All about Labiaplasty with Dr Lisa Friederich Female Plastic Surgeon

Labiaplasty podcast

Labiaplasty – what do you need to know? What questions do you need to ask? How do you pick your surgeon? What happens during the procedure? we speak with Dr Lisa Friederich who shares everything you need to know about Labiaplasty. Enjoy!

Trish: We’re here with Dr. Lisa Friederich, who is a Plastic, Reconstructive & Cosmetic Surgeon and she works in Sydney, so welcome, Dr Lisa Friederich.

Dr Lisa Friederich: Hi Trish, thanks for having me on for a podcast.

Trish: Lovely. Now, I’m really excited tonight because we’re going to talk about, you know, what people generally whisper about, which is labiaplasty, so we’re going to talk about the procedure of labiaplasty with you, which you do quite a few of, don’t you?

Dr Lisa Friederich: Yes, but people don’t like to talk about it, they’re usually quite shy, don’t like to advertise that they’ve had one done.

Trish: No. Well it’s really funny because I didn’t even realise that people would have this procedure done until, of course, I got involved in the industry and one of my daughter’s girlfriends had the procedure done a few years ago and my daughter always goes on about the fact that this girlfriend of hers said it totally changed her life because she’d actually … She probably thought nothing of it and then she’d been out with this guy and she’d seen him for a few years and he was always complaining about the way her vagina looked and it obviously affected her so much that she just couldn’t get past it and she ended up having a labiaplasty and she is as happy as Mary now.

Dr Lisa Friederich: Yeah. Yeah.

Trish: Yeah, tell us a bit about it.

Dr Lisa Friederich: Yes, people seek a labiaplasty for many reasons and I think it’s – Plastic surgery, cosmetic surgery, has become a lot more prevalent in the media recently so there’s a bit more buzz about it all but people were having these, they’ve been having labiaplasties for years. There’s a couple of reasons that people might have them. One is a functional reason, because even though they’re all normal, there’s different variations, just like some people have big noses, sometimes the inner lips, most commonly, can be … They’re called the labia minora can be just a little bit too long and they can dangle out and that can cause some women problems with chafing, it can cause bulging in their underpants, they can’t wear Lycra pants, they can have serious problems. I had one patient who just had ongoing fungal infections because of the increased mucosal area and this was just one of the ways to deal with that. We’ve had, perhaps, an increase in a more cosmetic approach to labiaplasty in the last 10 or 15 years because of the, perhaps, with the rise of the internet and, dare I say it, internet porn, I think now everybody’s seen the Brazilian’s now in vogue and everybody sees what’s there so now everybody’s a little bit more aesthetically aware of having nice neat bits down there, and so I think that’s another force that has triggered it.

Trish: Yeah.

Dr Lisa Friederich: So basically there’s a few different components to what we would call the vagina, I guess. It’s properly called the perineum and it’s the mons at the front, which is the fleshy part, then there’s the outer lips, which are the labia majora and then the inner lips, which are the labia minora. The clitoris has a clitoral hood, that can also be enlarged in some people and also the clitoris can actually be a little bit droopy or ptotic and then posturally, just … There can be differences in the variation of the labia minora, or the inner lips, join together at the back. Some can just be a little bit excessive there and have a tail, if you like, at the back, so all of those components can be addressed at a labiaplasty operation and certainly as we age, there can be that atrophy in those areas or, in fact, excess fat, so some people might come to have liposuction of the mons at the front, just because it’s a little bit chubby and out of proportion to the rest of them. A lot of older ladies might seek to have either fat grafting or filler to plump up the labia majora on the outside, so there’s actually quite an extensive range of procedures that can be offered.

