technique: Why Dr. Sieffert prefers the Wedge approach most
- Concerns about body dysmorphia & external pressure to pursue surgery
- How this procedure can be done in-office, awake, under local anesthesia
- Recovery timeline, activity restrictions & what surprises patients most
- Whether a partner will notice after healing
- How labiaplasty connects to hormone replacement therapy, the diVa Laser & the O-Shot
- Male vs. Female Surgeon: Why some patients specifically seek out a woman
- Why labiaplasty doesn't really help with incontinence - & the solutions that do!
Meet Your Experts:
- Michelle Sieffert, MD — Board-certified plastic surgeon specializing in labiaplasty and vaginal rejuvenation, among other surgical procedures.
- Jillian Birkle — Host of Asking For A Friend, bringing the questions patients are already thinking but haven't had the chance to ask out loud.
🎙️ About The Asking For A Friend Podcast 🎙️
Asking For A Friend is Donaldson's women's health podcast, featuring plastic surgeons, aesthetic providers and functional medicine experts based in Columbus, Ohio, talking through the things you actually want to ask but haven't found the right moment to say out loud.
No question is off the table! Because chances are, if you're wondering about it, someone else is too.
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We're brought up to be private about our privates. And so a lot of women don't talk about it for that reason because our whole lives we've been embarrassed to talk about these embarrassing things.
Speaker 2There is no normal when it comes to like what you look like down there. And I think who is coming in for this procedure.
Speaker 1I don't ever judge anybody's motivations or what they consider aesthetically beautiful. I just need to know are they healthy? Are they a good candidate for the surgery? And is the surgery gonna do what they are expecting it to do without creating complications? If you want a beautiful wound closure, you go to a plastic surgeon because there's just that attention to detail.
Speaker 2Just the impact that it has on those patients is probably so profound and meaningful. Asking for a friend podcast, take one. Welcome to the pod. I'm Jillian, and if you found this show, I'm gonna go ahead and assume you're someone who has questions, real ones. The kind you Google at midnight or have totally been meaning to ask a doctor about, but never quite got to it. That's exactly why we're here. Asking for a friend is where we actually talk about it with the experts, with the honesty, and yes, sometimes with the wine. Donaldson built this show because women deserve real answers, not a pamphlet or a well, just power through it. You've powered through enough. We're so glad you're here. Let's get in there.
Show Opening & Introductions
SpeakerTwin boys would be hard.
Speaker 2My sister has twin boys.
SpeakerOh.
Speaker 2I just turned 11.
SpeakerSo they're out of the crazy toddler phase and into the crazy preteen phase.
Speaker 2Oh, yeah.
SpeakerThey live here?
Speaker 2Uh Cincinnati. Yeah, my whole family's still there.
Speaker 1So it's just me up here, but it's good to have a little bit of separation, but be close enough to be able to get to them for the holidays and stuff.
Speaker 2Okay.
Speaker 1We roll in?
Speaker 2Yeah, well, one just love to go with it.
Speaker 1All right. Well, gosh, we're just nice normal people that like to talk to each other. We sure are.
Speaker 2We're gonna just get serious. So on that note, um, almost every woman has had some sort of question that they maybe are a little bit too embarrassed to ask, which usually leads to them quietly googling something very specific that they don't want anyone to find out that they're searching in hopes of finding out that they're normal. The reality is that women, our anatomy changes a lot throughout our seasons of life. And um sometimes those changes can, of course, profoundly impact our confidence and how we view ourselves. So that's why I'm excited today to have a conversation about something that a lot of women are curious about, um, but don't always feel comfortable asking out loud or for a friend. And that is labioplasties, which you, Dr. Seafert, perform here at Donaldson as well as Dr. Donaldson too. I'm really happy that you're here that we can debunk all things vinas, laviaplasties, and help the ladies out.
Speaker 1Of course, Jillian, thank you for having me. And I'm so excited to be talking about this topic today. This is among one of my favorite surgeries to do. And I think the reason why I love it so much is it's simplicity, ease of recovery, but also the privateness with which most women struggle with this. The scenario you presented is a really common one of women, they have this problem and they talk to absolutely nobody about it because it's almost taboo. They're trying to figure out number one, am I normal? And number two, is there anything I can do about this because it bothers them on a daily basis? And it's this quiet internal suffering, this little bit of pressure on their everyday conscience. And they're sitting at home trying to figure out what the heck is there out there. And because it's a topic that's sensitive, because we don't talk about our anatomy openly, not many people know that there's an answer and a relatively simple one for it. Those are all the things that I love about this surgery. And then, of course, from the technical standpoint, I just love performing the surgery itself. There are a lot of fine points that make it beautiful, and that's just the surgeon side of things. So really happy to jump into this topic with you today and curious to know what do women want to know?
Speaker 2Well, we have a whole list of questions and things that we've scoured the internet for. Thank you, Stephen, our SEO man.
Speaker 1He always finds the most interesting things. I never thought of that.
Speaker 2Well, whenever like you and I have some content time scheduled, I always message him first. I'm like, Are you seeing anything out on the interwebs? And he, without a doubt, every single time he just sends back like a full list of things. He's like, This is happening and this. And I'm like, You are amazing.
Speaker 1He always also pulls up things that you're like, I have no idea what that is. Like,
Why Labiaplasty Continues to Be a Taboo Topic
Speaker 1well, it's trending all over the internet. I went home and I researched that. Turns out I do know what it is. Someone just coined it.
Speaker 2You mentioned how this topic of labioplostes can kind of be viewed as like a taboo topic. And I kind of want to talk about your thoughts on why you think that is.
Speaker 1We're brought up to be private about our privates. And so a lot of women don't talk about it for that reason because our whole lives we've been embarrassed to talk about these embarrassing things. And so it doesn't come up very often. Not to mention, if you try to talk about this on social media, which is where a lot of women get information today, you get blocked by the algorithms.
