Labiaplasty in Saarbrücken
In the debate about morality and cosmetic surgery, everyone is entitled to their own personal opinion as to whether an operation is “okay”. However, fact-based debates are not satisfied with expressions of opinion about “good or evil”. In order to make a diagnosis and consider a therapy, you need a degree, special specialist training and a certain amount of professional experience as a practicing doctor. With the correct indication and correct execution, studies on labiaplasty show a treatment success rate of over 90 percent, with few complications [1] .
The argument that women should accept themselves as nature has created them is not new. In the 1990s, it was common to point the moral finger at women who pursued their desire for beautiful, attractive breasts. It was claimed that educating women about the different sizes and shapes of “normal” breasts would lead to satisfaction and freedom from discomfort.
For decades, research in the field of plastic and aesthetic surgery has focused on deviations from “normal sizes” and the reasons for dissatisfaction with appearance. The positive effects of plastic surgery on well-being and quality of life are scientifically well documented for both reconstructive and aesthetic surgery [2] .
Doctors’ personal attitudes to what they consider average can determine what they recommend to their patients. A personal bias may inadvertently lead to a failure to take the patient’s concerns seriously and to fully inform the patient according to the state of medical science. A culture of guilt and shame are incompatible with the values of medical ethics. Our aim is to help our patients make the best possible informed decision about their health.
The doctors at CenterPlast are highly qualified and have received multiple awards. We are proud of the feedback from our patients on Jameda, Google, Estheticon, Instagram and other media. See for yourself and don’t leave your health and appearance to chance.
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Information at a glance
Operation duration
1 hour
Aftercare
6 weeks
Anesthesia
Local anesthesia / twilight sleep
Thread tension
Self-dissolving threads
Hospitalization
Outpatient
Socially acceptable
after 5-7 days
Costs
Additions or alternatives
Why are labia of the same size perceived as beautiful?
The shape of the human body, like that of vertebrates in general, is fundamentally symmetrical. Unlike in mathematics, symmetry in biology is an approximate symmetry. Since there is no perfect symmetry in biology, it is not surprising that the mathematical symmetry of a photomontage is perceived as unnatural. A symmetrical body, symmetrical color patterns of flowers, butterflies and coral fish are intuitively perceived as beautiful. Symmetrical faces and symmetrical breasts are perceived as more beautiful than uneven ones. However, it is not known why humans and animals have favored symmetry to such an extent in the course of evolution [3] .
Epochs, cultures and individual perspectives shape our perception of beauty. In addition, an average appearance, a youthful appearance and symmetry are generally rated as attractive. The following features of the female genital area are considered seductive:
- symmetrical labia minora that do not protrude beyond the labia majora
- Full labia majora covering the labia minora
- a clitoral sheath that barely covers the glans
- a firm, discreetly bulging mons pubis that does not stand out under clothing
What are the reasons for correcting uneven labia minora?
Women do not make the decision to have labiaplasty for uneven labia carelessly. Aesthetic reasons, i.e. the desire to improve the appearance, are the most common motivation, similar to non-symmetrical breasts. However, there are also medical reasons for surgical correction. Enlarged labia on one side can impair the formation of the urine stream or even cause pain during sexual intercourse. This in turn can have a negative effect on the perceived female sexuality. In addition, affected women often suffer from skin irritation when wearing tight clothing and discomfort when exercising. Labiaplasty of unilaterally enlarged labia is a safe plastic surgery procedure and is associated with a high level of patient satisfaction [4] .
Procedure for labiaplasty
Preparation
The symmetrical correction of unevenly sized labia can be performed completely painlessly under local anesthesia or in twilight sleep. An overnight stay in the clinic is not necessary. For your comfort, a local anesthetic cream is applied before the injection. The surgical plan is transferred to the skin with a marker by the specialist Dr. Santos Stahl in consultation with you.
The OP
In order to be able to work with the greatest precision, the doctor performs the reduction using magnifying glasses. The cut is always based on the customized planning. The expert then gently removes the marked tissue, which is numb due to the local anesthetic. At the end of the procedure, the wound is closed with fine self-dissolving stitches. These dissolve around 20 days after the labia reduction.
The outpatient procedure on the vulva takes around 45 minutes. An inpatient stay with general anesthesia in a clinic is not necessary for labiaplasty.
