28. Labiaplasty and Female Rejuvenation Explained

For many women, the first question about labiaplasty comes from a very practical place: clothing feels uncomfortable, workouts feel distracting, bathing suits feel hard to shop for, or anatomy has changed after pregnancy or weight loss. In this episode, Dr. Bill Kortesis and Dr. Gaurav Bharti talk with Plastic Surgery Center of Nashville by H/K/B partners Dr. Mindy Haws and Dr. Mary Gingrass about candidacy, consultation conversations, recovery, technique, anatomy, and the reasons this procedure can bring so much relief for the right patient.

Dr. Mary Gingrass is a board-certified plastic surgeon in Nashville with more than 25 years of experience and a practice focused on cosmetic breast surgery and body contouring. A third-generation plastic surgeon, she is known for her patient education, revisionary breast implant surgery expertise, and national work teaching body contouring techniques.

Connect with Dr. Gingrass:

• Mary Gingrass, M.D. at Plastic Surgery Center of Nashville

Dr. Melinda Haws is a board-certified plastic surgeon in Nashville who focuses on breast enhancement, body contouring, and helping patients address changes after pregnancy, weight loss, or aging. She brings a thoughtful, women-centered perspective to aesthetic surgery, with an emphasis on clear education and individualized care.

Connect with Dr. Haws:

• Melinda Haws M.D. at Plastic Surgery Center of Nashville

Resources mentioned:

• Petals Hardcover by Nick Karras 

5 Things Women Should Know About Labiaplasty:

• Discomfort is one of the most common reasons women ask about labiaplasty.
• A consult should include a clear conversation about anatomy, goals, and what can safely be changed.
• Recovery is usually measured in days for daily activity, with longer restrictions for exercise, sex, biking, and anything that creates friction.
• Symmetry can improve, but natural anatomy still guides the final result.
• The happiest patients tend to be informed, realistic, and clear on what they want to feel better about.

Welcome to HKB Uncut: the Health, Knowledge, and Beauty Podcast. On this show, Dr. Bill Kortesis & Dr. Gaurav Bharti unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure. 

Dr. Bill Kortesis and Dr. Gaurav Bharti are board certified plastic surgeons and Co-Founders of HKB Cosmetic Surgery, an award-winning practice with ten locations across five states. 

Connect with HKB: 

• Website
• YouTube
• Instagram
• Before & After Gallery
• Blog
• TikTok

Transcript

SPEAKER_03 0:00

The industry of over-the-counter female sexual wellness is $55 billion a year. Personal lubrication agents alone is $1.9 billion a year, what people are spending on that.

SPEAKER_01 0:19

Welcome to HKB Uncut, the health, knowledge, and beauty podcast.

SPEAKER_00 0:23

On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance and what you need to know before you book a procedure. I'm Dr. Bill Cortesis. And I'm Gorov Bahardi. We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.

SPEAKER_01 0:44

In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you. Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.

SPEAKER_02 1:19

Thank you. Glad to be here.

SPEAKER_01 1:21

We're super pumped to talk about female rejuvenation and anything else that's on your mind.

SPEAKER_03 1:28

Absolutely.

SPEAKER_02 1:29

Awesome.

SPEAKER_03 1:30

I just was sitting on a panel at this at the big aesthetic meeting about female sexual wellness. And a couple of things to keep in mind. The industry of over-the-counter female sexual wellness is $55 billion a year. Personal lubrication agents alone is $1.9 billion a year, what people are spending on that. So we're really doing our patients a disservice if we're not doing something medical grade because they're getting it somewhere.

SPEAKER_00 2:02

What how often are patients requiring these type of interventions?

SPEAKER_03 2:08

It's more and more. More and more. And I think it's something you kind of have to elicit. Both Mary and I get a lot of patients who come in for labioplasty. And I I don't think there's much of a barrier there, Mary. I mean, I think we do would do quite.

SPEAKER_02 2:23

Well no, I think that it's easy to research on the on the internet. People come in pretty well educated. There's we have a young population to an old population. Like there's lots of people doing that.

SPEAKER_03 2:35

Yeah, yeah. No. And and not everybody likes to do that surgery. We do, and I think we do well with that population. Uh we see them, but I I think that we still, there's still a segment of women who maybe aren't there for labioplasty but are there for other female rejuvenation, you know, vaginal rejuvenation. And those are the ones I I don't know that we're as good at eliciting that or asking about that or following once we do ask. There's because we can labioplasty, we can make it look better cosmetically, we can fluff up the majora, we can trim the menorah, but we can also, you know, we've got the Morpheus V the N mode device where we can tighten up that vagina and we can help improve sexual response and help improve just the skin texture and tone non-surgically.