My earliest experience was as a trainee surgeon and the labiaplasties done back in those days were very basic compared to what is available these days. Back then they mostly did the edge … In fact, they only did the edge technique, which involved, it sounds a bit brutal and it probably is, to be honest, in fact, there’s no two ways about it. Basically a clamp is placed across the labia, it’s pulled out on stretch and then the edges are cut off and then over-sewn. Of course, because it’s quite straight forward, that procedure can be done by people who don’t necessarily understand the full range of procedures available and maybe don’t necessarily take into account all of the balance of structures there and they just think, “Okay, we’re going to trim them.” But, of course, if you over-trim, then there are no labia minora and that looks strange and the problem with using the edge trim technique is if the clamp is pulled out too far, it ends up … Not only do you over-resect, but you tend to get a bit of a shark bite, well, we call it scalloping, where there’s more taken from the central portion and so there tends to be a dog ear at each end, which doesn’t look very attractive at all.

Now this, of course, is very hard to fix after the fact so it’s really, I think … People do have better access to the internet now and they can … They’re certainly aware of the different procedures that are available and, I think, people are a lot more discerning about the surgeon that they choose. I think cost will always be a factor that will motivate people to choose their surgeon but, you know, you’ve only got one perineum or vagina and I just … When it goes wrong, you’re in trouble and it’s very hard and it’s potentially expensive to backtrack from that, so I think it’s really important to read around and do ask your surgeon what techniques they’re familiar with and make sure that you trust them to do the right procedure for you.

Trish: Yeah, because you’ve only got that one chance to get it right.

Dr Lisa Friederich: Yeah, that’s right and certainly I’ve seen pictures of people who’ve had botched procedures, if you like, where they’ve been over-resected and there are some procedures that can be done where excess skin is taken from around the clitoral hood and flaps are made and brought down but that doesn’t work in everybody at all and it’s still going to look a little bit abnormal and to find somebody who’s got the skill to do that, it’s going to be expensive, so I think, in the long run, you really … I think it’s just educating. Patients are very good at educating themselves these days and I think just being aware that you’ve got one body, full stop, we should take this into consideration in anything we do, I guess, we can go and buy another pair of jeans, you can do that. You can’t go and get another labia.

Trish: No, exactly.

Dr Lisa Friederich: So we should be … I think, anyway, that’s just something to consider.

Trish: Yeah, of course, and you want to go to someone who’s done a lot of them and has … It’s not one size fits all, so for example, it might be a different procedure you do on one person to the next, so you want to really make sure that you’re getting the right procedure for what you want to achieve at the end.

Dr Lisa Friederich: Yeah. That’s right. That’s right, and I think one of the benefits, or perceived benefits, of the edge trim procedure is that it removes the pigmented edge of the labia, which a lot of girls find that’s unattractive. The problem with that is that what you’re replacing, then, is a line of scar, which can, at times, be a little bit uncomfortable, and, of course, you’re opened up to some of the other dangers. I think in any consultation the surgeon probably just needs to let the patients know the pros and cons of all of the procedures. It is difficult, I found it difficult to get before and after pictures because most people don’t really want their photo shown and so that’s a difficult … Even to other patients, but ideally, if you can see before and afters from the surgeon then that’s brilliant, because then you sort of have … You’ve got some proof that they know what they’re talking about.

Trish: And you can see one that you think looks like yours, you think, “Oh my god, that’s what I look like and that’s what I want to look like.” So it’s perfect.

Dr Lisa Friederich: That’s right. Exactly. Yeah.

Trish: So can I ask you, I know that all the different procedures probably take a different time but how long would a labiaplasty procedure take, roughly?

Dr Lisa Friederich: Look, it depends what is being done but a standard labiaplastic trimming of the labia minora, if an edge trim is done, it’s a relatively quick procedure and would take between 40 to 60 minutes. If a patient has a wedge procedure, that just involves just a little bit more suturing, a two layer closure, it is a little bit more fiddly and that probably can go to an hour to an hour and a half.

Trish: Okay. And it’s always under general or are there situations where you could do it under a local?

Dr Lisa Friederich: No. No, look, you can definitely do it under local.

Trish: Okay.

