Indications of Labiaplasty Surgery

Labiaplasty surgery is a genital plastic procedure performed to reduce the size of the inner genital lips called 'labia minora' and provide symmetry. Labiaplasty is also known as 'labia minora reduction' (inner lip reduction). Labiaplasty surgeries cover both inner and outer lip aesthetics, but it is more synonymous with inner lip aesthetics because it is done more.

What is Labio minoraplasty and Labio majoraplasty?

The terms 'labio minoraplasty' is used for inner lip aesthetic surgeries and 'labio majoraplasty' for outer lip aesthetic surgeries. On the other hand, labiaplasty is a general term used for both inner and outer lip surgeries.

What is nymphoplasty? (Nymphoplasty / Nymphoplastie)

The inner genital lip is also known by names such as "Nympha" or "Labium Minus Pudendi". Labium = 'Lip', Minus = 'Small', Pudenda = 'Region to Shame'. “Nymphae” is the plural form of the word; that is, it means “inner lips” or “labia minora”.

In French-speaking regions such as France and some parts of Canada, the term ‘Nymphoplastie’ (Nymphoplasty) is preferred rather than labiaplasty.

Labiaplasty surgery indications

Inner lip labiaplasty is mainly indicated for congenital structural reasons. These indications are:

• Hypertrophy (inner lip being larger than normal)
• Asymmetry (unevenness between the two lips)
• Although there is no obvious structural problem, aesthetic concerns that produce dissatisfaction

Deformities in the inner lips can occur over time, that is, later. These are:

• Excessive color darkening over time
• Episiotomy incisions and suture marks in vaginal delivery
• Traces of Bartholin gland removal operations
• Deformations that occur after trauma, such as traffic accidents, bicycle traumas, and falls
• Cysts, tumors, and varicose veins (rarely) on the inner lips.

How is the size of the inner lips evaluated?

Several classification systems have been proposed for the size of the inner labia. In the classification proposed by Franco and Franco in 1993, the length from the base of the inner lip to the tip according to the width of the inner lips was accepted as;

• Under 2 cm (Type 1),
• Between 2-4 cm (Type 2),
• Between 4-6 cm (Type 3),
• Over 6 cm (Type 4)

Some consider 3 cm, 4 cm, or 5 cm and above to be larger than normal. Physical complaints and emotional state are considered in the foreground rather than these metric measurements in performing labiaplasty surgery.

What causes inner lip enlargement? What is labial hypertrophy?

Inner lip enlargement is medically known as “labial hypertrophy”. Labial hypertrophy is usually congenital and rarely acquired. Inner lips enlarge, especially in the post-adolescent period, and labial hypertrophy occurs. The condition of having a width of 4 cm or more from the base to the margin of the inner lips is generally known as 'labial hypertrophy'.

A vulva picture. A patient with labial hypertrophy with an inner lip width of 6 cm and a length of 14 cm.

Among the causes of labial hypertrophy, there are;

• Exposure to androgen (male) hormones taken from outside in childhood,
• Regional estrogen sensitivity,
• Stretching of the inner lips by pulling,
• The formation of dermatitis due to urinary incontinence,
• Vulvar lymphedema as in 'Filaria sanguinis hominis' infection
• Some bone marrow cancer diseases

On the other hand, having multiple pregnancies can also enlarge the inner genital lips.

What kind of problems does the enlargement of the inner lips cause?

Labial hypertrophy, that is, the inner lips being larger than normal, can cause these problems;

• Psychological
• Cosmetic
• Hygienic
• Sexual
• Functional aspects

It can cause embarrassment and loss of self-confidence in some women. Extremely long and drooping lips can cause pain due to stretching during sexual intercourse, chronic irritation, hygiene problems during menstruation and after the need for the toilet, sweating and odor problems after exercises such as fitness, irritation due to friction while wearing trousers, and being noticed from the outside when wearing tight clothes, walking, cycling and may cause discomfort while sitting. On the other hand, in our world where social media and the internet have become widespread, the excesses in the inner lips can be enlarged in the minds and become an important problem that affects the whole life.

Labial Asymmetry

The symmetry problem in the inner lips is known as "Labial Asymmetry". It can be observed that one lip is larger than the other, higher, more forward, darker or lighter in color. Inner lip asymmetry in women is quite common, just like the breast and face. In the case of labial asymmetry, both lips can be equalized by performing a labiaplasty operation.

Labial asymmetry is quite common!

According to our observations, the rate of visible labial asymmetry in women is around 90%. In symmetry disorders, one side may be longer, thicker, more drooping, more forward, or in a different color than the other. There may also be regional asymmetries in the margins of the inner lips, frenulum, and supra-clitoral structures. Also, if the base of one inner lip is more anterior or posterior than the other, it may appear as if one is larger than the other when viewed from the outside, even if the lengths of both lips are the same.

Labiaplasty revision surgeries

Labiaplasty revision means “correction operation” performed after inner lip surgery. “Labiaplasty revision” surgeries may be necessary for patients who have had labiaplasty operations before but have encountered undesirable results. Especially in recent years, in parallel with the increase in the number of operations performed, revision requests by patients are unfortunately increasing.

What is a normal genitalia? “Ideal Vulva”

In Western society, ladies’ general expectation or “ideal vulva” concept is that the inner lips do not protrude from the outer lips when the person is standing and the legs are closed. The inner lips should remain inside the outer (large) lips, which are covered with hairs. A longitudinal, straight line in the middle called the “Venus line” is the ideal vulva view. Ideal vulva criteria are the same in Turkey and in middle east as well.

The general expectations of the patients in labiaplasty surgeries are that the inner lips are as short as possible, there are no skin folds on the clitoris, and the outer genital lips are full. This ideal vulva appearance can be achieved with the operation performed with the "Barbie vagina aesthetic" technique.