SPEAKER_01 3:23

So if if if if a patient's like on the fence of like, do I need this? Do I not need it? How do they know if they're a good candidate to go down this road and to actually pick up the phone and call you to discuss these procedures?

SPEAKER_02 3:37

I think with labioplasty, people are talking about it more, and it's really easy to to research on the internet. So it's not nearly as taboo. It's also really um a lot of people are talking about it more because everybody shaves their pubic hair. So it's kind of right out there, front and center, if women are dressing around each other.

SPEAKER_03 4:00

Yeah, what Mary's saying, you know, it's interesting because I think the misconception is that women are doing this because they want it to be prettier. But I and there is a little bit of that, but I think a lot of it is really effective complaints about it's hard for me to wear workout pants because, as Dr. Jane Grass said, everybody's grooming down there. That didn't used to be a case, right? And so when people had a lot of pubic hair, clothes were made differently, so you couldn't see the pubic hair, and therefore you weren't going to pinch your labia menorah if it hung out. Now, with no pubic hair, everything is so thin. I see women all the time who have to tuck their menorah inside to look okay in a bathing suit.

SPEAKER_02 4:46

Yeah, I hear that complaint a lot. It it the young girls, especially, they're like, I'm embarrassed to wear a bathing suit, like a bikini, or it has to be like a full coverage bikini. Um they have to shop around. If they're shopping around it, it's time to look into options.

SPEAKER_00 5:02

Well, and when you do when you all do these, are they typically in isolation or are you combining with others? Like what's the typical patient, or can it be both?

SPEAKER_02 5:12

I would say the young people, it's in isolation, and we can do it under local anesthesia. So it's particularly advantageous to do it just a labioplasty, unless there's something else you can do, like upper eyelids under local anesthesia. But the weight loss patients are all another kind of high yield population, and they um often are having more than one procedure. So, you know, you just have to take each individual patient as they come in and make your recommendations, you know, accordingly.

SPEAKER_00 5:44

What techniques do you all do?

SPEAKER_03 5:46

If that's all they want, it's really easy to get that area completely numb and have them very comfortable do it under local, which is nice.

SPEAKER_02 5:56

Yeah, we just numb it up ahead of time. So when the numbing medicine is injected, they're pretty much, you know, 90% numb anyway. And you know, we're sitting there talking about the weather or kids, or you know, what what podcast are you listening to, or what Netflix are you? So it's it's a very almost everybody says, oh my God, that was so much easier than I thought. Oh, what was I worried about?

SPEAKER_01 6:21

Along those same lines, what what's the recovery like?

SPEAKER_02 6:24

It's a pretty easy recovery. We just say ice is your friend. So I would say for 48 hours, max 72, you should you know plan to kind of hang out at home and and ice. Um, but you can absolutely be up and around and you know, moving. It's just you don't want it to if you if it swells too much in those first couple days, the recovery gets longer. But it's a back to it's a back to work in a couple days surgery.

SPEAKER_03 6:53

And and really, if people need pain pills, and not everybody does, it's not everybody does, it's the first 12 hours. And it's usually, I always tell people if you've ever had dental work, sometimes when the numbing first wears off, you get like this incredible kind of neurologic burning, these paresthesias. And since it's all mucosal tissue, every once in a while people will get that that lasts a couple of hours. But then after that, you know, it's an area of the body, if it didn't rebound really quickly, women would stop having babies. It's an area that's built to heal really well and really fast.

SPEAKER_01 7:27

And in terms of limitations, post-op, like what are their limitations and for how long?

SPEAKER_02 7:32

I mean, don't get your blood pressure up, don't strain, ice.

SPEAKER_03 7:37

I I tell them not to have sex, not to ride a bike, not to run, or probably and garments, watch anything with the central seam for a couple of weeks.

SPEAKER_02 7:50

You're not gonna be wearing a thong for a while.

SPEAKER_00 7:52

What's your insertion timing? Nothing inserted for how many weeks? Six weeks, eight weeks?

SPEAKER_03 7:57

Oh, god, no. Three weeks.

SPEAKER_00 7:58

Three weeks. Okay.

SPEAKER_03 7:59

It just depends. If they're a big clitoral hood and menorah or if we go around the perineum longer, but I can't tell you how many 60 plus year olds I see in it two or three weeks, I'm telling they can start easing back into more activity, and they're like, honey, I'm already there.

