Majora Augmentation

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Plastic Surgery, Universidad del Valle Plastic Surgery, Cali, Valle del Cauca, Colombia

Keywords

Labia majoraLipofillingLipoinjectionGenital surgeryIntimate surgeryGenital rejuvenation

Enhance and shape puffy appearance.

It took us, aesthetic plastic surgeons, several decades to realize that in order to plan the right surgical rejuvenation of the face, it wasn’t enough to just pull or take away the excess skin; when analyzing young faces, they didn’t look tight; they had shapes and puffiness. That’s no different when planning a labia majora rejuvenation procedure.

In the prior chapter, we described how we can tighten the skin of labia majora, but then again, this alone is not sufficient for many patients. So, if we need to enhance labia majora, filling can be a very good option.

Since labia majora mainly comprises fatty subcutaneous tissue , they can be molded surgically by adding or removing fat. Reduction can be done with traditional liposuction.

Labia majora enhancement can be done with or without labia majora skin resection, and the most common fillers used are lipofilling from the very patient and/or hyaluronic acid. In this chapter we will talk about the lipofilling option.

Anatomy

Labia majora are part of the vulvar region; mons pubis prolongs posteriorly to form the labia majora which are rich in fatty subcutaneous tissue.

Labia majora are two cutaneous folds, wider in their anterior portion, and narrower posteriorly; they meet labia minora at their most posterior portion creating the posterior fold (Fig. 8.1).

../images/456687_1_En_8_Chapter/456687_1_En_8_Fig1_HTML.jpg — Fig. 8.1

What makes up the posterior fold

Assessment

It is important to understand what bothers your patient down there, so the first step must always be listening to your patient .

What Will the Patient Tell Me?

“I do not like these wrinkles in my labia.”
“I am unhappy and uncomfortable with my labia majora.”
“Why do my labia look so old? How can I make them look younger?”
“I feel my labia majora deflated.”
“My labia majora skin just looks old!”
“I would like my labia minora to be hidden by my labia majora.”
“My labia majora look asymmetrical, how can they be more alike?”
“I do not like to be able to see the inside of my vagina; can something be done about it?”
“I don’t like what my vagina looks like after so much weight loss.”

Sometimes when examining a patient, we can clearly see loose skin, and she may not feel comfortable if we leave her with a fatty-looking labia majora. So once again it is essential to listen to your patient, to be able to deliver the right treatment plan for her.

What to Look for in My Patient?

Labia majora:

With a flat appearance.
With reduced subcutaneous or fatty tissue (deflated).
Little or moderate loose skin.
Wrinkled (like fine lines, especially in the posterior end, which patients don’t like).
Not covering labia minora.
Leave an exposed external introitus.

What Filler to Choose: Fat vs Hyaluronic Acid?

When the patient does not need a lot of filling and is able to understands that she will need to come to for regular retouches, hyaluronic acid can be a good option.

When the patient needs a lot of filling and can realize the fact that it can be partially reabsorbed, she is a good candidate for lipofilling . Another condition for lipofilling is that the patient accepts fat extraction from donor areas, and of course, when she has fat deposits and grafting areas available.

Fat Lipofilling Advantages

Liposuction will be performed; therefore unwanted fat deposit can be reduced on the patient.
Usually there will be plenty of fat to inject on labia minora.
Fat as a filler has no extra cost.
There is very little risk of allergic reactions.
Once fat integrates labia majora, it will last many years.