Speaker 2If tonight's conversation got you thinking, we've linked more information in the comments that goes straight to our website where you can learn more about labioplasty.
Speaker 1So it's not easy to get information out there about it, and people are shy to ask about it. And it's not like when women sit down to have a conversation with their girlfriends, it might be easy to talk about their breast implants or something. But how are you going to bring up like, hey, I'm having some of these issues like down there? That's not exactly a conversation that you have with anybody that you're not super close with. And like you may not even bring it up with your mom. I think what has kept us from making this a bigger conversation and women from having the information that they need is really just that it's kind of a touchy subject.
Speaker 2I agree. And I think back to like when I was a kid and going through school and elementary school, we had like sex ed classes. Like, of course, they went over the female anatomy and like the changes that you're gonna go through, but I do not remember them ever point blank saying, like, there is no normal when it comes to like what you look like down there. And I think that would be something for all girls as they're going through those changes to at least know in the back of their mind.
Speaker 1They teach you in sex ed about the internal organs and anything that pertains to STDs or how babies are made. Right. But they don't really talk about. I mean, I mean, I mean, even reflecting back to medical school, the amount of glossing over that's done with the female genital organs is incredible. I assume obi guys get a lot more in-depth conversation about anatomy, but it's not really focused on, I don't think they care about it that much until it becomes a problem. I know. And not it's like this ugly part that nobody wants to look at, but it's really not ugly.
Speaker 2Yeah. It brings life. Hello. Um, and I know that this, of course, comes up in functional medicine as well. And I know Dr. Wesson has talked a lot about um just the female anatomy and then Courtney with sexual wellness. Do you find that patients tend to kind of dodge this topic if it comes up, at least like when you're in a consult with a patient? Do you get like, you know, a referral from our functional team? Or like what does that connection look like?
Speaker 1Usually the connection is patients are having issues with either libido dryness or they're going through menopause. And Courtney will do an internal exam to figure out are they a candidate for any type of hormone replacement? Um, are they a candidate for the diva laser? Are they a candidate for OSHOT, just kind of trying to help with some of those other uh issues, pain, dryness, if she notices that they have labia menorah or both excess, she'll talk to them about, you know, is this causing any bothersome symptoms? And then sometimes that leads to a referral to me. Most of the time, though, where I get uh my patients seeking out my assistance is they've just been looking around on the internet and they find me because they went into some Reddit chat room somewhere and asked, is my labia normal? And came across someone who had a labia plasty. And then they look up who does this surgery in town. And there are dwindling numbers of female plastic surgeons in Columbus, Ohio. So most of them are looking for a woman for the surgery, and most of them are looking for a plastic surgeon because this isn't traditionally something Obi-Gains are trained to do either. So they end up in my chair, and it just so happens I love doing this surgery and think it's really amazing. So I think we kind of find each other.
Speaker 2That's great. And I'm sure just the impacts that it has on those patients is probably so profound and meaningful. So I can only imagine like what that feels like for you
The "Labia Origami Anatomy Lesson"
Speaker 2to be able to help them in that way. So I love that. Before we get into the actual procedure itself and the various techniques that are available, um, I personally could benefit from a little anatomy lesson. And I see something on the table here that may aid in this conversation. So, what are we actually talking about down there?
Speaker 1So, talking about anatomy, I brought a model with me. This is really funny. This was published in the aesthetic surgery journal within the last year using origami to educate patients about labia plasty. Origami, this is done with paper towels because paper is not flexible enough. But I gave my own little shot at labia origami. And what this is showing is the labia menorah, which is this part, and we're showing it with some excess tissue, and then the clitoral hood coming up over the top, and then tucked up underneath would be the clitoris itself. And then this kind of all sits like folded kind of like this in between your legs, and then the labia majora envelop this in what would be traditionally considered normal anatomy, the labia menora tuck up underneath or inside the labia majora, in problematic anatomy. The labia menorah hang outside of the labia majora and experience dryness, experience tangling and twisting, experience uncomfortable interactions with clothing. So maybe getting a little bit chafed by underwear, tangled in a G string, all kinds of not fun things. And the surgery also is showing how the techniques of wedge labioplasty and clitoral hood reduction affect the normal anatomy. And then we can talk a little bit about this later, but I have an operated version also. Stay tuned. And you made all of this yourself? I made these myself. I have yet to pull out labia origami to talk to patients about this. So this is my debut.
Speaker 2I was about to say, I think this needs to be in your consults moving forward.
Speaker 1And when we get to talking about the surgery itself, I will explain how all this works together.
Speaker 2Well, I'm thoroughly impressed with this. And also not surprised because you're so intrigued. Well, yeah, actually, I am very intrigued. And it's also beautiful too.
Speaker 1Like
Abnormalities & What Labiaplasty Is
Speaker 1it looks a little bit like a butterfly.
Speaker 2Yeah, that's what I'm saying. Yeah. So that means that all vaginas are beautiful. So on the topic of abnormalities, can anything like make abnormalities happen or like an increased chance in those happening? So whether that be like childbirth, is it all just genetic? Can someone have like a normal vagina on the outside? And then something happens and then it changes. Like, explain that a bit to me.
Speaker 1You will not be surprised to know, as with a lot of things in women's health, it's not very well understood or studied. We don't know what genes might cause someone to have what we call labia menorah hypertrophy or clitoral hood excess. What we do know is growth of that area or that tissue is related to estrogen production because we see elongation and proliferation around puberty and around childbearing. And we also see shrinkage of the labia around menopause when estrogen goes away. While there aren't studies directly proving causation, we can make temporal inferences that these things happen at the same time. So they are most likely linked.
Speaker 2Interesting.