SPEAKER_02 8:16

I tell people six weeks for sex. Yeah.

SPEAKER_00 8:18

Will you talk? Will you all kind of get into the nitty-gritty about the technique that you guys like and why and what the other techniques are?

SPEAKER_03 8:26

I'm an unappointed trimmer. Yeah, there's two two basic techniques.

SPEAKER_02 8:30

There's the the trim and the wedge. I'm a I'm a trimmer too. I I mean, I take each individual patient. If if they have just a little bit of central redundancy and everything else is fine, then they might lend themselves to a a wedge. But I feel like it, you never can, I can never get enough. And people, you know, they want to see a difference. And uh, you know, it it doesn't affect your ability to lubricate, it doesn't affect your ability to orgasm. It it it's just skin that's hanging out anyway. So you're just getting rid of what's redundant. Um, and this is a really, really happy patient population.

SPEAKER_01 9:12

How how often are you doing the external with the internal? Because you mentioned, you know, doing laser for internal tightening. So how often are you doing a combo or are they isolated procedures?

SPEAKER_03 9:24

You know, we're not doing them at the same time. So we kind of isolate them separately because we're doing one set in the OR, and then if they want to do the vaginal tightening, that's separate. And not everybody wants vaginal tightening.

SPEAKER_02 9:40

And vice versa.

SPEAKER_03 9:42

Yeah, and the other thing with the trim is that the argument for doing the wedge technique is you keep the pigmented edge of the menorah. But nobody wants that, right? I really like that pigmented edge.

SPEAKER_00 9:55

Yeah, I've never heard anybody want to do that.

SPEAKER_03 9:56

Nobody's got to get rid of that. And you but it is technically, you're not just lopping it off. You know, you've got to design it so it flows in with the rest of the and you know, it took me a couple of years to figure that out, but it's a really variable.

SPEAKER_02 10:10

The anatomy down there is so variable. It never ceases to amaze me how different people look. And I I especially with the young people, I start the consult out saying, you know, you're normal. There's nothing abnormal here. It's just you don't it, it's just you don't like the way it looks. Uh, you know, a big hook nose is is completely normal too, but doesn't mean you have to go through life with a big hook nose when you can you can alter it and be more comfortable with yourself and in your own skin. And it it's a really, really happy, happy operation.

unknown 10:45

Happy operation.

SPEAKER_02 10:46

I agree. I agree.

SPEAKER_00 10:47

I I would say that I don't do this as high volume as you all do, but I have done and do a fair amount, and so do our other surgeons at here in the Charlotte area. But the interesting thing about this procedure, at least from a surgical standpoint, is that I'm telling you, man, patient satisfaction, I mean, it's like through the roof. Very high. Even if there's like a little micro issue or something, they would be like, I'll do it all day long. So I think there are a lot of things like that in thy surgery, but this one is like really, really, really high, and it always impresses me.

SPEAKER_03 11:17

I think it's kind of like um breast reduction and gynecomastia. Patients don't come in for this unless they're really, really sure they want to do it. You know, that there's that initial barrier that keeps you from getting a patient who may not be satisfied because they have researched it, they have geared themselves up, which is why they're also a high schedule rate, right? Because they're they're really they're really embested by the time they make it to the office.

SPEAKER_01 11:42

Do you do you see any complications or problems with the procedures and are revisions something that people and people often get for the for these cases?

SPEAKER_02 11:53

Revisions are rare, very rare. I I've done a few revisions from the outside. The only, I mean, the revisions I've done on my own patients have usually been a stitch that came apart a little too early and left a little, you know, notch or or something that just needed to be cleaned up. So they're you know, never believe a surgeon who says, I never have complications, but it it's it's a pretty kind, kindly healing um procedure. But but there are revisions, uh, there are some people who had problems and come in for a secondary opinion. And sometimes you can help them, sometimes you can't. It's if you take too much out, it you're stuck.

SPEAKER_03 12:37

Yeah, you know, and I I think it's also about patient communication, right? Because the patients that I've had who've every once in a while there's revision, just one edge, or it's not quite as, and you're never gonna get complete symmetry in this area. And I never I think once they've been so asymmetrical, they really, really want to be symmetrical. There's a little bit of that, and like Mary said, maybe a wounded edge. I've had one healing problem, like in 20 years of doing these.

SPEAKER_02 13:03

We do probably it's it's rare.