After the procedure
Immediately after the labiaplasty, you will be continuously monitored in a so-called recovery room. After you have fully awakened, you can drink something and, if you tolerate it well, you can also eat something. You will be supported by our nursing staff when you go to the toilet for the first time. Before you leave the practice, check-up appointments will be arranged and the behavioral measures will be discussed with you in detail. You will be given a comprehensive written report and a telephone number where you can reach the surgeon 24 hours a day in an emergency.
The anatomy of the labia minora (labia minora)
The vulva (vagina) comprises the pubic mound, the clitoris and its foreskin, the vaginal vestibule, the labia majora and labia minora. The labia minora of the female genital area are thin folds of skin located inside the labia majora. The anterior junction of the large lips is called the anterior commissure (Commissura labiorum anterior). The posterior junction of the labia majora in the direction of the perineum is called the posterior commissure (commissura labiorum posterior) or fourchette. The outer labia cover and protect the clitoris, urethral opening and vaginal entrance. They form two folds in the front section that surround the clitoris. The upper pair of folds forms the foreskin of the clitoris, the lower pair of folds is called the frenulum clitoridis.
The labia minora have important functions for the female sexual organ. They keep the vaginal vestibule moist and prevent germs from penetrating the inner part of the female genitalia. At the same time, they also protect the opening of the urethra. The labia are sensitive to touch and swell when sexually aroused. The labia minora are supplied by the external and internal labial arteries (arteria pudenda externa and interna) and have a dense vascular network. The tissue is permeated with numerous nerve endings and lymphatic vessels. There is no subcutaneous fatty tissue in the labia minora [5] .
The labia minora contain sebaceous glands and sweat glands. The dark color of the labia minora or pubis is caused by a higher concentration of the skin pigment melanin in the pigment cells (melanocytes) and the horn-forming cells (keratinocytes). These cells are located in the lowest layer of the epidermis (basal cell layer). Under the influence of sex hormones, such as during pregnancy, the areas can become darker in color. During sexual arousal, the small lips fill with blood and become increasingly red in color.
What is the “normal” size of the labia minora?
The length and width of the labia minora vary greatly from person to person and change with age and body weight. The average width of the labia minora from the anterior to the posterior commissure is 4 centimeters. The average length of the labia minora is one centimeter [6] . If the labia minora protrude beyond the labia majora, this is referred to as labia hypertrophy [7] .
If the labia minora protrude beyond the labia majora or are disproportionately larger than the labia majora, patients may find this aesthetically unattractive. Labia can also be enlarged on one side. A visible side inequality can be accompanied by emotional and, to a certain extent, physical complaints. Symmetry in the genital area can be restored through a minimal surgical procedure to reduce or adjust the size. Labiaplasty surgery can meet the needs of women both cosmetically and functionally and improve the well-being of female patients.
What size divisions of the labia are there?
The size of the labia minora is measured in centimeters for length, width and thickness. Numerous classifications of labia size have been described. The proposed categories do not allow any conclusions to be drawn about the severity of the symptoms or treatment recommendations. The usefulness of these classifications is therefore controversial. Nevertheless, we would like to give you an overview of common classifications:
The first published classification of the maximum measured length of the labia minora by Felicio [8] .
- I: The labia minora is smaller than two centimeters.
- II: The length of the labia minora is two to four centimeters.
- III: The length of the labia minora is four to six centimeters.
- IV: The labia minora is larger than six centimeters.
Classification of the maximum measured length of the labia minora according to Cunha [9] .
- I: Excess skin in the posterior/lower region, adjacent to the vaginal entrance.
- II: Excess in the middle and anterior region adjacent to the clitoris.
- III: Excess in the entire area, including the foreskin of the clitoris.
Modified classification of the maximum measured length of the labia minora by Chang [10] .
- 1: The labia minora is smaller than two centimeters. The labia do not protrude beyond the labia majora.
- 2: The labia minora is larger than two centimeters and protrudes beyond the pubic cleft.
- 3: The labia minora is larger than two centimeters and protrudes beyond the pubic cleft. The clitoral hood also protrudes over the labia majora.
- 4: The labia minora protrudes over the clitoris and anus.
