Dr. Medalie of Cleveland Plastic Surgery is an expert in labia minora reduction and vagina rejuvenation (labiaplasty and vaginoplasty in Cleveland, OH). 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!
The term vaginal rejuvenation covers several different procedures. It is sometimes called female genital plastic surgery, female genital rejuvenation surgery, female genital cosmetic surgery, vulvovaginal plastic surgery and designer vagina surgery, among other terms. Among the procedures that comprise female genital plastic surgery are labiaplasty, clitoral hood reduction, labia majoraplasty, monsplasty and vaginoplasty. Before discussing each one, it is important to look at the anatomy.
External anatomy of the female genitalia
The hairbearing area over the pubic bone at the upper portion of the female genitalia is called the mons. The hair-bearing outer lips are called the labia majora (singular is labium majus). The inner lips are called the labia minora (singular is labium minus). In the upper portion in the center is the clitoral hood, sometimes called the prepuce, which covers the clitoris in part or entirely. Below the clitoris is the urethral opening, and below that is the vaginal opening.
TV interview of Dr. Medalie about Labiaplasty
Labiaplasty and Vaginoplasty combination procedure
Labiaplasty procedure
Labiaplasty, Vaginoplasty, Hoodectomy What’s the difference?
Before you begin navigating through this site or surfing the web, its important to know what procedure you are looking for. Depending on your need, there are three common procedures performed to the vulva.
Labiaplasty
For women that experience discomfort when wearing tight pants or exercising or feel embarassement about the size of their labia, labiaplasty surgery (also known as labia minora reduction or labioplasty) is the right procedure.
No-Labiaplasty can be performed with mild oral sedation and local anesthesia.
Typical surgery time is around 1-1.5 hours.
I typically give my patients antibiotics for three days around the surgery. I have NEVER had a post-operative infection. Sometimes patients who take antibiotics get yeast infections and this has happened to several of my patients. The treatment consists of stopping the antibiotics and applying a topical anti-yeast agent. Please be aware that smoking is the number one reason for post-operative infections and healing problems. I thus require my patients to STOP SMOKING at least 6 weeks prior to any labiaplasty procedure.
The labia are very vascular and bleed easily. During the surgery, local anesthetic is injected into the tissue-this blocks the sensation and also constricts blood vessels. As a result, there is very little bleeding during the surgery. I have NEVER had a patient have a bleeding complication post-op.
While it may seem that this is a very bad area to have surgery on, in fact, the labia are very resilient and heal speedily. Pain that may require narcotic pain medicine typically lasts only a few days. After that, ibuprofen (Motrin and Advil) is sufficient. I recommend that patients take a week off from work, but if you have a desk job, you can go back sooner. The post-op care is fairly easy and involves cleansing several times per day and the application of antibiotic ointment for a week. Most of the swelling and all of the external stitches have disappeared by two weeks.
I recommend that patients refrain from intercourse for at least 4 weeks after surgery. This does not mean that other types of sexual activity cannot take place. Even after 4 weeks, the labia incisions may be sensitive and patients need to use caution and plenty of lubrication.
Some of the deep sutures under the skin can take up to three months to completely dissolve. For this reason, some patients may report sensitivity issues such as itching for up to three months post-op. After that, sensation issues are very uncommon. Damage to the clitoris with resulting changes in the ability to have orgasm has never happened in my patient population.
Yes – I frequently perform multiple procedures on labiaplasty patients. Sometimes, I perform clitoral unhooding. This procedure removes some of the skin overlying the clitoris to allow for greater stimulation during intercourse. The labia majora can also be reduced (this is more typically asked for by my older patients or patients who have lost significant amounts of weight). Vaginoplasty or vaginal rejuvenation is a procedure to tighten the vaginal introitus after child bearing. This is easily performed in conjunction with labiaplasty. Finally, all the other cosmetic procedures that I perform (e.g. breast augmentation, tummy tuck etc.) can be performed at the same time as labiaplasty. These would require a trip to the operating room and general anesthesia.
Simple labiaplasty under local anesthesia and mild sedation costs around $4300 at Dr. Medalie’s outpatient procedure clinic. Clitoral hood reduction can be added for $750. Labia majora reduction is an additional $2000 (or $3500 as a stand alone procedure). All procedures are less expensive when combined with other procedures such as vaginoplasty or breast augmentation.