Dr Lisa Friederich: In fact, the best way, we’re looking to start doing that at Silkwood, just because the prices for hospital admission are increasing and although there is an item number for a labiaplasty, it is rarely honoured by Medicare. They will only do it for congenital abnormalities, they require photographic proof, and even in some extreme circumstances, they won’t give approval for, so we can’t rely on that, which means patients can’t use their health insurance to cover their hospital costs and those hospital costs can be three to four thousand dollars, so the procedure can be done, you know, a lot of surgeons have, well, I’m not sure many but certainly at Silkwood, we have a minor operating theatre, which we can’t do general anaesthetic procedures in but we can do local anaesthetic procedures and the best way to soften the procedure is to apply topical local anaesthetic, much as might be used when having fillers or laser treatment, and that’s left on and then markings are done and then injectable local anaesthetic is applied or injected, and that’s much less painful after the topical anaesthetic is put on and then the procedure’s done. We have the Diathermy, we have surgical lights, we’ve got sterile gowns, we’ve got everything that we would have in theatre and we have a nurse assistant and we even have stirrups, so we can pretty well replicate the procedure.

I think the only problem is that clearly when you’re awake for something, you’re going to feel the local anaesthetic at some stage and that can be a little bit uncomfortable, so that’s why we try and put … We put the topical on.

Trish: Sure. And with the … I just think because it’s a surgery and because you’re cutting, what about scar? Is it possible to have scar tissue? Because I could think of nothing worse than having a big lumpy scar around by my vagina.

Dr Lisa Friederich: Well, again, this is one of the things with an edge trim procedure is that patients will be replacing that long pigmented edge with a line of scar, now in a wedge technique, if you imagine there’s a slice of pie taken out of each labia, so there is a … Sort of a linear scar there. Now most scars, in fact all scars, take six to eight weeks to … Or wounds take that long to become a scar as such and in that time they make collagen and [inaudible 00:13:40] material to heal themselves so they will feel hard and firm, plus there’s a lot of swelling in the first week, which slowly settles and that can also make the area seem a bit woody or firm. Over time, you know, beyond that six to eight weeks, the scars will remodel themselves, this is true of any scar, so you’ll notice if you cut yourself it will be a little bit … It will be pink or red and then gradually over … They don’t stop. I mean, I’ve got scars that I think have still improved two years after the fact, where the wound will soften, the line of the scar will become pale and it will contract in.

So, down the track, no, I don’t think most people will have a problem with the scars but you do need to give them a chance to heal and in this procedure we say, “Look, you just need to avoid having sex or intercourse or anything that will cause friction down there for four to six weeks.” I prefer for people to wait six weeks just so that the wound is as strong as possible because, if it breaks down, then there can be problems.

Trish: Yeah, sure. That was going to be my next question, how long, so six weeks to be safe. Four’s okay but six is better.

Dr Lisa Friederich: I think it depends on the procedure and it depends on your progress. I think it’s just important to … For the patient to be seen by their surgeon. I usually see people at that four week mark just to say, “Yes, that looks fine, I think you can … You know, have some gentle sex.” Or if I think it’s just … Or if I’m particularly concerned, and I’m more concerned with a wedge technique than I am with an edge trim, everyone’s not … Not everybody has a partner at the moment so it’s not as big a problem to wait a little bit longer.

Trish: Yep. And what about healing time? How long would someone need off work, for example? When you have it done, are you all right to walk out the door or do you have to walk … You know.

Dr Lisa Friederich: Yes, you are. You’re probably still numb when you walk out the door but it usually … The first few days are the worst and it’s … Wear some loose tracky dacks, loose knickers. I would say don’t have any knickers but it’s good to have just a sanitary napkin in there to catch … Because there’ll be a little bit of spotting of blood from the wounds and so having a little sanitary napkin and that sanitary napkin, you can actually put those in the freezer so they’re nice and cool and they can provide a little bit of relief down there and then it’s just sort of sitting with your legs slightly apart and taking it easy, so avoid too much walking in that first week, just because of the chaffing, and the other thing that can help are salt baths, just to sooth the area and clean it. It’s usually fine to have a shower, let the water run over, no scrubbing as such, and then applying just either a Vaseline type cream or a Chlorsig, which is an antibiotic ointment, over the area and then just pop in a little sanitary napkin.

