Hi, I’m Dr. Gary Alter. I’m a board certified plastic surgeon and board certified urologist. I’d like to talk to you about botched labiaplasties. In my practice about 40% of the women that see me for female genital surgery are for reconstruction of botched labiaplasties. The rest of the patients come for primary labiaplasties. So these women are coming to see me because someone else did their labioplasty and they have a bad complication. And I see women literally from all over the world.
There are different techniques of labioplasty, and each one of them has its own set of complications. Therefore, when I see a woman, I have to determine her specific problem so that I can determine the best method of reconstruction to give her a normal appearance.
The most common botched labiaplasty that I see, is a result of a trimming labioplasty and trimming labiaplasties are usually done by gynecologists, but are also done by some plastic surgeons. These botched labiaplasties are often a result of the surgeon not paying attention to detail or not having a good aesthetic eye. So this woman will come to me with a wide variation of deformities. For example, asymmetry of each side of the labium. Scallops or irregularities of the labia, a disconnect from the clitoral hood to the labium, and in the worst circumstances, amputation of one or both of the labia. So when I see this woman, I have to determine the best technique in order to reconstruct her to look normal again.
Additionally, I see some women that come in with complications from a posterior wedge technique. In this technique, the doctor has removed a pie slice or wedge from the bottom portion of the labium and resutured it together. Unfortunately, some of these women will have a disruption of the suture line where it opens up. So I also don’t like that technique because the blood supply is not as good, so it’s going to increase the chance of it opening up. In addition, the posterior wedge leaves the thickest tissue behind and also the darkest tissue behind. So these women will come in oftentimes with a disruption of the suture line and too much labia. So I then reconstruct them. I will remove some extra labium, try to make it more what they want, which is a smaller labium, and then fix the suture line.
The central wedge technique also has its set of complications. I developed and created this technique in the mid 1990s. I meticulously outlined the technique in which the odds are that the patient’s going to get a good result. Unfortunately, it looks very simple and a lot of doctors will just do the procedure without paying attention to detail. This can result in significant complications such as an opening in the wound, asymmetry, over removal of tissue, and so a patient that is very, very unhappy. So when this patient comes to see me, I oftentimes have to repair the opening or remove some tissue on one side or the other to make it symmetrical.
So each one of the different techniques has its set of complications, and the patient has to be looked at individually in order to determine the best way to reconstruct her.
Often women who have a botched labiaplasty will return to the original doctor to get reconstructed. Unfortunately, the doctor that created this deformity frequently does not have the skills to reconstruct her adequately. In fact, the doctor may remove more tissue, which makes it much more difficult for me to adequately reconstruct her. So I think the best thing for the woman to do is if she has a major botched labiaplasty, to reevaluate the situation. Don’t rush back into getting fixed and look at all her options.