Sadly, it’s not rare that I encounter patients who’ve had a labiaplasty or vaginoplasty performed by another surgeon with less-than-satisfactory results. The outcomes are so bad that they want the outcome revised, modified, saved or otherwise redone.
By far, the wisest choice for a revision surgeon is the one who did your original work – it’s certainly much more financially favorable. But this is only true when that surgeon is well-experienced and respected in their field. Not all results are ideal, and your surgeon—if they are reputable, experienced and secure in their talents—certainly wants you to be satisfied. They should go out of their way, for little or no cost, to revise your results to your satisfaction, provided a minimum of 3-4 months (and usually 6 months) has passed from your original operation and healing is at 100%. It frequently just takes a little shave of a small edge or polyp or removing a modest amount of tissue to achieve better symmetry.
Unfortunately, many unsuspecting women select relatively inexperienced gynecological surgeons to operate on them, with disastrous results. Poorly performed (or botched) procedures are usually done at the hands of gynecologists. Most plastic surgeons will not do vulvovaginal plastic work unless they’ve specifically been trained in vulvovaginal aesthetic work, but many GYNs think that because they know the anatomy, they can figure out how to do a vulvovaginal procedure, without the specific training in vaginal tightening or aesthetic labiaplasty that is so important. In most cases, these untrained GYNs remove far too much tissue and/or close with sutures that use too large a caliber, are too tight, and are poorly placed. They frequently leave a hypertrophic clitoral hood untouched, which does not leave an aesthetically pleasing result.
Different Types of Revisions & “Redos”
Reduction revisions, which are performed when not enough has been taken off, and shaping revisions are relatively easy and successful when performed by a well-experienced plastic or cosmetic gynecologic surgeon. As a gauge of experience in revision, I’d recommend finding a surgeon who has performed at least 100 cases.
Situations where far too much has been taken off are more difficult. It is impossible to put some back or build new labia from nothing, but if there is enough redundant tissue above in the clitoral hood area, a flap of hood skin may be brought down and anastomosed to the sides of the vaginal opening. This will result in a rudimentary, aesthetic and functional labia. A few surgeons around the world are experimenting with medical grade silicone implants under the skin in areas of labial amputation.
This type of revision, as well as other complicated revisions, should only be performed by a well-experienced surgeon adept and experienced in performing revision surgery, and this generally does not come cheap. Most surgeons charge more for a redo than for a first-time labiaplasty, as redos are usually harder, more time-consuming, and fraught with failure than the original surgery. This is why it is so important to choose the right surgeon in the first place. Seeking the right professional to perform your labiaplasty is important, and definitely not the time to skimp or go with whichever doctor accepts insurance or charges less, especially if they are just starting out. These doctors are rarely equipped to properly perform your surgery, especially if your anatomy is challenging.
Dr. Goodman performs all types of revisions and redos, and is the winner of the 2018 “Best Labiaplasty Revision” award from ISCG (International Society of Cosmetogynecology).
Dr. Goodman has performed more than 800 labiaplasties, and over 50 major total revisions or flaps. Additionally, he is the author of the chapter on “Labiaplasty Revisions” for the 3rd Edition of the Plastic Surgery textbook, “The Art of Aesthetic Surgery: Principles and Techniques.” His revision charges are modest and only include what’s necessary to bring the results up to the patient’s standards. He understands each revision patient has already paid once for a procedure she now needs to have done over, and he rarely charges more than the cost of a primary labiaplasty, with the one exception being a V-Y flap revision.
There are also times when the best course is not surgical at all. Dr. Goodman is highly experienced in working with hormonal (estrogen + testosterone) therapy, sexual counseling therapy, non-invasive laser or RF work, or implants. He will always be honest—if your individual revision is especially challenging, he may refer you to the good care of Dr. Gary Alter in Los Angeles, the most experienced reviser in the world. (Referrals are judiciously provided, as Dr. Alter’s fees are generally well over $10,000- $15,000.) Dr. Goodman utilizes both his own techniques and adaptations of Dr. Alter’s techniques.
Below are several pre-and post-revision photosets. Feel free to click here to read a blog post on the subject.
Patient had LP by her general Ob/Gyn, resulting in partial amputation on left, irregular tissue removal, and failure to do anything about hood. Patient wanted to be “evened out” but “…not look scalped…”
Patient had inadequate linear LP. She wished for a very trim look and further reduction of her hood.
Patient had a fistula after her V-wedge elsewhere, not a rare phenomenon. She wished removal of the fistula, as well further size reduction of labia and hood.
Patient wished for further size minimization and relief of “sag” and diminished hood size after a linear LP by a P.S.
Patient had inadequate, unbalanced LP by Ob/Gyn. Wished further reduction and outer (majora) reduction in order to have “…less sag.”
24 year old underwent a LP from her local ObGyn who left her frenular folds hanging, did not manage the posterior commisures properly, used wrong sutures on the labia, and reduced her hood with a midline hood incision, leading to extensive scarring. Revision consisted of a hybrid linear and mini-wedge remodel of the labia with re-attachment of the frenula and posterior commisure reduction, plus RF airbrushing of the central hood to get rid of the grooved scarring. Patient traveled all the way from the East Coast to Davis, CA for her surgery.
44 year old traveled from Las Vegas to Davis, CA to have her poorly performed labiaplasty by her ObGyn revised utilizing combined linear incisions, a reverse “U” hood revision, plus airbrushing.
17 year old who had a labiaplasty performed by her local general Ob/Gyn, who did not take enough off, did no work on the hood, and sewed things up with very large, delayed absorbable tight sutures which left the tissue irregular and scarred and looking much worse than before her surgery. My revision involved a careful modified curvilinear revision with hood reduction. The “After” picture is at 6 weeks post-op and will further smooth out with time.
Patient has linear LP elsewhere, resulting in inadequate removal of tissue; curvilinear re-do with attention to the clitoral hood and posterior commissure was performed
Fistulas in V-wedge labiaplasty repaired in a linear fashion
Previous V-wedge LP where lower left side separated, and inadequate hood was removed.
Revision of previous LP, minora and majora, marked by major prolonged swelling, which resulted in widened, “saggy“ labia.