Speaker 1Most of the time, young women prior to puberty, their development, they won't have extra labia menora tissue. And then after puberty is when most women say they notice this becoming a problem. Some women notice it gets worse with pregnancy and childbearing, but most of the time, once it's there, it may get a little bit bigger over time, but nothing substantial. They just notice that the growth happens and then it's there and it's bothersome for many, many years. Now, with the labia majora, that is actually the problem with the labia majora relates to aging and loss of estrogen, also childbearing, that that area deflates. And so we are either doing something to refill it with fat grafting, or we're removing extra skin so that it's a little bit tighter. Really, that's more of a cosmetic than a functional issue. It can be functional for some women, but most of the time it's not.
Speaker 2Yeah, and not to get on a tangent, but I'm remembering I did see a TikTok recently, and it was about um women going through menopause. And this woman was saying, like, ladies, did you know that she will fall off at some point? Like, said it just like that, and I'm watching it and I'm like, oh, so we have this to look forward to as well. Like, is that true? Like it like it falls wrong.
Speaker 1So no, it doesn't, but the labia menorah do shrink up a little bit. It doesn't fall off, correct. And also hypertrophic labia, the word hypertrophy in medicine means overgrowth. So when there is overgrowth there, menopause doesn't shrink it and reverse that. But the labia that are there, and whether they've been operated on or they're normal, they will shrink down a little bit, and that's totally normal. And then also lubrication changes with hormone changes. So we are actually, and thank God, experiencing a reawakening of interest in women's health and hormone replacement because some of those problems may be avoidable just using hormone replacement therapy. Actually, so many of the things we experience around menopause may be completely avoidable with appropriate hormone replacement therapy and maybe even beginning as early as pre-menopause before women start to experience hot flashes and all the changes that go along with actually getting into hardcore menopause. We are still learning and we don't completely know. We have some clues. And is it something that we can reverse? No. Anything outside of surgery? No, not yet.
Speaker 2Well, I'm relieved to hear that it doesn't fall off.
Speaker 1Yeah, it doesn't fall off. That really scared me. Yeah, no, it doesn't fall off, but
Who Is A Candidate for Labiaplasty & Why They Choose It
Speaker 1there are lots of changes that can create discomfort.
Speaker 2I think that's a great segue into talking about the functional reasons why someone may need or want to consider a labioplasty. From your standpoint, who is coming in for this procedure and what finally makes someone pick up the phone and give us a call for a consult.
Speaker 1Women are either, so they may fall into one of two categories or be a combination. They are either looking for an aesthetic change because they don't like the way it looks. They are coming in because they're having functional issues or the combination of both. It's most commonly both. The functional issues that they complain of most often are friction-related issues. So they're working out, they're walking, what have you, or with intercourse. The friction is uncomfortable on the labium menorah. And so they want to improve their comfort. Sometimes it can cause recurrent urinary tract infections or recurrent uh minor infections like uh yeast infections or BV. Occasionally women will complain of pain, mostly with intercourse. And then the aesthetic side, obviously, there's a wide range of normal here, but when women are standing upright, if the menorah hang outside of the majora, that would be what we consider abnormal or candidate for surgery. However, I have operated on women who, when they stood up, everything tucked up nice and neat, but they did have some extra hypertrophic tissue that they just didn't like the way it looked. And we were just trying to get things more streamlined. I don't ever judge anybody's motivations or what they consider aesthetically beautiful. I just need to know: are they healthy? Are they a good candidate for the surgery? And is the surgery going to do what they are expecting it to do without creating complications? Outside of that, I'm a passive observer to the journey and I help guide, but I'm not there to tell someone that, oh, that's not what it is supposed to look like, or like when you stand up, nothing hangs out. So that's normal. So you can't have the surgery.
Speaker 2I love that. And there's a question I have later on for you, but I I want to ask it now because I think it's relevant. What would be some like red flags for you in your seat when someone's coming in for this consultation that may indicate that they're pursuing this for the wrong reasons or outside pressures?
Speaker 1Great question. So probably the number one and number two would be body dysmorphia and patients who are being pressured by uh spouses or significant others to have surgery. Those are two incredibly difficult things to parcel out. But usually if someone can't explain their motivations for having surgery, or they are claiming that they have an anomaly that I don't visualize, I don't see anything wrong, or they are just absolutely nitpicking every part of their genital area apart. Sometimes that can be an indication that maybe they're suffering from body dysmorphia, which we get the psychologic help that's needed for that prior to doing any kind of intervention surgically. And I don't love those situations. I want women to be having these procedures for themselves, which is by far and away. I don't most men don't know what that area is supposed to look like, nor do they really care. It's usually for the woman. I want a woman to come in because it's something that she wants for herself.
Speaker 2Hopefully it's okay that I ask this, but have you ever had someone come in where like you can tell that they're being pressured by their spouse to thankfully, no.
Speaker 1Great. Let's keep it that way. Like I said, most men they don't know what it's supposed to look like and they don't care what it looks like. And if they're that picky,
Can Childbirth Change the Appearance of Labia
Speaker 1aye. Yeah, I do it for you, not for him.
Speaker 2Agreed. So I want to get onto the topic a bit about childbirth, because obviously childbirth changes a woman's body in every regard, especially down there. From your standpoint, can childbirth change the appearance of the labia?
Speaker 1Yes, it can, not in the same way that hormones do. So the hormones can cause the hypertrophy or the overgrowth. Childbirth can cause tears. Sometimes those can be tears to the perineum, which is sort of the back of the vulva behind the anus and the vagina. So tears can happen there. And this surgery doesn't fix those tears. There are other surgeries to improve that area, but not a labioplasty. I will see women who have labial tears from childbirth where the labia just splits. And most OBGINs don't repair those at the time. Most of the time it's because it affects the urine stream, and women will notice splitting of the stream so that they kind of get like spraying everywhere, which I know is a little bit disgusting, but um, so you have to put it back together to prevent that problem.
Speaker 2So why would an OBGYN, like why would they not repair that in the moment? Just there are other priorities that would take precedent, or can you explain that?
Speaker 1There may be some that do. Most of the time they'll repair the um the perineal tear, yeah. That makes sense in a psiotomy repair. But if there are labial tears, sometimes they're even overlooked because they're not extremely obvious at the time. And so women will find them after the fact.