I frequently perform labia reduction and vagina rejuvenation surgery on patients who live out of town and are unable to easily to see me in consultation prior to the procedure. I have several requirements for these patients: I must see pictures of them prior to scheduling surgery. They need to contact my office and have my patient care manager email them a medical history form to be filled out and sent back. Typically, the patient will come into town 1 day prior to the procedure, and I will see them the day of surgery. I will perform a phone consultation about 3 weeks prior to surgery. I will then perform the operation and patients can usually return home the day after surgery. Your post-op visit will be a virtual visit with my nurse, Michelle, about 10-14 days after surgery. I will then follow the progress of the patient via e-mailed pictures. My patient care manager has information about hotels in the area as well as financing. You may contact her at valerie@clevelandplasticsurgery.com.
Please visit Dr. Daniel Medalie’s photo gallery to see before and after labiaplasty and vaginoplasty pictures. You may also call him at 216-393-9924. You can also e-mail his patient care manager, Valerie, at valerie@clevelandplasticsurgery.com.
Vaginoplasty
After childbirth, or as women age, their vagina can become, in popular terms, “loose.” Vaginoplasty, also known as vaginaplasty or “vaginal rejuvination”, is popular for tightening the vagina or improving sexual experience.
As a woman’s body ages, it goes through a number of changes. Wrinkles develop and skin sags. Fat deposits increase and muscle mass may decrease. The vagina is no stranger to change either. While most young women have taut and stretchy vaginas, a number of women find that they lose vaginal tone and strength as they age. Some of this simply comes as a woman ages, and some of it comes from childbirth or simply because of the natural vaginal state. The severe strain put on the pelvis and the vagina in particular can cause the vaginal opening to be stretched, and it can cause a loss of tone in the muscles which surround the vagina. Vaginal rejuvenation is a technique which is used to help increase the tone and tightness of the vagina. During vaginal rejuvenation, the vaginal opening and walls will typically be tightened, and the surgeon will also help to rebuild and reinforce some of the surrounding supportive tissue. All of this helps to return the vagina to a younger, tighter state. Vaginal rejuvenation is not only a surgery designed to correct or perfect a physical condition, but it is also meant to boost the patient’s confidence and help them achieve a better quality of life. After vaginal rejuvenation, a patient should return soon to their normal activities. Vaginal rejuvenation is a surgery that with the proper care will not interfere with the patient’s quality of life and should show results in a very short time.
Reduced vaginal tone can be a contributing factor in a loss of sexual sensation and satisfaction. During sexual intercourse, a certain amount of friction is needed to ensure the ideal amount of pleasure for both partners. Oftentimes, a loose and weak vagina is unable to provide enough friction to give the woman or the man optimal pleasure. This can leave both partners with a feeling that sex isn’t as good as it once was, and this, in turn, can result in a lowered interest in sex and a lowered level of intimacy. Restoring tightness to the vagina can increase sexual satisfaction for both partners.
Vaginal rejuvenation can solve problems with sexual sensitivity that are directly related to a lack of vaginal tone or stretching of the vaginal mucosa from childbirth or episiotomy. If the vaginal walls or opening have been stretched too much during childbirth, vaginal rejuvenation can decrease their size. If a man feels like his wife’s vagina is just too loose and the wife feels that his penis isn’t thick enough to fill her up, vaginal rejuvenation may be able to help. Vaginal rejuvenation can also address issues where a lack of vaginal tone is caused by weak vaginal and perineal muscles.
Vaginal rejuvenation cannot solve every problem relating to female sexual function and pleasure. It cannot solve sexual problems that stem from emotional or relationship issues. It is not a solution for sexual dysfunction or anorgasmia. It cannot solve a low interest in sex, unless that low interest is an outgrowth of low sexual satisfaction due to vaginal relaxation. Vaginal rejuvenation only affects the vaginal introitus or opening. It does not typically address issues relating to the labia or the clitoris (for more information on how to address these issues, please see the labiaplasty page). Similarly, vaginal rejuvenation can’t solve incontinence issues that are caused by weak pelvic muscles. It cannot solve urge incontinence, which is caused by overactive bladder muscles. It also cannot cure overflow incontinence, which occurs when the bladder doesn’t fully empty.
Vaginoplasty (vaginal rejuvenation) is designed to remove extra mucosa, plicate (tighten) the underlying muscle and close the defect in a way that tightens the vaginal vault. A diamond shaped piece of perineum and internal vaginal mucosa is removed to allow tightening of the underlying muscle and closure of the vaginal introitus (external opening). Typical tightness is to allow only two and one half finger breadths of space in the vaginal introitus (opening). The operation is outpatient and takes around 1-2 hours. It is typically well tolerated, and healing is similar in time and length to a standard episiotomy performed at childbirth. This must be performed in a surgery center under general anesthesia. The average cost, including anesthesia and facility fees, is around $7000. It is less expensive if performed in combination with other procedures such as labiaplasty and clitoral unhooding.