Trish: And can you … Can you use scar creams? For example, your silicon based ones or maybe some oil or anything like that? Is that [crosstalk 00:17:33]

Dr Lisa Friederich: You can, I mean, look, there’s three things that are proven to be effective in all scars and those are silicon, massage and pressure, and we know that from burns. Now, pressure means wearing a pressure garment, which is not really practical in the labia region. It’s also difficult to apply the sheets of silicon, so using the silicon gels or ointments are a much better option there. I would advise people to wait for the scars to fully heal and start silicon two to three weeks after, if everything has healed up. Massage, I think, is very effective and you don’t necessarily need to have oils or anything fancy, you really just need something that helps lubricate, so it can be just regular moisturising cream but the most important thing is just to wait until the wounds have healed so perhaps just very gentle from perhaps three to four weeks and then from that period on, a firm bimanual massage, and that will help soften the scar, it will help the edoema reduce, it will help the collagen remodel.

Trish: Yeah. Yeah. So I’d probably be inclined to use something like, I suppose, an almond oil or something because you think, “Oh, it hasn’t got any, you know, chemicals in it or anything like that to freak you out.” That’s for me, anyway, I’d be like, “Ooh.”

Dr Lisa Friederich: Any of them. There’s lots of really nice oils that you can use. Interestingly, when I was just a little baby resident back in WA, one of the most effective oils for moisturising that I came across in the dressing clinic there was peanut oil and I’ve never come across it in another … It was amazing. So try that on your leg sometime, it’s fabulous.

Trish: Yeah, right. Peanut oil.

Dr Lisa Friederich: Yeah, it’s great. Great for moisturising.

Trish: Awesome. Now, I was going to ask you, is there a time of … I suppose when you speak to the lady who wants it done, you would talk about her menstrual cycle because there must be, surely, a better time than others, I don’t know … Is there?

Dr Lisa Friederich: [crosstalk 00:20:04] say that. The very first patient I ever had for a labiaplasty came in wearing a tampon.

Trish: Oh, no.

Dr Lisa Friederich: And I was a bit shocked because most people, I guess, would not present that part of them for an examination while they’re currently menstruating but, you know, I guess as long as it’s … Ideally, you don’t want that to be the case but it doesn’t necessarily preclude people from having surgery. It’s more a practical thing in that some people can be a bit sore down there when they have their period so maybe it’s not the time to have it and if you’ve got menstrual blood, you’re going to need to have either a tampon or you’re going to need to have a sanity napkin.

Trish: Yeah, wouldn’t be comfortable.

Dr Lisa Friederich: And you probably don’t want to be poking around down there.

Trish: No, no.

Dr Lisa Friederich: So I would suggest it’s much more convenient and practical to try not to be menstruating when you’re going in for surgery. You probably want to time it so you’ve just finished your menstrual cycle, because that gives you three weeks to get back on track or, you know, some people, if they’re on their contraceptive pill, just they skip a period and some people do that for three or four cycles, some people just skip two every now and then, so that’s also another option.

Trish: Yep. That makes a lot of sense. And the other thing I was just thinking, so what about when you go to the toilet after you’ve had it done? Should you rinse every time afterwards or …

Dr Lisa Friederich: So, there’s a couple … Yeah. Ideally you could just use a non …

Trish: Alcoholic.

Dr Lisa Friederich: Non-scented.

Trish: Oh, yeah, yeah.

