How Do “Botches” Happen?

Medically termed “Unintended Avoidable Female Genital Mutilation” and nick-named “Botched Labiaplasty,” these unintended outcomes are becoming much more frequent as well-intentioned Ob/Gyn surgeons, too uninformed to know what they do not know, sail into the uncharted waters of female genital plastic and cosmetic surgery.

Not entirely to blame, these Ob/Gyns, who rightfully consider the vulva and the vagina, including the labia minora and labia majora to be their “…home territory,” but have not received any training in plastic surgery, much less in labiaplasty, figure “…well… how hard can it be? Just clamp and cut it off…” (SHUDDER..!)

Well… it is not entirely that cavalier an attitude. Health insurance (whether private, public or Kaiser) does not pay for cosmetic surgery. Many patients know this. They are shortsighted or naïve when it comes to fully researching the procedure of labial reduction labiaplasty, but do know that if they maximize the functional nature of their situation (chafing, pain, entanglement, sexual problems, etc.) rather than the aesthetic (diminished self-esteem, dissatisfaction with overall appearance, etc.) they can get the surgery covered by Insurance. Even though they hope and expect an aesthetic outcome, they minimize or do not discuss the aesthetic aspects in order to “…get it covered.” A majority of the time, while rarely anywhere as near an aesthetic outcome as if they had seen an experienced surgeon to begin with, the outcome is tolerable. The “elephant ears” are gone, at least. Unfortunately, when performed by a general Ob/Gyn, poor outcomes are frequent, and disasters are rare. As a medical-legal consultant for both plaintiff’s and defense attorneys, virtually 100% of the botched work I am asked to evaluate was performed, usually in the Hospital under general anesthesia, by a general Ob/Gyn. Patient trying to get insurance to cover + “general Ob/Gyn” + in-hospital/general anesthesia frequently = DISASTER.

Whom To Choose for Your Revision?

I personally have performed ~900 labiaplasty procedures, ~ 400 by wedge modifications and ~ 500 by linear modifications, in addition to ~ 50 revisions of other surgeons’ unintended and “botched” results. These are amongst the most revisions of any P.S. or Cosmetic Gynecologist in the business. These revisions have been of a variety of techniques and combinations, including re-wedge, mini wedges, various linear revisions, RF (radiofrequency) “airbrushing” techniques, island flaps, and hybrids. As I have performed so many labiaplasties, and have seen just about every kind of anatomy out there, I find I am more able to individually design than a surgeon who only performs wedges, or (more commonly) only performs linear/trim. Please understand: for your best chance to achieve some semblance of normality, make sure you choose a surgeon who is savvy in ALL labiaplasty techniques as, believe me, (s)he will need to be skilled in ALL the surgical “tools” (approaches) to revision in order to make you whole. “If all you have is a hammer…everything looks like a nail!” Look at your prospective surgeon’s website: Does (s)he have a separate page on Revisions? When you look at his or her B&A photos of their primary work, does this surgeon perform both linear and wedge approaches on all different anatomies? If your proposed revision surgeon only does linear/trim technique labiaplasties, (s)he is operating with one hand pinned behind his/her back when it comes to revisions. And, what about out-the-door price? Does your prospective revision surgeon punish you by setting their revision price far higher than their primary procedure price (unless the revision is especially complicated.) Dr. Goodman understands the trauma already incurred, and charges only for the degree of complexity involved.

The Issue of Pain After Botched Labiaplasty. New Treatment Options

It is so important to see the right practitioner for consultation after “labiaplasty gone wrong…” While aesthetics are frequently an issue, in my experience as a revision labiaplasty surgeon, the issue of post-surgical pain is as, if not more, important than aesthetics, and will be discussed In detail below. While, after > 900 labiaplasties that I have personally performed, I have never had a patient with ongoing post-LP pain, this is frequently the major issue for patients not operated on by a labiaplasty specialist. This is because I:  a)never take off “…TOO much,” and  b) always use the right type and caliber of sutures placed in the right manner. However, this is not at all the case with surgeons (usually Ob/Gyns) who have not taken a stand-alone course in female genital plastic/cosmetic surgery. In my opinion, it is far below the Standard of Care (“SOC”) for any Ob/Gyn not specially trained in both plastic surgery technique and specifically labiaplasty to do this specialized procedure. If you have been “botched” by such an individual, in addition to seeking the best revision specialist you can find, you might consider a visit to a Plaintiff’s attorney specializing in medical malpractice.

The best Revision Consultant should not only be a good revision surgeon, but should also be savvy in the treatment of post-LP vulvar pain. This typically occurs in cases of labial amputation (too much removed, with exteriorization of the light pink mucosal tissue meant to be “inside,”) incisions made too deeply injuring nerve structure, or poor “standard ObGyn” suture type and technique, causing “grooving” or “train tracks,” leading to irritation of branches of the pudendal nerve. This type of pain is called “neurogenic pain,” and can be treated by a savvy practitioner with so-called “neuroleptic medications,” medications specifically designed to ease neurogenic pain. Since these types of medications, although safe, can cause side-effects (sleepiness, feeling “out-of-it), Dr. Goodman has developed a very effective side-effect-free protocol involving a combination of hormonal and neuroleptic medications applied topically, frequently relieving this type of pain. Additionally, Dr. Goodman and his Fellow/Associate Dr. Reed are in the process of evaluating a cutting-edge therapy involving the use of PRP (platelet-rich plasma) for therapy for neurogenic pain. Combining a topical neuroleptic with tissue-healing PRP to first treat the pain, adding later revision surgery if considered appropriate is the ideal revision opportunity. Additionally, and equally important, Dr. Goodman is a sexual health practitioner, an Elected Fellow of ISSWSH (the International Society for the Study of Women’s Sexual Health), and is prepared to work with the sexual health ramifications of “Unintentional Avoidable Female Genital Mutilation.”