The demand for labiaplasty — a surgical procedure that changes the shape of the labia — is on the rise. It’s reportedly because of the popularity of tight-fitting leggings, which can leave some women feeling self-conscious or physically uncomfortable due to the size and shape of their labia.
“Some of the clothing is very form-fitting so if someone had a very prominent area down there that could potentially show through,” Dr. Gordon Lee, professor of plastic surgery at Stanford University said. “Some patients are more self-conscious about it than others.” He adds, “I can see that being a source of concern.”
Dr. Marisa Lawrence, a plastic surgeon in Atlanta, agrees, telling Yahoo Life, ”Contour irregularities may be obvious when wearing tight-fitting clothes such as leggings, bathing suits and jeans.”
Nearly 19,000 labiaplasty procedures were performed in 2021, up 36% from 2020, according to the Aesthetic Plastic Surgery National Databank. Prior to that, requests for labiaplasty increased by more than 217% from 2012 to 2017, according to the American Society of Aesthetic Plastic Surgeons. “It seems to have increased over the years,” says Lee. “There’s more of an awareness of it … and perhaps [more] acceptance that it’s OK to talk about some of these things and it’s not anything to be ashamed of.”
So what exactly is labiaplasty? Here’s what you need to know about the procedure, according to plastic surgeons.
First, a brief anatomy lesson
Labiaplasty is sometimes dubbed “designer vagina” surgery. While that’s catchy, it’s not exactly accurate. Labiaplasty doesn’t change the shape of the vagina, which is an interior, elastic, muscular tube that leads from the vaginal opening to the uterus. The labia are external genitalia and consist of four “lips.”
“The hair-bearing outer lips are called the labia majora,” explains Lawrence. ”The inner lips are called the labia minora. In the upper portion in the center is the clitoral hood, which covers the clitorisin part or entirely. Below the clitoris is the urethral opening, and below that is the vaginal opening.”
There are “wide variations” when it comes to the anatomy of female genitalia, explains Lawrence (case in point: the Labia Library). “The labia minora vary in length, thickness, symmetry, protuberance and the degree to which they project beyond the edge of the labia majora,” she says.
As Debby Herbenick, professor at the Indiana University School of Public Health and author of Read My Lips: The Complete Guide to the Vagina and Vulva, puts it: “Every body is different and that’s true for vulvas, too.”
What is labiaplasty?
Labiaplasty, which is typically performed under local anesthesia and costs around $3,600 on average, is a plastic surgical procedure that reduces the size and sometimes the shape of either the labia majora or labia minora, explains Lawrence. But it’s more frequently performed on the labia minora.
“The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora,” says Lawrence. “A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia minora no longer protrude past the labia majora.”
There are two types of labiaplasty: the trim method and the wedge method. In a trim procedure, “the extra tissue is excised and sewn up directly,” explains Lawrence. “It is preferable to use when a large amount of tissue is to be removed or when patients request removal of the dark irregular edges of the labia minora, leaving only pink tissue behind.”
The wedge procedure involves removing a central wedge — a triangular piece, “almost like a slice of pizza,” says Lee — from the part of the labia minora that sticks out the most. “The advantages of this technique include preservation of the natural edge architecture and a shorter scar,” says Lawrence. “Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures. The technique chosen for each patient will depend on the patient’s anatomy and cosmetic preference.”
Lee notes the wedge technique has “some advantages” because the scar is hidden, while the scar from the trim procedure is along the edge. With the wedge technique, “it basically doesn’t have a scar where you can see it,” he says. “As plastic surgeons, we make every effort to try to camouflage or hide the scar no matter where it is on the body.”
Why do some people get labiaplasty?
There are several reasons why some opt to have the procedure. “Women and other people with vulvas may have labiaplasty for aesthetic reasons — e.g., to create more symmetrical labia, to remove darkened edges if they personally have a ‘pink ideal,’ or if they feel their labia are bigger than they would like,” Herbenick said.
Some choose labiaplasty “to have more comfortable sex or to more comfortably engage in exercise, as for some people their labia are sufficiently long that they get pushed inside the vagina during intercourse or are chafed while walking or exercising,” Herbenick explains.
Lawrence also points out that “many women may feel self-conscious about their appearance in intimate settings,” which might influence them to get the procedure. “And, for women who experience changes to the labia after childbirth, a labiaplasty may be included in their ‘mommy make-over,’ restoring their vulva to their pre-childbirth appearance,” she says.
Media and pornography may also play a role in why women choose to have labiaplasty surgery. “We do know that some women and others with vulvas are influenced by media images of smaller labia,” says Herbenick. “And in some ways this is a vicious cycle. It can be considered ‘obscene’ in some countries to see labia hanging down and, as a result, companies may choose actresses with smaller labia or may digitally alter labia, so that they can sell their photographs or pornographic videos in more markets. Unfortunately, that creates a false impression that labia tend to be small and that’s not true; labia come in all sorts of shapes, sizes and colors.”
But Lawrence says that, “rather than a media-driven desire to look a certain way,” she attributes the increase in labiaplasty surgery to “better access to both information about the procedure and to the procedure itself.”
What are the risks?
Overall, the risks associated with labia minora reduction surgeries are “very low,” says Lawrence. Complications may include bleeding, hematoma and infection, as well as asymmetry, poor wound healing, overcorrection or undercorrection of the labia, according to Lawrence.
Lee notes that “one of the more concerning risks” is the removal of too much tissue. “This can happen if the surgeon is not a board-certified plastic surgeon or is not experienced in doing this type of procedure,” he says. “If the tissue is excessively removed, this can look very abnormal and you can’t exactly put the tissue back. Also, if the cuts are not done precisely, the shape of the labia may be abnormal and not smooth. Patients can also have asymmetry of the labia.”
Lee stresses the importance of finding an experienced surgeon to help reduce these risks. “Even if it’s a board-certified plastic surgeon, you really want to make sure the surgeon is experienced doing this procedure,” he says. “Botched procedures happen when they aren’t trained or have never done one before.”
How long does it take to recover?
Most patients take a week off from work to recover, notes Lawrence, “during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underwear and an elastic garment. This can be done ‘20 minutes on, 20 minutes off.’”
Trim labiaplasty generally allows for a quicker recovery, according to Lawrence. “While the most distorting swelling is gone by six weeks, residual swelling may take six months to disappear,” she says.
But most patients are able to go back to an office-type job after about a week, according to Lee. Patients can resume normal activities, including exercise and sex, as well as using tampons, after about 6 weeks post-procedure.
What are the benefits of labiaplasty?
Experts say the benefits are both cosmetic and functional, with Lawrence pointing out that research shows labia minora labiaplasties have “high rates of overall satisfaction,” including “improved self-esteem.”
Herbenick says that “if the size or shape of someone’s labia was interfering with their sex life, exercise or daily walking, then labiaplasty may offer both physical and psychological benefits.”
That said, the procedure isn’t without risk, and “people should feel like they are fully informed of the possible benefits and risks before making their choice,” says Herbenick.