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How to Choose the Right Surgeon for Your Labiaplasty
For a lot of women, the decision to finally ask about a Labiaplasty is a long time coming. It is not unusual for a patient to tell me she has been thinking about it for years before she ever even fathomed making an appointment. And for good reason. This is about as personal as it gets, and it can take a long time before someone feels ready to say it out loud. And once you finally feel ready, you run straight into the next hurdle: who do you even talk to about this? Your OBGYN? A Plastic Surgeon? A Urogynecologist? Is this even something a Plastic Surgeon does? It's a fair question. So let's clear it up.
Whose Realm Is It, Anyway?
The truth is, there is overlap. Labiaplasties are performed by Plastic Surgeons, by OBGYNs, and by Urogynecologists, and no single specialty "owns" this procedure. Where it gets a little murkier is that people often lump together two very different things: the outer vaginal anatomy, which is what a Labiaplasty addresses, and the inner vaginal canal, which is where concerns like vaginal tightening come in. Some surgeons do both. Some do only one. For example, I perform Labiaplasties on the external anatomy, but I don't do any internal vaginal surgery.
Here's the other piece that trips people up: a label doesn't tell you which procedures someone actually performs. And this is true across ALL of Plastic Surgery, not just Labiaplasty. After training, every surgeon curates their practice in a way that suits their interests and their skill set. So just because someone is a Plastic Surgeon or an OBGYN doesn't necessarily mean they perform this procedure regularly.
Outside vs. Inside: Knowing What You're Actually Addressing.
A Labiaplasty is not vaginal tightening. They are two different things, and getting clear on which one you're after is one of the most helpful things you can do before a consultation.
Externally, there are three structures that can be addressed: the Labia Minora (the inner lips), the Labia Majora (the outer lips), and the Clitoral Hood. Internally, there are both surgical and non-surgical methods for vaginal tightening. But there are also things like prolapse and pelvic floor issues that may need to be parsed out and addressed separately.
That's why it's so important to go over ALL of the symptoms and concerns you're having. What feels like one problem may actually be a few different things. It could be prolapse. It could be a pelvic floor issue. It could be that you would benefit from vaginal tightening. Or it may be that you don't need anything done externally at all. And it may not be the same provider who addresses all of these things--which is totally ok. The goal is getting each concern to the right person.
If you'd like a refresher on the anatomy and the two main surgical techniques before we move on, check out my earlier post, Labiaplasty: The Procedure No One Is Talking About.
Less Homework, More Trust.
Plastic Surgery is nuanced, period. Every procedure I perform involves careful planning around a patient's individual anatomy and goals, and Labiaplasty is no different. What does make it a little different is this: Labiaplasty is a procedure a lot of providers list on their website without actually having much experience performing it. And because it feels so intimate, by the time a woman comes in to talk about it, she has usually been thinking about it for a long time. You deserve to spend that courage on someone you trust. So the goal here isn't to scare you away with all the nuance--it's to help you find a surgeon you feel good about.
Better Questions Than "Are You Board Certified?"
Board Certification matters, but the better question is: Board Certified in WHAT? And even then, Board Certification tells you a surgeon met the standard for their specialty but doesn't tell you how much of their practice is devoted to any specific procedure. That's where the conversation in your consultation comes in to play. Here's what I would want to talk through with any surgeon:
How many of these do you perform? A surgeon who does Labiaplasties regularly will be able to give you a ballpark without much hesitation.
What is your complication rate? Every surgeon who operates has complications. The point isn't to find someone with zero--it's to find someone who is open with you about them and has a plan for managing them.
How have you managed your complications? This is a big one. How a surgeon handles things when they don't go perfectly tells you a lot about the kind of care you'll get.
What techniques do you use? The two main approaches are the Wedge (picture removing the middle slice of a pizza to take it from a large down to a medium) and the Trim (cutting off the crust). Many surgeons have a preference, which is absolutely fine.
Why would you recommend this particular technique or approach for me? This is an important conversation. A good surgeon should be able to explain the why behind their recommendation based on your anatomy.
How to Research Your Surgeon.
Because this procedure is so intimate, most women aren't casually chatting about it with their girlfriends over coffee. So the research typically happens online. In fact, most of my patients who come in for a Labiaplasty find me through Reddit. I think that's because people there can share honest assessments and feedback without any outside influence.