Classification of the maximum measured length of the labia minora according to Motakef [11]. Categories I to III are supplemented with the letters “A” in the case of additional asymmetry and “C” in the case of a hanging clitoral hood.
- I: The labia minora is smaller than two centimeters.
- II: The length of the labia minora is two to four centimeters.
- III: The length of the labia minora is greater than four centimeters.
The correction options for asymmetrical labia
An approximation of the size of the labia can be attempted from a size difference of one to two centimeters. The genital procedures or methods are often combined, for example with a clitoral hood lift. If there is a size-related imbalance between the two labia minora, the expert can restore the symmetry of the vulva as part of a labia reduction procedure on both labia. A one-sided reduction is rarely carried out. After labia minora reduction and clitoral hood tightening, 93 percent of women report an improvement in their self-esteem, 71 percent have an improved sex life, and 95 percent have less discomfort [12].
The aim of a surgical reduction is to achieve an average labia size with a holistic approach, improve clinical symptoms, balance asymmetrical labia and achieve a beautiful appearance. Enlarging the labia majora in combination with reducing the labia minora is a good procedure to rejuvenate the appearance of the vagina and thus the appearance of the entire genital area.
Common surgical procedures include the straight shortening of the labia minora (“edge resection”) and the V-shaped removal of excess skin (“wedge resection”). Other techniques are the removal of the epidermis (“deepithelialization”) and variation of flap plasty (“W-plasty”). In addition, Fr. Dr. Santos Stahl has experience with a variety of surgical techniques. Depending on the patient-specific findings, she can develop a suitable surgical plan and select the appropriate labia reduction procedure. In this way, the asymmetry can be corrected and the patient can be relieved of any discomfort.
Straight-line shortening – “edge resection”
In the so-called “edge resection”, the edge area of the labia minora is removed. This technique was already described in 1976 and continues to be used with good success [13]. Asymmetrical or protruding labia minora can be corrected by the expert reducing the excess around the edges. This technique is particularly suitable for reducing or adjusting very pronounced labia.
For the average closure of the vaginal entrance, a minimum length of one centimeter of the labia minora must be spared. The edge area of the labia minora occasionally has a dark skin color, which can be perceived as disturbing. The advantage of this labia reduction technique is that the dark skin of the labia is reduced along with the excess.
The disadvantage of the technique is that the scar site on the outer edge of the labia is exposed and can be irregularly shaped. At the ends of the suture point, skin peaks may form.
V-shaped reduction – “wedge resection”
The V-shaped removal of excess tissue from the labia minora was described in 1998 by the American plastic surgeon Alter [14]. The protruding tissue is removed like a “V”. The doctor tightens the edges of the labia. This technique can be used to adjust labia of different lengths and volumes. The remaining scar is usually inconspicuous.
The risk of excessive labia reduction tends to be lower than with straight labia minora shortening. The probability of gaping wound edges is low with careful planning and execution, good aftercare and good health. Nevertheless, in contrast to a straight labiaplasty, a follow-up procedure may be necessary if the wound does not heal properly. Due to the tightening effect on the labia, an additional clitoral hood reduction should be considered with this technique.
Tightening of the labia minora – “deepithelialization”
A labiaplasty can be performed by removing unwanted tissue, also known as deepithelialization. This is an extremely gentle technique. By precisely planning the incision, the labia reduction can achieve the desired size and shape. The scarred areas can be easily hidden in the natural skin folds and are therefore barely visible to the naked eye. The reduction can be performed on the inside or outside of the labia minora. It is possible to reduce the labia minora by one centimeter with this procedure. An additional technique may therefore be required for large labia.
Labiaplasty with a scalpel or laser?
For the general public, the thought of lasers and laser beams evokes associations with a modern, miraculous, pain-free treatment. The use of lasers in surgery dates back to 1964 [15]. Nevertheless, the fascination with laser surgery in the media is unbroken. Exaggerated hopes have led to an ethically questionable use of lasers in medicine [16].
There are no scientific comparative studies. A leading plastic surgeon (operator) in the field of intimate surgery writes that the use of a scalpel, laser or scissors to remove the unwanted tissue is probably irrelevant, but careful, side-to-side removal of the tissue and closure are most important for a good result [17]. The fact that the cutting radius of a scalpel is over 2,000 times finer than that of the CO2 laser speaks against the use of the laser.