Dr Lisa Friederich: Not alcoholic, no, no. The face wipes you can get, the non-scented face wipes. You can just dab yourself with one of those. I’ve occasionally used Histoacryl glue on the wound edges because that seals them up. One of the problems after any procedure down there is stinging with the urine, so the glue helps that but the glue can become … It can stick everything together or it can just become a bit hard so I’m not convinced. I sort of … Sometimes I use it and sometimes I don’t but in that case, it’s a bit more comfortable to pee and it does, it does seal the wounds up so it’s a bit easier to clean as well. But otherwise, just a light gentle wipe and … It depends how vigilant patients are. They can always just have a little salt water bath. I mean, it can get a bit impractical depending upon how many times you’re planning to pee that day but just sitting in a saltwater bath, it’s a good idea to have those three to four times a day. That just cleanses the area, and then a pat dry and then air dry and reapplication of cream or Chlorsig cream or Vaseline cream, that just provides an oily barrier over it and that will be repeated each time.

They key is to always try and remove those creams. Vaseline’s probably a little bit heavy so Chlorsig, which is an eye ointment, is my preferred cream to use because that will wipe away quite easily and just make sure that you don’t reapply it on old, crusting ointment so …

Trish: Wash it off first and then reapply.

Dr Lisa Friederich: Yeah. Yeah, and it will come away quite easily.

Trish: Right. Oh, that’s great. Well, I’m sitting here and I’m squeezing my legs as tight as I can, it’s just the thought of, I was like, “Ah.” But it sounds like it’s pretty simple, like it’s not really a big deal, it’s sort of, like, you think, “Oh my god, labiaplasty.” But it’s … Of course, every surgery’s a big deal but if you can think you can have it with a local, six weeks-

Dr Lisa Friederich: No, I think that’s right. I think really … I probably didn’t properly answer before but I think really depending upon the sort of job you had, you probably would get away with just a week off but if you have the luxury of having two weeks off, well, even better. You know, some people that have very physical jobs might want a little bit longer but it’s also something … People recover quite differently and some people bounce back very quickly, so, as I said, I recommend one to two weeks and if they need to take more, I can write a script, sorry, a medical certificate.

Trish: Yeah, yeah. Of course, of course. Oh, no, well this has been great. I can’t think of anything else that anyone would want to know but thank you so much for your time tonight. I can hear little puppies there in the background.

Dr Lisa Friederich: Oh, sorry, I was going to say … Sorry, the only other point I was going to say is that I think in the media a lot of people, perhaps men, have criticised women for wanting to get labiaplasties, saying, “Well, it’s all normal, they’re all normal so why do you need it for?” And I detected this sort of undercurrent of criticism of plastic surgeons who perhaps are offering it or young girls who are wanting it but the bottom line is that none of these men question penile surgery. I mean, there’s lots of men getting penis enlargements and there’s lots of people getting breast augmentations, nose jobs, you know, for whatever reason, I think … I don’t like it if girls feel pressured by boyfriends but if they’re unhappy with their labia, their vagina, that’s going to cause them distress on a daily basis and they certainly should see someone about it but not feel guilty about it and after a discussion with the surgeon, they can then make an informed decision, so that’s just my … One of my little peeves.

Trish: Yeah, I agree with you, actually. It’s all about choice. Just because I might think it’s crazy, it doesn’t matter, it’s the person that’s having it and it’s all about choices and that’s why we live in the society that we live in, is the fact that if you’re not happy, you can fix it if you want to or if that’s what you decide to do, go ahead and do it.

Dr Lisa Friederich: That’s right. Yeah. That’s right.

Trish: No judgement . Yep. Well, that’s awesome, thank you so much. I can, I can-

Dr Lisa Friederich: Okay. Lovely to talk with you, Trish.

Trish: Yeah. I can hear little puppies in the background there growling away, so they’re probably dying to get you back to them, so thank you so much and for those of you out there that would like to visit Dr Lisa Friederich, or if you want to have a consult with her, talk a bit further or find anything else about labiaplasty, you can either drop us an email to [email protected] or you can find Dr Lisa Friederich on our website, you just go straight to Silkwood in Bondi Junction, so thank you very much, Dr Lisa Friederich.

Dr Lisa Friederich: Thank you.

Trish: Okay, take care.

Dr Lisa Friederich: Thanks everyone for listening.

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