You might notice something else while you're looking: you aren't going to find many before and after photos of this procedure, online or on social media. That isn't a sign that a surgeon lacks experience. Given the nature of the procedure and the anatomy involved, very few patients are comfortable having their photos shared--even anonymously. I do a fair amount of Labiaplasties in my practice, and very rarely does a patient allow me to use her photos anywhere in my practice. And I completely understand why.
So what should you look at instead? Two things: real patient experiences, and the surgeon's knowledge base. Read what actual patients are saying in forums and reviews. Then look at the surgeon's website. If Labiaplasty is just a line item on a long list of procedures, it's probably not something they focus on. But if they have pages built out that walk you through the anatomy, the different surgical approaches, what recovery looks like, and so on, that's more than likely a sign it's something they perform at a higher volume.
What About Sensation?
This is one of the most common questions I get.
The structure we protect is the dorsal nerve to the Clitoris. This is the nerve you are trying to conserve for sexual function, and it is a no-go zone. These nerves run right in the midline at the top of the Clitoris, and they sit deep to the top layer of skin. Knowing this distinct anatomy allows tissue resection without the risk of nerve injury.
When it comes to the Labia Minora, removing tissue--no matter which technique is used--typically does not change sensation in a way that alters sexual function. However, it's important to note that any scar anywhere (and the labia is no exception) may never feel the same as the surrounding tissue.
That said, there are a couple of things that CAN affect how sex feels, even though they aren't technically sensation issues:
Removing too much tissue. Taking too much can predispose a woman to vaginal dryness, which can absolutely change how sex feels.
Making the posterior vagina too tight. Depending on your anatomy, sometimes the incision needs to extend all the way around the back (posterior) part of the vaginal opening. In these cases, it's imperative not to make that area too tight, because a scar that's too tight can affect the size and feel of the posterior vaginal opening.
Both are worth talking through with your surgeon.
What a Good Consultation Feels Like.
This is true of ANY consultation, not just a Labiaplasty. First and foremost, you need to feel like you are in good hands. You should feel like you can be honest and open, and like you're sitting across from someone who makes you feel safe and who you can trust.
You want a surgeon who can clearly explain your anatomy, the procedure, and why they are recommending what they recommend. What you don't want is a surgeon who seems to be addressing concerns you never brought up. If you came in to talk about one thing and walked out with a list of "problems" you didn't know you had, that's worth pausing on.
The overall vibe should be educational, transparent, and trustworthy. Trust your gut on this one.
Ask About Aftercare, Not Just Surgery:
The surgery itself is only one part of the picture. You also want a clear idea of what happens after. A few things worth asking:
What does follow-up look like, and how many times will you see your surgeon?
What happens if there's an issue, and can you actually get a hold of your surgeon if you need them?
Does your surgeon have hospital privileges? If something were to happen that needed to be addressed surgically--like draining a hematoma (a collection of blood)--where would that take place?
Yes, swelling and tenderness will absolutely happen in the first couple of weeks. Talk to your surgeon about ways to minimize discomfort after surgery, and about their specific post-op requirements. For example, in my practice the rule is nothing per vagina--so no sex and no tampons for 6 weeks--and we assess your healing at 3 weeks to talk about getting back to a more normal exercise routine. (You can read more about what to expect in my post on Labiaplasty Recovery.)
Knowing your surgeon's restrictions ahead of time matters, because it helps you decide whether now is the right time in your life to actually follow them. Let's face it, six weeks is six weeks, and it's a lot easier to plan for it than to be surprised by it.
Walking Out Confident.
You should walk out of your consultation feeling confident in your surgeon. You should leave with a better understanding of your own anatomy and of the why behind the surgical plan your surgeon has recommended.
As a female Plastic Surgeon, I know how hard this topic can be to bring up at all. I appreciate every patient who sits in my office and says it out loud, because I know it isn't easy. You deserve to feel comfortable through this entire process--from the first phone call to your last follow-up visit.
And remember, a consultation is not a commitment to surgery. Take your time, get your questions answered, and get a second opinion if you need to. If you're considering a Labiaplasty and would like to talk through whether it's right for you, I'd love to meet you in my Seattle practice.
Dr. Megan Dreveskracht is a board certified Plastic Surgeon in Seattle, Washington.
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