The use of the scalpel enables more precise surgery and thus protects the surrounding tissue. PD Dr. Stahl has the expertise to carry out risk assessments and the expertise to carry out calculations of exposure to laser radiation in accordance with §5 of the Occupational Health and Safety Ordinance on Artificial Optical Radiation. Nevertheless, we do not use lasers, as there is no advantage for our patients.
At what age can a labiaplasty be performed?
The patient’s quality of life is the main deciding factor for the timing of intimate vaginal surgery. It is often difficult for outsiders to understand the suffering. Without medical training and many years of experience, neither the type nor the severity of a malformation can be assessed. Insecurity or fear of sexual contact can affect self-confidence and be very stressful.
The questions of young patients are answered with great sensitivity by a very experienced plastic surgeon during a personal consultation with the parents. This appointment is very helpful for everyone involved.
The consent of both parents is essential before treating young women. The benefits and risks are usually carefully weighed up in at least two appointments. Especially in the case of minors, it can be helpful for those affected and their parents to obtain a second opinion. The size and shape of the labia change only slightly after puberty. A labiaplasty can therefore be performed for the first time before the age of 18 in justified exceptional cases.
What are the risks of correcting asymmetrical labia?
The surgical techniques of intimate surgery have been successfully performed by plastic aesthetic surgeons for many years. The scientific data situation is very good in comparison with related surgical techniques. Excerpts from the surgical results of over 1,200 patients are summarized here.
92 to 94 percent of patients are satisfied with the results of intimate surgery and report an improved sex life and self-esteem [18]. In around 3 to 6 percent of cases, mostly minor and temporary complications can occur, such as wound healing disorders, an encapsulated thread (thread granuloma) or temporary scar pain [19]. Other general surgical risks include inflammation, secondary bleeding, thrombosis or embolism.
Complaints relating to scars are very rare and can be corrected. Swelling is a temporary, common and unavoidable consequence of surgery. Adherence to the recommended behavioral measures after labiaplasty and your general state of health naturally have a decisive influence on the complication rate.
Cigarette smoking, for example, frequently leads to corresponding wound healing disorders or inflammation. In a personal consultation, the specialist answers frequently asked questions and analyzes your case together with you. It provides information on rules of conduct before and after the procedure.
Why can you entrust yourself to Dr. Santos Stahl?
Competence, safety and convenience are values that set CenterPlast apart. Dr. Santos Stahl is a highly qualified plastic surgeon who acquired her technical skills in Brazil and honed them in the USA, France and Germany. Brazil is the country where most of the pioneers of aesthetic and plastic surgery come from.
Dr. Santos Stahl is proficient in a variety of intimate surgery techniques. It can therefore offer you the technology that will produce the best results for you. Experience is essential for surgical planning, as every patient is different. Decisive for the result of labiaplasty correction is not only the perfect technical execution of the methods, but also empathetic listening in order to offer you the treatment that satisfies you. Your concerns will of course be taken into account when selecting the surgical procedures. The joint decision is crucial to ensuring your satisfaction.
Before and after pictures to correct asymmetrical labia
Before and after pictures may not be published on the Internet for legal reasons. However, before and after photographs of intimate surgical procedures can be viewed during a personal consultation so that you can get a realistic picture of the success of the treatment. The images were taken with the patients’ consent and they have given their permission for other women to be shown them in anonymized form for the purpose of information.
AUTHOR
Dr. Adelana Santos Stahl
Our aim is to offer optimal, discreet and precise treatment based on our extensive expertise in the field of plastic surgery.
Dr. Adelana Santos Stahl has a unique international perspective with a female view of plastic surgery. Your individual and detailed approach is the key to the beautiful and natural results. Having trained in Brazil, one of the largest and best-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best.
She completed her medical studies and training as a specialist in plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the state medical examination.
Two years later, in 2011, she received the German and in 2012 the EU specialist certification (EBOPRAS) for plastic surgery. From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris.
A VDÄPC Fellowship (continuing scholarship for graduate students) in Switzerland, France and the USA has further enriched her professional experience. Dr. Santos Stahl is active in various renowned professional associations. In addition to the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP.
She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.
She has been based in Saarbrücken since 2019.
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