Speaker 2I'm sure that's not a fun discovery. What would you say is the biggest difference between someone getting a labioplasty through a plastic surgeon and their primary OB?
Speaker 1Something that I'm realizing is really changing in our general medical sphere is that people are doing a lot of crossing over into doing procedures that they weren't necessarily trained or that aren't classically owned by their profession. So there are probably gynes that do this surgery as well. But traditionally it's been within the realm of plastic surgery. It's something that we're trained to do during residency or in fellowship. That's why most people would be seeking out a plastic surgeon over a gyne. But just like there are lots of dermatologists moving into plastic surgery and plastic surgeons moving into functional medicine, there's all kinds of shifting happening in medicine. It may ultimately not depend on your surgeon's specialty, but their experience and expertise.
Speaker 2Okay. So maybe is it also safe to say, like, if they would perform the surgery, it would be more focused on like solely functional purposes versus like the aesthetic?
Speaker 1Potentially. Yeah, potentially. And uh their techniques may also be a little different just depending on sort of what their specialty hedges towards. What I found is a lot of my uh Gyne colleagues who do perform this surgery prefer an
Wedge & Trim Technique Model Example
Speaker 1edge trim technique, and most plastic surgeons prefer a wedge technique.
Speaker 2Well, that's a wonderful segue into our next section, which is talking about the procedure itself. Talk to me a bit about both of those.
Speaker 1Absolutely. So for treatment of labia menorah hypertrophy, we can either do a wedge technique or an edge trim technique. So both of the techniques can effectively deal with the hypertrophy or the excess tissue. They do so in different ways and have different consequences of those different treatments. Maybe I can just show you with my little model. So this is set up to talk about the wedge technique, which essentially, if you imagine the labia, there is upper labia that's normal and or I guess anterior and posterior labia that's normal. And then centrally, or sometimes posteriorly, there's this excess. This is the area that usually hangs down. And in the wedge technique, we are just removing that area of excess and then pulling normal tissue back together. And this simulates once that wedge of tissue is removed on either side and the staples are where the sutures are, how it pulls that back together. And then you can imagine if this is sort of sitting this way in your body, that extra tissue no longer hangs down like that anymore. And you also have no scar except for right here along the edge of the labia, and then no scar back here. So, in contrast, an edge trim technique, if you imagine, so we're gonna look at this kind of anatomically how it sits in the body, the edge trim technique basically just goes across the edge of this area that's hypertrophic. Bigger excess and removes it and then closes it up, which places a scar all along the edge of the labia. That can create thick and painful scars, and it also creates a cosmetic issue that the scars create what's called scalloping. So they kind of become a little bit wavy and it becomes very operated looking. Whenever possible, use this technique, the wedge technique, because I think it looks more natural afterwards. And it doesn't leave a scar all along the edge of the labia, which can have functional consequences, but definitely has cosmetic consequences. In the worst case scenario, the edge trim can be too excessive, too much labia is taken off. And in inexperienced hands, that's very possible without meaning to, because the labia does shrink down. And even if you feel like you've marked enough, sometimes it can shrink down quite substantially. And then people end up with amputated labias. That is not a mistake that can be corrected.
Speaker 2Ouch.
Speaker 1Yeah. And it that can create functional issues like dryness and pain. Oh, I bet it would create a lot of issues. So the the wedge technique is my preferred technique. And like I said, I think people look the most natural afterwards
The Artistry & Attention to Detail a Plastic Surgeon Brings
Speaker 1and it creates the least scar burden.
Speaker 2So it sounds like the um wedge technique requires a lot of precision and artistry. Would you say that that is one of like the selling points, so to speak, to having this done at a plastic surgeon's office compared to an OB?
Speaker 1There are OBs who or dynes, I guess. It wouldn't be an O, they're OBN. They're trained in general in both. But they certainly could be performing wedge technique. The benefit to seeing a plastic surgeon versus someone who's trained in OBIN is every ounce of our training is focused towards, first of all, the combination of form and function. So the way something functions is just as important to us as the way something looks. And then surgical technique that is meticulous to make healing the best it possibly can be. And that's a major difference between specialties that not all specialties combine the form and function part. The function part is more important than the form part. And then there's not as much focus on wound healing, on patient optimization, on technique and meticulous tissue handling. So you go to a plastic surgeon because you're looking for things. Everybody in medicine knows if you want a beautiful wound closure, you go to a plastic surgeon because there is just that attention to detail. That's what draws people into plastic surgery. And then that's how we are trained. It's drilled into us as a point that everything is done meticulously and with the utmost care for the tissues.
Speaker 2That's great.
Speaker 1As weird as that coming out of my mouth sounds. No, it makes sense to me. The tissues, like you know, our skin. It's it's very delicate and it needs to be treated with respect.
Speaker 2So when you talked about the trim technique and how it's kind of yeah, or you can gross there's the wedge and the edge.
Speaker 1It keeps it easy. The wedge.
Speaker 2Edge, wedge and edge.
Speaker 1Yeah, the edge is just the trim off the edge. So that one that I'm gonna totally screw you up. Oh my god. There's the wedge and the edge.
Speaker 2So for the latter, the edge, um, what you mentioned healing and how that's like of the utmost importance, obviously, like with any surgeon, but especially with plastic surgeons. Would you say that the edge technique, the trimming, that requires like a bit of a different healing process? It may be like a bit, because you mentioned like the scars are a bit more intense, I think.
Speaker 1Yeah, yeah, there's more scar burden, there's more incision to heal.
Speaker 2Okay.
Speaker 1Um, and it can heal with more problematic scars because of the location and the length of the scars and sometimes the way that they're repaired too. Interesting. Yeah, so it's a number one drawback. I guess number one and number two is the sensitivity of the scar and the appearance of the scar. And the biggest problem of all is if the labia is just straight up amputated.
Speaker 2Don't like that.
