Labiaplasty

This procedure focuses on reducing the size or shape of the inner lips (labia minora), as well as the removal of dark skin tone tissues which are the cause of nuisance for many women for reasons related to physical sensation in the area, or psychological reasons such as lack of self-confidence or sexual performance if a woman dislikes the appearance her vaginal lips.

This procedure aims to reduce the size and look of the exterior vaginal lips by removing the excess fat and tightening or lifting relaxed skin presents there.

Dr Novikova performs labiaplasty procedures under local anaesthesia in the procedure room in Cape Town or Johannesburg. You will be instructed to apply a special anaesthetic cream to numb the skin over the area and take a tablet that will allow you to relax before the procedure. I will inject a local anaesthetic into the area to remove any discomfort during the procedure.

Labiaplasty can be done in many different ways. Common types of procedure are trim or curvilinear technique (or trim technique or “barbie” labiaplasty), V- labiaplasty or central wedge resection and de-epithelization techniques.

Trim or curvilinear labiaplasty is when the edges of the labia minora are removed. This technique reduces the size of the labia minora. Because the end of the labia minora is excised, the area loses its natural look. Women who choose trim technique usually desire to have the darkened skin of labia minora to be removed. The lips will look pink with this technique.

V-wedge labiaplasty is done when the V-shape area is cut off and is in the middle of the lips and they are re-shaped with sutures. Although the edges have a natural look as they are not cut off, there will be a tiny scar in the middle of the area which is not visible once you heal.
It’s common for the clitoris to look bigger once the lips are reduced in size because of its proportional size. In such cases (which is 90% of labiaplasties in her practice) she will perform the clitoral hood reduction at the time of labiaplasty.

At times women choose to remove excess skin of labia majora or big lips or have fat filling or hyaluronic acid fillers injected into big lips to improve the look. All of these procedures can be performed at the time of labiaplasty. She uses a diathermy or laser beam to perform labiaplasty. She will use dissolvable sutures during labiaplasty that are hidden under the skin and choose the technique of labiaplasty based on the patient’s preference on the final look they desire. Your anatomy, expectations are discussed in detail and you will study before and after photos of her cases to decide on your preferred technique of labiaplasty.

Dr Novikova will send you a prescription to collect from your usual pharmacy. Bring all the medications to the hospital with you.
Check in with the receptionist and she will show you to your bed, you can have a friend or relative accompany you. You will meet one of the nurses who will show you around the ward. You may not see Dr Novikova immediately as she will be operating. Directions will be communicated to the nursing staff as when you need to take your oral pre-med and apply the anaesthetic cream. Usually 30 mins before your operation is due to start. Dormicum will relax you and Emla cream will numb the skin. Once you are advised by clinic staff that it is time to go to theatre please use bathroom to empty your bladder. Please re-apply Emla cream at this time for enhanced effect.

Your operation will take place in an operating theatre, you will lie on an operating bed with your knees in stirrups, you will be made comfy and warm by the theatre nurses. Dr Novikova will inject local anaesthetic so that you do not feel discomfort whilst she performs the surgery. You may experience a burning sensation during injection. At the end of the surgery an ice pack will be applied to area of surgery to help minimise swelling, and you will be taken back to the ward in your bed. You will be required to leave the ice pack in place whilst in hospital – it will be beneficial to your
recovery and healing process if you apply an ice pack overnight whilst at home for the first night.

• Avoid sitting immediately after the operation.
• Apply an ice pack every 4-6 hours within the first 24 hours while awake. Place an ice-pack over a thin pad, NOT directly onto the skin. Apply the ice pack and an additional pair of underwear so that the ice pack sits in between and can be held there by underwear. An ice pack is very helpful in the first 48 hours after the surgery. We advise it to use it at all times as it decreases / prevents swelling / bruising and helps with the pain.
• Wear loose fitting clothing and cotton underwear.
• You will be prescribed non-inflammatory medications to take for 3 to 5 days after the operation. The medications will help with pain and decrease the swelling. The medications will not cause drowsiness.
• You should avoid sexual intercourse for 6 weeks.
• You should not use tampons for 6 weeks.
• It is important to keep the area of surgery clean and dry. You will need to wash every time you have open bowels or pass urine. To keep the area clean, you can take salt baths in warm water. If passing urine stings you can pour clean water over your vagina whilst urinating. Do not rub the delicate healing tissue, and only pat dry.
• Constipation might complicate recovery so laxatives may be needed. You can take over the counter medication such as movicol or use glycerol suppositories if required.
• Do not apply any creams, soaps or detergents. In the first week after surgery you may use salt water (put a spoon of salt into a sports bottle) to wash genital area after you pass urine or have bowel movement. It is important to keep the area clean and dry.
• You will be prescribed an antibacterial ointment to apply to the scar area twice a day for 2 weeks, and antibiotics to take for a week after surgery only if your risk of infection is high.
• You can perform light exercise one week after the surgery, and your regular exercise 2-4 weeks after surgery. You should avoid strenuous exercise for 4 weeks.
• The sutures used are dissolvable and should take 6 weeks to dissolve.
• Dr Novikova usually sees her patients post operatively 1-2 weeks and 4-6 weeks after the operation for a check-up.

The procedure takes one to two hours and once the anaesthetic wears off, usually one hour after the operation, you can go home.

Sitting and peeing during the first week after the operation may be uncomfortable

• Bruising, swelling and soreness are usual for up to two weeks, but these symptoms are expected to improve with each day.
• Bloody or blood-stained discharge can be expected for 1-2 weeks.
• The skin may be partially numb for several months after the operation. Permanent numbness is very rare.
• Occasionally (very rarely in my experience), patients feel that the desired look is not achieved with the surgery and they want another operation.
• The scarring is not visible once the area is fully healed as you will see from before and after photos.

• If you have a fever, feel hot and cold.
• If your pain does not go away with pain medications or is getting worse.
• If you have unusual bleeding.
• If there is unusual swelling or redness around the area of surgery.
• If you have any concerns or questions you are not sure or are worried about

The chance of complications after this procedure are very small.

Dr Novikova has performed many labiaplasties and is skilled in various techniques of the labiaplasty procedure. She has participated in workshops and meetings on aesthetic gynaecology and is certified by European Society of Aesthetic Gynaecology. She is a pelvic surgeon and endoscopic (minimally invasive surgeon) with many years of experience in the field. Each labiaplasty is different as no one has the same anatomy and she adjusts her technique based on the patients desires, concerns and their anatomy. She will share before and after photographs during the consultation and her team, which includes a practice nurse, scrub nurse and herself, are always available to answer your questions and provide pre-procedure and post-procedure support to make the recovery as easy as possible.