SPEAKER_03 13:05

It's rare.

SPEAKER_02 13:06

We do all absorbable sutures, so they they come in at a week and have anything that hasn't dissolved yet in a week, the nurse will um just snip out, and then they see us at two weeks, and for the most part, they're healed, like they're they're rearing and ready to go. Um, and almost everybody says this was so much easier than I thought. Just like breast augmentations. They they you get yourself so worked up about it, and almost everybody walks away and says, Oh, that was way easier.

SPEAKER_03 13:36

Very similar, I think.

SPEAKER_02 13:37

Yeah, I've seen especially doing it under local.

SPEAKER_03 13:39

There's there's also that patient population that has has a very enlarged clitoris but has a really full clitoral hood. So, you know, it and we've learned, we all learned doing these that if you have a long clitoral hood and you only trim the menorah, then you get almost like a penis deformity where it looks even longer than it is. But some women with a really long, very prominent clitoris, you can't trim that back as much as you would like to denude the clitoris, and then you can't wear tight. So I think there's some patient education about how much you can and can't do and what restrictions there are of the anatomy. And I know there's a couple people in the US who will actually do like clitoral setbacks. I think that's is the way of a fool.

SPEAKER_02 14:25

I would not risk that for I it may be great in somebody's hands who does it all the time, but I I I would not advise it in my hands. I I start every consult, I do every consult with a mirror. So I'm I'm explaining their anatomy, showing them exactly what's going to be trimmed off, what what we would can expect that it's gonna look like. I show them this is your labia menorah, this is the labium majora, this is your clitoral hood, um, this is why the clitoral hood is important, and you know, sometimes they have a lot of perineal redundancy, oftentimes they don't. And, you know, just looking very specifically at their anatomy and and finding out what their concerns are, and then talking about what can and can't be done or should and shouldn't be done.

SPEAKER_00 15:15

You know, there there's some cases where when patients have had like um pretty significant tears on delivery and and and uh psiotomies. What what do you all do? Do you all manage that that posterior aspect and if it is you know significantly extended and and kind of deepened almost to the level of the and it's will you all do some approximation or can you talk to the um listeners about kind of what can be done there so that they can have just a narrower entry point?

SPEAKER_02 15:40

I mean, that's really more getting into vaginal tightening. And um if they've had you know great like big-time tears, usually I would combine that with our urology friends. Um, and and it most of the time they've addressed that with other doctors. So it isn't something that we specifically have gotten into, but we absolutely have people we can refer them to. If but I see I see more minor tears all the time, and and a lot of it's really easy to fix. People ask if you can fix our hemorrhoids, and I said no. No, I don't know.

SPEAKER_03 16:15

Well, I draw the line there. I draw the line there. And I agree with Mary. We have a you wouldn't want me doing your hemorrhoids. We have a really nice female urology group like down the street from us, that's three women. They do this a lot, so we don't see that much. Um and usually what I tell them is if I can't see it, I can't fix it. And everyone, because every once in a while I get somebody, and typically it's an assault victim who feels like things are stretched out and I can't really even see what they're talking about, or evaluate that, and then I send them on to the urology group.

SPEAKER_02 16:48

Yeah, there can be a lot of social um and psychological overlay to these procedures. So it's again really important to talk to each individual patient and see what their motivations are. And you know, there's a young population that that comes in too that that you you do have to be careful. Uh this isn't really for someone under 18. And if someone's under 18, they have to have their parent there.

SPEAKER_00 17:12

Right.

SPEAKER_03 17:13

But it's you're not even really fully developed, so I I have had I had once an 11-year-old, I think it was she was 11, she might have been 12, who was sent to me by the pediatrician who was a really great volleyball player, but had a menorah that hung like six centimeters outside of the drawer, and she couldn't wear the volleyball spanks, the spandex that they wear for their shorts. It just wasn't possible. And so that was a long conversation, but even she was able to do it under local. So it's, you know, sometimes it's about correcting an issue. You know, the other thing, do you guys have that book, The Petals Book, in your office, the coffee table book that's called Petals? It was done, and I'm pretty sure this is in the intro, the front of the book, by a photographer and his son in the Bay Area. And all it is is pictures of numerous labia, menorah, and majora, the lithotomy view, like page after page after page.

SPEAKER_02 18:12

And we have that so it shows the variability.

SPEAKER_03 18:15

It's a great thing to say you are normal, but we fix normal all the time if you're not happy with your normal. But it does kind of help for those people who feel embarrassed or feel, oh, there's something wrong with me. It's not wrong, but it doesn't mean you can't fix it.