Speaker 1And I have seen patients in the office for that problem too.
Speaker 2Really?
Speaker 1Yeah. So they come to you like for a revision. Yeah, they want to know what can be done, and I don't have anything great to offer them. There's not a great way to reconstruct that area once it's had too much tissue taken off.
Speaker 2Oh, that's probably sad
Why Choose the "Wedge Technique" Over the "Edge Technique"
Speaker 2news to deliver to the patient.
Speaker 1Yeah.
Speaker 2Why the wedge over the edge technique? Why do you prefer that one?
Speaker 1I love the wedge because the scar burden is less, and I think the appearance is more natural. Um, the edge leaves a scar along the edge of the labia, and that scar can become tender, painful, and scalloped, which doesn't look the greatest. Whereas the wedge, there's a much smaller scar, it's a more hidden scar, doesn't tend to create as much functional scar sensitivity or tenderness. And I just I think it looks nicer. However, I will say I am also trained to do the edge trim. And in certain cases where the patient's anatomy dictates that, I will use the edge trim technique, but I much prefer a wedge. I just think it's a very elegant and beautiful surgery with an elegant and beautiful result. And I know most women aren't examining their labia that closely, but if you ever look at pictures of one versus the other, you can see exactly what the difference is.
Speaker 2What type of patient will be coming in where you would say, like, oh, I'm going to do the edge technique?
Speaker 1So someone who uh has less of the traditional hypertrophy where it's kind of like a tongue that's like this, but who has excess all along from the top to the bottom, they would be a little bit better candidate for. And I have found actually in that case, sometimes I can use the wedge and it comes out really nicely. But in some cases, there's just so much extra tissue and it is so elongated that there's nothing that I can do short of an edge trim. And then I have a conversation with a patient about the benefits and drawbacks of that technique. But in those cases, there's not another choice of what to do to get the best results. The technique has to shift. And that's also the I have a lot of training and a lot of experience doing labioplasties. And so I am able to be versatile and offer both. But having done lots of them, I have a very natural preference for one technique over the other.
Speaker 2Thanks for sticking with us. If our show has helped give you greater clarity about your health, we invite you to subscribe and leave us a review. It helps us keep doing this and it helps women like
Labiaplasty Under Local Anesthesia
Speaker 2you and me find the answers we're sometimes afraid to ask. I want to talk a bit about the fact that this procedure can be done in office. I think that is something that a lot of women may not know. And I think that's something that they should know because if they're considering this, then it kind of takes the intimidation and fear out of it. So can you just talk a bit about like what the process looks like if someone's coming in on surgery day?
Speaker 1That's one of the most surprising things to women is that this is a procedure that we do awake in office under local. It seems like it's a very sensitive area, and the ease with which we're able to get it numb without a lot of pain is very shocking to patients. First of all, we bring everyone in about a half an hour ahead of the procedure because we use topical numbing medicine. So when you come into our office, we'll take you back to one of our prepping and staging rooms where you'll put on a gown and one of our wonderful staff will apply numbing cream to the entire area, and you're gonna sit with that numbing cream for a minimum of a half an hour to really allow it to work and get the surface of the tissues numbed up. During that time, we also offer oral sedation. So oral sedation is not putting you to sleep, it's just giving you a little bit of anxiety, anxiety reduction. It takes the edge off exactly. Just as many women do this with just the numbing and no oral sedation as do it with the oral sedation. And it largely depends on how nervous they're going to be with the procedure. So women who say, I am so anxious to have this procedure. I've never had a procedure awake and I don't know how I'd be. Those women are who we give the oral sedation to. It's something, it's a melt. You just put it under your tongue or on your tongue, and it takes about 20 to 30 minutes to start working. And then you get about an hour of just relaxation. You are not asleep, you're still awake and having conversation with us, but it kind of turns on the I don't care button. And then we move you into our procedure room. In the procedure room, a lot of care is taken to getting people into a comfortable position because they are in what we call lithotomy, and that's with feet up in stirrups. And probably the most painful part of the procedure is keeping your hips relaxed and from getting sore. Women have a tendency to try and hold their knees up because they're I they don't want their knees to fall open and just be complete open and butterfly. It gets painful when they try and hold them up. So we use pillows to position. Um, I have staff who will actually stand up against the legs and just help keep that tension out of the hips. We get you positioned. And then I come in, I clean off the numbing medicine, and we put up the surgical drapes and clean with the surgical soap. Once that's done, I do the markings and then inject the numbing medicine. Now, people here inject and they think, oh my God, you're gonna give me a shot down there. Most women don't feel a darn thing. And that is probably the most shocking part of all of this for women is we are putting numbing medicine in with a needle and syringe, and they don't feel it. So then once we inject the numbing medicine, the rest of the procedure is completely pain-free. We're usually having a conversation. I put on whatever music the patient likes, my staff are talking, we're all having conversations. We really get to know each other because the procedure is usually about an hour or two. It can be up to two hours, depending on how many different parts of a labioplasty we're doing. If we're doing everything, labiomajora, labia menorah, clitoral hood, it's usually about two hours. The addition of fat grafting, we usually will convert over to a procedure in the operating room for comfort and because of the length of procedure. Um during that time, patients are not really feeling much of anything. We're just talking, they'll feel maybe some pulling and tugging on occasion, but nothing crazy that they can't handle. And then when the procedure is over, we're applying topical uh antibiotic ointment, putting witch hazel pads, and then just a regular menstrual pad, and they are on their way home. If they do have the oral sedation, they have a driver to take them home because it's then you're kind of like drunk driving. Yeah. A couple of drinks and you can't drive yourself home. So bring a driver if you're taking oral sedation. But the entire process, all told, is two to three hours out of your day. And then the injectable numbing medicine gives you somewhere between four to six hours of complete anesthesia of the area. Yeah.