Yes – I frequently perform multiple procedures on vaginoplasty patients. Sometimes, I perform clitoral unhooding. This procedure removes some of the skin overlying the clitoris to allow for greater stimulation during intercourse. The labia majora can also be reduced to decrease the extra skin or augmented with fat to puff up the loose skin (this is more typically asked for by my older patients or patients who have lost significant amounts of weight). Labiaplasty is commonly performed at the same time as vaginoplasty. Finally, all the other cosmetic procedures that I perform (e.g. breast augmentation, tummy tuck etc.) can be performed at the same time as vaginoplasty. These would require a trip to the operating room and general anesthesia.
Vaginoplasty needs to be performed in the OR with the patient asleep and typically costs around $7000. It is less expensive when combined with other procedures such as labiaplasty or breast augmentation.
I frequently perform vagina rejuvenation surgery on patients who live out of town and are unable to easily to see me in consultation prior to the procedure. I have several requirements for these patients: I must see pictures of them prior to scheduling surgery. They need to contact my office and have my patient care manager e-mail them a medical history form to be filled out and sent back. Typically, the patient will come into town 1 day prior to the procedure, and I will see them the day of surgery. I will perform a phone consultation about 3 weeks prior to surgery. I will then perform the operation and patients can usually return home the day after surgery. Your post-op visit will be a virtual visit with my nurse, Michelle, about 10-14 days after surgery. I will then follow the progress of the patient via e-mailed pictures. My patient care manager has information about hotels in the area as well as financing. You may contact her at valerie@clevelandplasticsurgery.com.
Hoodectomy
Hoodectomy also known as “clitoral unhooding” is the right procedure for women that have decreased sexual sensitivity due to extra skin surrounding their clitoris. It can also reduce extra tissue that gives the labia an asymmetric or “top heavy” appearance after primary labiaplasty.
Labiaplasty
Labiaplasty is a surgical procedure that reduces and/or reshapes the labia minora (labia minora reduction) – the skin surrounding the vaginal opening. In most women, the labia minora are seen only when the legs are separated. However in some women, large labia minora are visible when the legs are not apart, or are barely separated, causing embarrassment, self-consciousness, and distancing in relationships. Enlarged labia may also be noticeable in tight fitting pants, and can cause discomfort during intercourse, with clothes, or with exercise. Enlarged labia are usually congenital but may be increased from hormonal changes or childbirth.
Labiaplasty is a procedure to correct this problem. I utilize a newly described technique of labia minora reduction (labiaplasty) which preserves the contour, color, and anatomy of the labia minora edge. The excess labium is excised in a “V” manner and the upper and lower edges are sutured together. Therefore, the only suture line visible on the edge is a small transverse line instead of a long longitudinal vertical suture line. This significantly decreases the discomfort and visibility of the procedure. Most of my patients have chosen to have the surgery with local anesthesia only and mild oral sedation (which is very well tolerated). The average cost including facility fee is around $4300. The surgery is outpatient and takes around 1.5 hours. I recommend that patients take off 7 days from work and refrain from heavy exercise and sexual intercourse for 3-4 weeks. Pain is usually controlled by narcotics for the first several days and then ibuprofen (Motrin, Advil etc.) after that. Irritation can last for several months, but is usually transient. In general this is a very well tolerated procedure.*Plastic surgery results can vary from patient to patient and are not guaranteed.
I also perform other female genital surgery including labia majora remodeling, vaginal rejuvenation or vaginoplasty, pubic liposuction and pubic lift.
Vaginoplasty
Vaginoplasty (vaginal rejuvenation) is designed to remove extra mucosa, plicate (tighten) the underlying muscle and close the defect in a way that tightens the vaginal vault. Typical tightness is to allow only two and one half finger breadths of space in the vaginal introitus (opening). Most candidates for the surgery are women who have had several children and notice that their vaginal tightness is not the same as it was prior to child bearing. The operation is outpatient and takes around 1-2 hours. It is typically well tolerated and healing is similar in time and length to a standard episiotomy performed at childbirth. This must be performed in a surgery center under anesthesia. The average cost including anesthesia and facility fee is around $7000. It is less expensive if performed in combination with other procedures such as labiaplasty and clitoral unhooding.*Plastic surgery results can vary from patient to patient and are not guaranteed.
Dr. Medalie also performs other female genital surgery in Cleveland, Ohio including labia majora remodeling (surgical reduction and fat augmentation), clitoral unhooding, pubic liposuction and pubic lift. Labiaplasty and vaginoplasty can be performed as a combined procedure and the average cost is around $11,000 (this includes anesthesia and facility fee).
For more of Dr. Medalie’s labiaplasty and vaginoplasty patient photos, please visit his photo gallery.