SPEAKER_00 18:30

And it it is interesting. I mean, you guys have probably seen it where there'll be such significant asymmetry where one side is huge and the other side is essentially, quote, maybe more anatomic. Is it is it common to do just one or do you always do the other side? What are strategies there?

SPEAKER_02 18:45

I would say 10%. That's pretty common.

SPEAKER_00 18:48

Yeah.

SPEAKER_03 18:48

Yeah. And and you know, I'll I usually if there's I usually take even if I just take the edge of the mucosa off the other side, just because I think the surgerized edge of the mucosa looks a little different from that that you can't really see the scar, but it's it just looks a little different. I think it makes it look a little better, even if I'm just taking off a couple of millimeters. But you know, and to your point, G, it's interesting because you would think this would be a natural fit for gynecologists, but it really isn't. They're busy doing other things, they see so much anatomic variability. They're not concerned with, they're like, you're perfectly normal. And you know, we see women in their 50s all the time who have some pretty tough asymmetry that they're trying to sit on or be comfortable with that they've dealt with their entire life or their entire adult life.

SPEAKER_02 19:41

I would say most of those significant asymmetries are postpartum, where one side just got was got more swollen or or just babysat more on one side.

SPEAKER_03 19:55

And it seems to be it's either postpartum or it's just it was always like that. I've had a couple of you know 22-year-olds come in with their moms, and the mom's like, this has been hanging out since she was five years old playing Barbies. This is this is just who she is. This has nothing to do with puberty.

SPEAKER_01 20:11

But isn't that everything we do, by the way, is it nothing symmetrical?

SPEAKER_03 20:14

Nothing like symmetrical. You're right.

SPEAKER_02 20:16

Nothing symmetrical. And it could be what they're sisters, they're not twins. That's right.

SPEAKER_03 20:19

And the worse the asymmetry, the harder it is to deal with, right? I mean, people will deal with really, really low-hanging breast easier if it's both sides than if it's just one side.

SPEAKER_01 20:31

Which, you know, which is a it's it's interesting. So I assume you let them know this is gonna be better, they're not gonna be identical, right? Well, what's the what's the takeaway with that? I mean, because that's what we tell patients with breast surgery. It's like, hey, we're gonna get their asymmetry as close to each other as possible, but it's never gonna be identical.

SPEAKER_02 20:50

Uh it's very rare. I'd say they're very realistic. These are just normal people that aren't like doing any kind of filming or you know, anything down there other than they just want to be more comfortable in clothes and maybe feel more comfortable in their own skin during intimacy. And um it's uh I have it's very rare where people are expecting symmetry or or perfection, they just want it to look better and feel better.

SPEAKER_00 21:17

And you have majora, you know, adjacent to it, kind of shielding it when you're in the standing position. So I at least I think a lot of them just don't want it hanging out.

SPEAKER_03 21:25

Exactly. And I think I think it's you have to examine them both sitting with their legs up, but also sitting and standing, and that's also where you can really pick up if that clitoral hood is gonna be giving you problems later. And you know, some women's majora really don't come together at the front, there's always no separation, and I think before and after pictures are important so they can understand that we're not gonna completely just like we can't put breasts right next to each other if they have a really wide cleavage line, some of it is your inherent skeletal asymmetries.

SPEAKER_02 21:57

And there's a lot of variability in majora, too.

SPEAKER_03 22:00

Yeah, a lot of it.

SPEAKER_02 22:01

And and some we do some fat injection, um, even some alloclay injection, where but it it's it's really a separate issue.

SPEAKER_03 22:11

Yeah, and I not you would think there would be more of them we do at the same time, and I think that's almost the exception rather than the rule.

SPEAKER_02 22:18

Yeah, I would say it's the for sure in my practice.

SPEAKER_00 22:21

Well, guys, this uh this is a wonderful um discussion, and um sounds like the takeaway um is that I don't know, this is a pretty straightforward procedure that really makes a lot of your patients very happy.

SPEAKER_02 22:33

Very happy.

SPEAKER_00 22:35

And I think for our our our listeners, if there are any questions about this, um please reach out and we'll make sure that they get answered. And we thank you all very much for tuning in.

SPEAKER_02 22:44

Perfect. Yeah, thanks for having us. We'll do it again sometime.

SPEAKER_01 22:51

Thank you for listening to HKB Uncut. If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.

SPEAKER_00 22:58

To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.