This patient came to see Dr. Medalie at his Beachwood office asking about labiaplasty which is also known as labia minora reduction. The labia minora are the inner labial lips and can be irritating if they protrude beyond the labia majora (the outer labial lips). The patient had extra tissue which was making it uncomfortable for her to perform normal daily activities. Her goal was to have the protruding labia trimmed so that no tissue projected beyond the edges of the labia majora. The procedure was done in Dr. Medalie’s office under local anesthesia with mild oral sedation (Ativan) and she is shown 3 months after surgery. This demonstrates how well and quickly the labia heal. Below is information from the American Society of Plastic Surgery that I have added some notes to as well.
What Is A Labiaplasty?
The term labiaplasty refers to a procedure that reduces the length of the labia minora. It is the most commonly performed vaginal rejuvenation procedure and it can relieve symptoms women experience from twisting and tugging of the labia.
Reasons Patients Want A Labiaplasty
Women opt for surgery for a variety of reasons, including pain from twisting and tugging of the labia when riding a bike or during intercourse, itching, irritation and self-consciousness.
What Does A Labiaplasty Do?
The goal of the procedure is to reduce the labia minora so that they don’t hang below the hair-bearing labia majora. A labiaplasty may be performed to reduce asymmetry when one is longer than the other, or, more commonly, to reduce the length of both labia so that the labia no longer twist, tug or fall out of a bathing suit.
Anesthesia For A Labiapasty
Labiaplasty is a procedure that can be done under either local anesthesia with oral sedation or under general anesthesia.
Labiaplasty Procedure
The most common type of labiaplasty is the trim procedure, in which the extra tissue is removed and sewn up directly. I personally believe that this is an inferior procedure compared to the wedge resection and almost always perform some type of wedge resection. Next in popularity is the wedge procedure, which maintains a natural border after a pie-shaped piece of tissue has been removed. Extra folds of the clitoral hood can also be reduced at the same time. Closure is usually done with absorbable sutures.
What Are The Risks Of A Labiaplasty?
The risks associated with labiaplasty include those of most surgical procedures, including bleeding, hematoma and infection. The most common complication is over-resection (this can occur with trim procedures more than wedge procedures). While some women desire an aggressive reduction, this can result in chronic dryness, scarring at or near the vaginal opening and pain with intercourse. Healing problems are more likely to occur with a wedge procedure, particularly if the patient is exposed to substances that cause blood vessels to shrink (such as smoking).
Recovering From A Labiaplasty
Most patients take a week off from work, during which they can reduce swelling and pain by icing with a cold pack sandwiched between the patient’s underpants and an elastic garment, like Spanx. This can be done “twenty minutes on, twenty minutes off.” The patient can also lie with her bottom elevated to reduce swelling.
Patients can resume wearing tampons or having intercourse after four to six weeks.
While the most distorting swelling is gone by 6 weeks, residual swelling may take several months to disappear.
What Are The Results Of A Labiaplasty?
Labiaplasty typically results in shorter labia that no longer hang down below the level of the hair-bearing labia majora. Most patients who experienced symptoms from twisting and tugging of their labia generally find relief after surgery. According to multiple studies, labiaplasty surgery is associated with a high satisfaction rate of over 90 percent.
This pleasant 22 year old woman came to see Dr. Daniel A. Medalie of Cleveland Plastic Surgery at his Beachwood office to inquire about breast augmentation and correction of protuberant areolae. She is 5’4″ and 135 lbs and wanted to be a full C cup after surgery. She was interested in reducing the size and protuberance of her areolae and elected to also have peri-areolar mastopexy (lifting). She chose to proceed with the surgery in an outpatient setting and had a successful 2.0 hour procedure. The implants placed were Allergan silicone 330 cc silicone breast implants. The patient is shown 6 months after her breast enhancement and areolar reduction and flattening procedure and is very pleased with the results.
A breast augmentation procedure includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on her own.
Step 2 – The Incision
Incisions are made in inconspicuous areas to minimize visible scarring.We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. Ths incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.
Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.