Speaker 2Well, it doesn't sound too bad. Yeah. The fact that you can drive yourself is a huge, yeah, just point to call out because I think a lot of women who are considering getting a labioplasty, they don't want anyone to know. Right. They don't yeah, they don't want anyone to know they want to drive
How Long Does Labiaplasty Take to Perform?
Speaker 2themselves. So having that as an option, I think, is really important to call out. And I think it's great that we can offer that, but also offer sedation if needed. Oral sedation. One question. So when I've gotten content with Dr. D before about labioplasties, it sounds like he usually does it like from like 30 minutes to an hour. And from what you just told me, it sounds like yours maybe a little longer. Is that correct? Or it really just like depends on the patient?
Speaker 1It just depends on the patient. I think the main difference is that I'm usually doing more than one thing. So I'm usually combining a labioplasty with a clitoral hood reduction. That's a very common combination of surgeries because usually when one is hypertrophic, so is the other. And so we're addressing all of that together. And it is a little bit more lengthy, but not a big deal. And I'm also talking about not just the time like of the procedure itself. I'm talking about the time from when we go into the room, do all the positioning, do the whole surgery, and then put you packed together afterwards. Every surgeon has a different speed at which they perform surgeries. The speed doesn't matter unless someone is like excessively lengthy in the duration of their surgery, then it's a problem. What really matters is what is the outcome that they're delivering. There are great surgeons who do things in like record time, and there are great surgeons who take a little bit more time to do things. And it really doesn't matter. I don't think the patient really cares
Choosing Between a Male & Female Surgeon for Labiaplasty
Speaker 1either, as long as the outcome is a good one that they are happy with.
Speaker 2One thing that I think is really interesting and great for patients to know is that both of our surgeons at Donaldson, so you and Dr. Donaldson perform this procedure. So I think there's a lot to be said that we have a male surgeon and a female surgeon for any of the procedures that we do, but especially for labioplastys.
Speaker 1Yes.
Speaker 2Do you find that some patients come to you specifically?
Speaker 1Are people seeking a woman? Yeah. Yeah.
Speaker 2And of course, Dr. Donaldson is amazing at what he does, and especially labioplastys, breast dogs, all the things. But yeah, for me, my standpoint, if I were to be seeking this procedure out, similar to like my own like lady doctor that I go to, she's a lady because I just want a lady down there. So do you find that that's like a common theme among patients that you see?
Speaker 1Absolutely. So both Dr. Donaldson and I love doing this procedure and find it to be number one, very high patient satisfaction, but also just a very, I mean, for lack of a better way to say it, just a very beautiful and finesse surgery. Um, patients definitely fall into two categories: patients who are absolutely looking for a female surgeon to do the surgery, and patients who don't necessarily care what the gender of their surgeon is. And I think that's common all across medicine. Some women only want to go to women for more things that are more female related. And some women, it doesn't matter. They're going to go to whoever they trust and whoever is good at what it is they're looking for. My patients usually seek me out for that reason because I am a female and I'm known for doing this procedure. And that's what they're looking for because it makes them feel more comfortable.
Speaker 2Well, I think it's awesome that we have the both of you here to help our patients and be their friends. McDonaldson is great. Shout out, Dr. D. Yeah. And shout out to you too, because you're pretty cool and
Labiaplasty Recovery Expectations
Speaker 2very talented. And we're very lucky to have you.
Speaker 1Oh, thanks.
Speaker 2Talking about recovery and those first few days after a labiaplasty, what is the number one thing that you would want patients to know about that time? Would it be to not have sex? Would it be to not ride a bike?
Speaker 1What would it be? Great question. We have a few general guidelines. The first is no tampon wearing and no intercourse for a month. Sorry, guys. No tight clothing for two weeks. And then your first two weeks, there are some activity restrictions to help prevent any bleeding after the surgery. So no lifting more than a gallon of milk, no house chores, and no exercise for the first two weeks. And then you can start regular house chores, regular lifting, and light exercise at two weeks. But anything that creates any kind of friction. So things like bicycle riding, horseback riding, um, running. And I tell people, listen to your body when you're doing things. If it feels like too much down there, it probably is. Don't do it. But start light, low impact. And then at a month, you can go back to doing everything, but kind of work your way up to it over the course of weeks two and three.
Speaker 2So is the main thing that you want patients to avoid is like sutures popping open or like what could happen if they don't take your that's one of the things we're worried about is the incision breaking down.
Speaker 1The other major one in the first two weeks, and why we're so strict about activity restrictions, is because that's when the risk of bleeding from any surgery is the highest. So bleeding complications for any surgery we usually see within two weeks of the operation. So we are trying to limit anything where there's a lot of activity and where there's an increase in heart rate and blood pressure, both of those things can contribute to a bleeding episode. Bleeding can require a trip back to the procedure room to get whatever is bleeding stopped. Sometimes we can treat it with conservative measures. Now, that doesn't mean not going back to work. There are certain professions that it's more difficult to go back right away. But usually within five to seven days, most jobs people can go back to as long as they're not doing heavy lifting or tightly strenuous. Yes. And you can't wear tight clothing for two weeks. Now, underwear are tight clothing, but you can wear underwear, but you don't want to wear leggings, which is mostly what we're trying to avoid are leggings and tight, like pencil type jeans.
Speaker 2That makes sense. Yeah. Um, so this might be kind of like a weird question, but so say someone's coming in for labioplasty. Do you schedule it around like their menstrual cycle? Because I could only imagine like recovering from this, like while you're on your period.
Speaker 1Like, does that play a part in anything or is that just so we don't try and strategize around the menstrual cycle. We just know that if a woman is on her period, it's not a problem during the surgery, but just afterwards, she's just gonna have to be a little bit more on top of cleanliness. So I usually recommend that women get one of the peri bottles. It's a squeeze bottle that has a little crooked neck on it, fill it up with warm water, and then use it to cleanse the area gently. And it also depends how much bleeding there is, but just at regular intervals throughout the day. And then you can wear a pad, you just can't wear a tampon. But no, I have plenty of women who they come in and because they're stressed out about the procedure, their period comes early. We would never cancel a surgery for that reason. It doesn't bother me in the slightest. It just requires a little bit more strategy on the patient's part to make sure that they stay clean and that they're changing out their pads regularly.
