Majora Resection

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

Keywords

Labia majoraGenital surgeryIntimate surgeryLabiaplastyGenital rejuvenation

Tight skin, younger look

Labia majora are one of the more visible vulvar areas . When thinking about performing a labia majora resection, it can be done due to excess skin or fatty tissue.

We all know force of gravity can’t be ignored. In time, and after years of being exposed to it, everything starts pulling down and vaginas are no exception.

That’s when similar aged-related changes occur on the skin, face, and labia majora.

With age the skin starts losing hyaluronic acid, and then it feels dehydrated reducing its glow, thus causing the appearance of fine wrinkles. Same happens to the vulvar skin, which elasticity declines as gravity force causes laxity and hurts the skin tone, something more evident in labia majora. That’s the moment to help women, providing them with tightening options.

Anatomy

Labia majora join labia minora in their posterior aspect making the posterior fold which is part of the external introitus.

Since with age, the skin becomes saggy; the posterior aspect of labia majora where three structures join together (labia majora, labia minora, and outer introitus) will show the more damage.

It is also important to always remember that labia majora are covered by regular skin, while labia minora is covered by mucosa, because when making an incision on labia minora, this heals very well with an almost unnoticeable scar, as with any incision done on mucosa. On labia majora, however, just as it happens with regular skin scars, it will be more obvious at first, so we must never promise that it will fade away completely, especially on the vulvar area where there can be pigmentation, which can leave a more evident color mismatch between scarring tissue and regular skin.

Assessment

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

What Will the Patient Tell me?

Too much tissue

“I do not feel comfortable wearing tight pants because my labia show too much.”
“I do not like how bathing suits show my labia majora with a space in between.”
“When wearing tight cloths my vagina looks like a piggy bank slit!”

Too much skin

“I don’t like my labia majora saggy look when I’m standing up”.
“Why do my labia look so old? how can I make them look younger?”
“I don’t like that one of my labia majora looks longer than the other”
“I think my labia majora started to enlarge and ended up with excess skin after years of waxing.”
“After I lost a lot of weight the skin of my labia majora feels excessive.”
“I do not like to be able to see the inside of my vagina, can something be done about it?”

What to Look for in My Patient?

We need to recognize first what’s bothering our patient , is it excess skin or excess fatty tissue? Although both can be improved with labia majora reduction, approaches will be slightly different.

For those patients with skin excess as the main problem, we find enlarged and deflated labia majora, while for the group of excess fatty tissue, we’ll find bulky labia majora without skin sagginess.

Labia Resection for Flabby Skin

Advantages

The best method to remove excess skin if labia majora are too flabby. It is also advised to perform fat injections at the end of the procedure for better results.
When planning for a skin resection, if we only take the superficial skin and plan to plicate the deep dermis, we can get a puffier appearance, even after the resection. Be careful not to leave hair follicles alive inside, as to avoid inclusion cysts.

Disadvantages

When only performing resection of excess skin, the patient may ask for a labia majora augmentation procedure after surgery.
It can leave a visible scar especially for patients prone to vulvar hyperpigmentation.
When too much skin is resected, especially in massive weight loss patients, it can leave an exposed introitus, which can be very uncomfortable to the patient increasing the possibility to end up having a dry vagina.

Labia Majora Resection of Excess Fatty Tissue (Skin and Fat Resection)

Advantage

We can avoid unwanted results of saggy labia majora, by not performing only liposuction when trying solve one issue, which would make the patient undergo a secondary procedure to tighten or resect labia majora skin.

Disadvantage

When there’s too much fat excess, it won’t be enough with just resecting skin and subcutaneous tissue portion; it would be better to start with liposuction first and then continue with skin resection by the end of the procedure.

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