Step 3 – Inserting And Placing The Breast Implant
After the incision is made, a breast implant is inserted into a pocket either:
A. Under the pectoral muscle (a submuscular placement)
B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.
The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.
Step 4 – Closing The Incisions
Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.
Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.
Step 5 – See The Results
The results of breast augmentation are immediately visible. Typically they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.
*Plastic surgery results can vary from patient to patient and are not guaranteed
This pleasant 33 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had too much tissue for the peri-areolar approach and was scheduled for a double incision mastectomy with free nipple grafting and chest contouring by limited liposuction. His gender confirming surgery was performed as an outpatient and took approximately 90 minutes to perform. In his after picture he is shown 5 years post DI and is very pleased with his contour. He also embarked on an excellent exercise regimen and built up his body musculature to highlight his improved chest contour. The DI scars in the post op picture are hidden in the shadow of the enlarged pectoralis major muscle. *Results may vary
Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:
Top Surgery For Transgender Patients
The procedure is based on the following:
Size and shape of breast
Elasticity of skin
Patient’s needs and preferences
PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is removed (in a doughnut pattern , also known as-“peri-areolar or “purse-string” mastopexy”). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized areola. By necessity, the edges of the incision around the nipple will be “scalloped” or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary, this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.
Double Incision: In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double incision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples (and sometimes the pigmentation), and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, “dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)
This gender affirmation patient contacted Dr. Medalie for a top surgery procedure. He was scheduled for a peri-areolar incision double mastectomy. The procedure was performed through a keyhole incision and the patient is shown 6 months post op. He is very pleased with his FtM top surgery results.
This pleaseant 51 year old came to see Dr. Medalie in his Beachwood office. She complained of difficulty with exercise and sexual activity due to the large size of her inner labia and desired vaginal rejuvenation by reducing her labia minora . She underwent the labiaplasty and clitoral hood reduction under local anesthesia and mild oral sedation at Dr. Medalie’s Beachwood office, and the pictures show her three month after her vagina rejuvenation surgery. She has excellent reduction in the size of her labia minora with no protrusion of the labial tissue beyond the labia majora. Her clitoral hood is also more streamlined with less central excess. She is very pleased with her outcome.
Dr. Medalie of Cleveland Plastic Surgery is an expert in labia minora reduction and vagina rejuvenation. He also performs clitoral hood reduction and fat injection to the labia majora. He has presented his techniques and results at national meetings and in book chapters. His labiaplasty and vaginoplasty patients travel from all over Ohio, the midwest and east coast. Please visit his photo gallery to see examples of his work!
Labiaplasty for central hypertrophy. Before and three months after the labial reduction procedure.
This pleaseant 49 year old came to see Dr. Medalie in his Beachwood office. She complained of difficulty with exercise and sexual activity due to the large size of her inner labia and desired vaginal rejuvenation by reducing her labia minora . She underwent the labiaplasty and clitoral hood reduction under local anesthesia and mild oral sedation at Dr. Medalie’s Beachwood office, and the pictures show her three month after her vagina rejuvenation surgery. She has excellent reduction in the size of her labia minora with no protrusion of the labial tissue beyond the labia majora. Her clitoral hood is also more streamlined with less central excess. She is very pleased with her outcome.
Dr. Medalie of Cleveland Plastic Surgery is an expert in labia minora reduction and vagina rejuvenation. He also performs clitoral hood reduction and fat injection to the labia majora. He has presented his techniques and results at national meetings and in book chapters. His labiaplasty and vaginoplasty patients travel from all over Ohio, the midwest and east coast. Please visit his photo gallery to see examples of his work!