Speaker 2Yeah, I was just thinking, like if you're already bleeding from the recovery and then boom, Aunt Flo comes. I just feel like that'd be a lot more.
Speaker 1Yes. Yeah, it's usually not too big of a deal unless someone has really, really heavy periods. But even then, people are usually able to work around it.
Speaker 2What surprises patients the most during the recovery process?
Speaker 1I think the first thing that surprises them is the sensation when the numbing medicine wears off. So it's wise to have medications, specifically Tylenol and ibuprofen, in your body before the medicine wears off. And then we also give the pain pill to help with that because once it does wear off, you can take Tylenol, Ibuprofen and be fine during the day. And then as soon as you lay down and your the noise and all the things you have to do go away, your brain just goes and focuses on that it's uncomfortable and it's hard to sleep. I bet. Um, I think the other thing that surprises them is how quickly their bodies recover after the procedure. It sometimes seems like a long time, but it actually goes relatively quickly when they look back retrospectively. So any surgery is that way, though. Even a week feels like forever when you're recovering from surgery. Yeah. And then people look back a year later and they go, oh my gosh, I it was a week. Like that was so fast. I don't even remember it.
Speaker 2That makes sense though. Um, what are the most common frustrations or concerns that come up for patients in the recovery process?
Speaker 1The no sex thing is frustrating for some women. Um, and the no exercise thing, especially women who are fitness instructors. So I have a lot of uh cycle instructors because as you can imagine, that'd be tough. That area under a lot of duress, a lot while they're on the job. They can't they can't go back to that for a month. So that's tough. And also, women for a lot of us, exercise is our lifeline sometimes. It's our mental sanity. And when you can't do what you're used to, that gets a little frustrating. And people get like you get a lot of pent-up energy that you need to do exercise to relieve. And I completely understand that, but you have to follow the the people who end up with complications like bleeding are the people who threw the instructions out the window and did what they wanted to. Unfortunately, your body doesn't listen to what you want it to, it listens to anatomy physiology.
Speaker 2Yeah. And do you have a lot of patients that have like not followed the occasionally, yeah.
Speaker 1And the one that they violate is the no intercourse rule. That's the one that I find most frequently gets the time course gets pushed back a little bit.
Speaker 2And you might get it, but also unlike surgeries.
SpeakerIt just sounds pinky.
Speaker 1Some of our some of our um funniest stories from our office are when that specific act has led to some issues after surgery. And we're not laughing about it in the moment because if there's something going on, you know, we're professional and we're treating it. But then when the patient is able to laugh about it is when we're able to laugh about it. I respect that.
Speaker 2What about alcohol consumption post procedure and in the recovery phase?
Speaker 1Kind of whenever is normal for you. You don't want to take it obviously right after the procedure. Um with pain meds. Yeah, with pain medication. But after I don't have a timeline for when you can start drinking again, I would probably just not drink that first night. And in general, you shouldn't consume in excess. It's not good for your
Most Common Labiaplasty Questions for Reddit & Google
Speaker 1body or your brain. You are correct. Heard it here first. Actually, asked Dr. Weston.
Speaker 2Yeah, seriously. If she was here, she would be backing you up on that. Well, we've covered a lot of technical ground, which I think has been helpful for me because um I am just a marketing girly. We do have some questions that I have found from Google and Reddit. Um, and when I say I, I also mean our lovely Steven on the marketing team who scours the internet for us, and we love him for that. Thank you. Steven.
Speaker 1Thank you, Steven. Oh, and I love me some Reddit.
Speaker 2So here's one. I'm nervous my partner will notice I had surgery after a labiaplasty. Is that common?
Speaker 1I am not sure a lot of partners would notice. Really? Yeah. Because they're not really looking at what it looks like down there in the first place.
Speaker 3Yeah.
Speaker 1Main giveaway would just be the visibility of scars. So if this is a new partner, the scars heal very imperceptibly. So it does take scars six months to a year to fully heal, but I would say by three to six months, they're pretty imperceptible. And they're also not scars can be a little bit thick initially. That goes away somewhere three to six months. So those would be the only things giving away that you've had surgery. Otherwise, they wouldn't be able to tell if they're a new partner and a long-term partner, like I said, I don't think they're really evaluating that area as closely as we are.
Speaker 2Yeah, that makes sense.
Speaker 1The reason why I love this technique is because it doesn't look operated. It doesn't give an appearance that someone could look at it and go, Oh, it looks like you've had surgery or something looks weird down here.
SpeakerYeah.
Speaker 1Because the scars are well hidden. And it's really just your like this is all the edge of your labia. It's not scar where then the scar is just a little one right here and they heal imperceptibly.
Speaker 2So that's a good point.
Speaker 1A little bit of it is the technique and how it heals and looks very natural.
Speaker 2This is something that we should reiterate again because from what you've said, it's very important. And it's also a question here that people have searched. How long until I can have sex after a labioplasty?
Speaker 1One month.
Speaker 2One month, not a day before. Um, what age do people get labioplasty most often?
Speaker 1Usually 20s to 30s, usually post-childbearing. However, I have seen all the extremes. I've had very young women come in for labioplasty after puberty. I've had women who are in the peri-andopausal range. I don't see very many postmenopausal women. Because it shrinks, potentially, or different generations. In general, women in the postmenopausal range are not really looking for surgery on that area. They're usually seeking out facial rejuvenation at that point.
Speaker 2What clothing choices help during recovery from a labioplasty?
Speaker 1Loose clothing. So probably not thong or G-string underwear, but granny panties. And then looser shorts, looser pants, jogger pants. Thankfully, wide leg everything is in right now. So it gives you a lot of room. Um very comfortable. Get a labiaplasty now before wide leg jeans grow out of style. Yeah, before the pencil jeans come back into style. And leggings will be forever popular. Just avoid leggings the first couple of weeks. Yeah, leggings and biker shorts.