This 30 year old patient came to see Dr. Medalie at his Beachwood, Ohio clinic to discuss mommy makeover surgery. She elected to have a full abdominoplasty (also known as a tummy tuck) with liposuction of the abdomen, flanks and sides as well as a full breast lift (also known as a mastopexy). She also had excess tissue in the armpit region (axillary ectopic breast tissue) which she wanted to be removed. The surgery was performed as an outpatient and the patient is shown 9 months after her body contouring procedure. She is extremely happy with her new abdominal contour and her rounder and perkier breasts. Her armpit region is also much smoother with minimal bulging. Below is information from the American Society of Plastic Surgery. Plastic Surgery results can vary
The goal of a mommy makeover is to restore the shape and appearance of a woman’s body after childbearing. Many women notice changes in their bodies post-pregnancy. There are many areas of the body that can be addressed, most commonly the breasts, abdomen, waist, genitalia and buttocks. A mommy makeover is typically performed as a single stage procedure. There are many techniques used to perform a mommy makeover, and many factors should be taken into consideration when choosing which techniques are best:
This pleasant 28 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had too much tissue for the peri-areolar approach and was scheduled for a double incision mastectomy with free nipple grafting and chest contouring by limited liposuction. His gender confirming surgery was performed as an outpatient and took approximately 90 minutes to perform. In his after picture he is shown 1 year post DI and is very pleased with his contour. He also has had good hair growth from testosterone therapy. *Results may vary
Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:
Top Surgery For Transgender Patients
The procedure is based on the following:
Size and shape of breast
Elasticity of skin
Patient’s needs and preferences
PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is removed (in a doughnut pattern , also known as-“peri-areolar or “purse-string” mastopexy”). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized areola. By necessity, the edges of the incision around the nipple will be “scalloped” or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary, this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.
Double Incision: In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double incision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples (and sometimes the pigmentation), and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, “dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)
FtM DI top surgery and body contouring for gender affirmation
Before Top Surgery and lower abdominoplasty After Top Surgery and lower abdominoplasty
This pleasant 27 year old trans man came to see Dr. Medalie in regards to FtM “top surgery”. He had too much loose skin for the peri-areolar approach and was scheduled for a double incision mastectomy with free nipple grafting and chest contouring by limited liposuction. He was also interested in contouring his lower abdomen and decided on a lower abdominoplasty with liposuction. His gender confirming surgery was performed as an outpatient and took approximately 2 hours to perform. In his after picture he is shown 1 year post DI and body contouring and is very pleased with his contour. He has begun an extensive work out regimen and in combination with his lower abdominoplasty and testosterone, his newly contoured body demonstrates excellent musculature and chest contour.*Results may vary
Below I have attached some information from my main web page that discussed the surgical options for top surgery. Here is a link to that page:
Top Surgery For Transgender Patients
The procedure is based on the following:
Size and shape of breast
Elasticity of skin
Patient’s needs and preferences
PERI: In general, patients who have smaller breasts can have the entire surgery performed by having a small incision at the outer edge of the areola from 12:00 to 6:00 o’clock. A lighted retractor and surgical scissors are used to perform a complete sub-cutaneous mastectomy. Liposuction of the chest is also performed as needed.This provides the most optimal results and can be almost invisible after it heals. If the skin appears a little looser at the start of the case then a complete peri-areolar incision is made. A small amount of skin is removed (in a doughnut pattern , also known as-“peri-areolar or “purse-string” mastopexy”). A subcutaneous mastectomy is performed and then the outer edge of the skin is closed with a purse-string to the newly down-sized areola. By necessity, the edges of the incision around the nipple will be “scalloped” or bunched up initially. This settles down to a great degree over time. If the patient understands that scar revision may be necessary, this is a very reasonable approach. The nipple may experience compromise of its blood supply and also have sensation or erectile capacity changes.
Double Incision: In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, it is usually recommend to remove the excess skin and breast tissue in the crease of the pectoralis muscles (elliptical or double incision mastectomy) and put the nipples and areolae back on as grafts. This surgery has the advantage of immediate and predictable results. I can contour the skin flaps and place the nipples where I want to. It has the disadvantage of permanently altering the sensation and erectile capacity of the nipples (and sometimes the pigmentation), and it leaves larger scars on the chest. Over time they fade and flatten out. At each end of the scar, “dog-ears” may form. These are small bunches of tissue created by the closing of the ellipse as a straight line. They tend to settle down over time, but may need to be revised. I always try and address the dog ears at the time of surgery but this may extend the length of the scar. Dog ears are more likely in patients who are heavier and have more tissue to start with. I always perform liposuction of the central and lateral chest (to flatten the dog ears) as well as the area in front of the armpit. I have been asked why a scar may meet in the center of the chest on some top surgery results but not on others. This is dependent on pre-existing anatomy. If the tissue meets in the middle (such as in the example right below) then the scar by necessity will meet in the middle (this can’t be seen in the example because of the patient’s chest hair.)
This patient came to see Dr. Medalie complaining of severe gynecomastia and lateral excess skin and fatty tissue as well as excess skin of the abdomen. He had lost a great deal of weight and was concerned about the displaced nipple/areolar complex, excess breast tissue and lateral excess skin and fatty tissue. His male breast reduction surgery was performed on an outpatient basis.He had a complete double mastectomy with nipple areolar reconstruction by grafting and side and chest liposuction. His incisions were extended quite far on his sides in order to remove the excess lateral skin as well. The patient is shown 4 months after his procedure. His chest contour is much improved and his nipples are smaller and in a better position. His abdomen is much tighter ands the excess lower skin is gone. He is working out and lifting weights and has excellent body aesthetics from his body contouring procedure.He is extremely pleased with his outcome. The tattoos are temporary to see how they would look in the future.*Plastic Surgery results are not guaranteed
Gynecomastia surgery reduces breast size in men, flattening and enhancing the chest contours.
In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple). In these cases the position and size of the areola can be surgically improved and excess skin may be reduced.
Plastic surgery to correct gynecomastia is technically called reduction mammaplasty.
What Is Gynecomastia?
Gynecomastia is a condition of overdeveloped or enlarged breasts in men that can occur at any age. The condition can be the result of hormonal changes, heredity, obesity or the use of certain drugs.
Gynecomastia can cause emotional discomfort and impair your self-confidence. Some men may even avoid certain physical activities and intimacy simply to hide their condition.
Gynecomastia is characterized by:
Excess localized fat
Excess glandular tissue development
Sometimes excess breast skin
Presence unilaterally (one breast) or bilaterally (both breasts)
What Are The Steps Of A Gynecomastia Procedure?
A male breast reduction procedure includes the following steps:
Anesthesia
Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.
Liposuction Technique
In cases where the chest tissue is primarily the result of excess fatty tissue, liposuction techniques alone may be used. This requires insertion of a cannula, a thin hollow tube, through several small incisions.
The cannula is moved back and forth in a controlled motion to loosen the excess fat, which is then removed from the body by vacuum suction.
There are various liposuction techniques that may be used; the technique most appropriate in your case will be defined prior to your procedure.
Excision Technique
Excision techniques are recommended where glandular breast tissue or excess skin must be removed to correct gynecomastia. Excision also is necessary if the areola will be reduced or the nipple will be repositioned to a more natural male contour. Incision patterns vary depending on the specific conditions and surgical preference. I find that almost always a patient will need a small incision to remove glandular tissue under the nipple. I try to make the incision at the areolar skin junction on the lateral border of the areola from 6-12 o’clock.
Combination Of Liposuction & Excision Techniques
Sometimes gynecomastia is treated with both liposuction and excision. This is the case in the example above when there is both excess fatty tissue and glandular tissue present.
What are the steps of a tummy tuck procedure?
A tummy tuck procedure includes the following steps:
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and belly button.
The shape and length of the incision will be determined by the amount of excess skin. Once the abdominal skin is lifted, the underlying weakened abdominal muscles are repaired.
A second incision around the navel may be necessary to remove excess skin in the upper abdomen.
The upper abdominal skin is pulled down like a window shade. The excess skin is trimmed and the remaining skin is sutured together. A new opening for the belly button is created. The belly button is popped through to the surface and sutured into position.
Step 3 – Closing the incisions
Sutures, skin adhesives, tapes or clips close the skin incisions.
Step 4 – See the results
Your tummy tuck will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. Get more information about tummy tuck results.