Speaker 2Okay, so a very specific workout here that people have asked about. Okay. How long until I can do Pilates after a labiaplasty?
Speaker 1So somewhere between two and four weeks, just depending on, and you really just pay attention to your body, how much activity, motion, friction is going on down there and how strenuous is your Pilates class. Pilates, just like any exercise, has a wide range in how strenuous it is. So you want to leave a more strenuous and more highly active stuff for a month, but you can certainly ease back into easier stuff starting as early as two weeks. I like low impact and low stress exercise.
Speaker 2Like walking, like on a walking pad or journals?
Speaker 1Yeah, or just really light, easy movement with Pilates or yoga, as long as you're not like doing the splits.
Speaker 2Ouch. Um, what activities are strictly off-limits and for how long after labioplasty?
Speaker 1Tampon wear, one month. Intercourse, one month. Those are the off-limits.
Speaker 2Strictly off-limits.
Speaker 1Uh bike riding and horseback riding would also fall into the strict one-month category.
Speaker 2Does labioplasty help with incontinence?
Speaker 1It does not measurably help with incontinence. Things that help with incontinence would be things like hormone replacement, the diva laser, the O-shot, or kind of depending a tummy tuck actually helps with incontinence, little known fact. So that leads us into a little bit of the functional conversation because women who have issues with labium and or hypertrophy not uncommonly will also have issues with either arousal and climax or dryness or urinary incontinence, all of which are things that our functional medicine team can help with, whether that be with the use of the Diva laser, which is a laser that I absolutely love. It's an internal vaginal laser that helps with urinary incontinence. It helps with sensation and it helps with lubrication. And I even think provides a modest amount of tightening in that area. And then the OSHOT, which helps more with arousal stimulation and orgasm. And then hormone replacement therapy, whether that just be local vaginal hormone replacement therapy or more systemic estrogen and progesterone replacement. So those are all part of the larger equation. And that's the beautiful part about our practice is we are combining the form and function with functional medicine, treating all of you and getting you optimized, not just doing a procedure and fixing a small part of it. So the conversations naturally, especially in the procedure, will meander and occasionally touch on the Thiva laser, the OSHOT, hormone replacement, just depending on where people are in their lives. And we find that patients will absolutely cross over into functional and use those services. And I'm definitely a proponent of them. I think they're wonderful and I've seen them do great things for patients.
Speaker 2Well, you took the words right out of my mouth because I was going to say that our practice is so special because we're at the intersection of wellness and appearance. And I think this is all such a great example of that.
Speaker 3Yep.
Speaker 2Knowing that surgery isn't always the whole answer, especially for a lot of our patients, um, especially patients who are considering labioplasty or who are approaching perimenopause, menopause stages of their life. You mentioned the diva shot, um, the laser and the O shot. What else could we talk about just from a functional standpoint when we're thinking about issues that women can face down there that really marries the two parts of our practice together, surgical and functional?
Speaker 1So hormone replacement, and it's something that we're learning so much about right now. And what we're focusing on more broadly is how hormone replacement impacts the symptoms of menopause, but also things like bone density, um, skin and hair, muscle density. But I think what we're gonna find is that there are gonna be a lot of improvements in women's vaginal health with hormone replacement as well. One thing that we do know is that hormone replacement in women who are postmenopausal decreases their risk of having a urinary tract infection. And a very large amount of mortality comes from urinary tract infections in women 65 years and older. And so we're, I think we're gonna find that those benefits maybe even start with women in their early 40s, and then of course ranging all the way into the postmenopausal uh timeframe.
Speaker 2Truly is what makes our practice so special and how we can help patients. So yeah, just it's wonderful.
Speaker 1Our practice is also a very safe place to ask the questions that you don't feel like you can ask other providers.
Speaker 2So that's why we have this podcast.
Speaker 1Labiaplasty is one of those things, and people will always they'll say all the time when they come in, they'll, oh, this is a silly question, or I feel embarrassed to ask this. Nothing is off limits, nothing is embarrassing or silly. Just this is a place where it's safe to ask those questions. But also hormone replacement. I feel like we've been not purposely, but we've been misled for a long time about hormone replacement. And so women are shy to ask about it or to ask for it when they're not having hot flashes anymore or they don't have osteoporosis already. And they're like, well, then I don't need those things, right? But the answer to that question is no. There are lots of other indications for having hormone replacement.
What You Can Do Next!
Speaker 1And I think it's such a vital part of the journey that you should feel comfortable asking it. You should feel comfortable asking us about it.
Speaker 2Well, this has been such a wonderful conversation, Dr. Seaford. So I first want to thank you so much for talking to me about labioplasty and women's health and vaginas. It's always just great to talk to you.
Speaker 1Of course, it really has been a wonderful conversation. Thank you, Jillian. I really appreciate you being here and just being a wonderful host and being a wonderful part of our team.
Speaker 2Oh, thank you. Make me cry. I do have one more question for you though. If there's one thing that you would tell a woman who is struggling with some symptoms down there, or she's insecure and just doesn't know how to like take that next step, what would you tell her?
Speaker 1Um, I would say just make the phone call. Pick up the phone, call us, come in and have a conversation. It's a very safe space. I'm just a girl. It's the girl talking about the girl problems. You might feel a little nervous. We're very warm and welcoming. There's nothing that's off limits. And it's just a conversation. Doesn't commit you to anything. Come in and find out if you're a candidate, come in and find out some of the details, and then you can make an educated decision if it's the right move for you at this time in your life. Perfect. That's beautiful.
Speaker 2We're so happy you're here. This has been another episode of Asking for a Friend, a Donaldson podcast. For more episodes and everything Donaldson offers, head to donaldsonhealth.com. Take care of yourself.
