Dr. Toby Meltzer Performs Labiaplasty

Date of Surgery: April 2000

1. This patient had undergone vaginoplasty with Dr. Meltzer three months earlier. Here is what her result looked like, prior to labiaplasty.
2. About 90 minutes before she came to the operating room, the lower part of her pubic hair was shaved, and EMLA cream was applied to her vulva, under plastic-wrap occlusion. She was also given 10 mg of Valium to take orally. [Note to consumers: one 5cc tube of EMLA probably won't be enough. This patient asked for and received three 5cc tubes -- about the right amount.]
3. Once in the operating room, the EMLA cream was removed, the patient's vulva was washed with Betadine, and blue surgical drapes were applied. Here we see the operative site after completion of these preparations. Surgery is about to begin.
4. Here some of the Betadine has been wiped off, and the skin incision lines, as well as a few alignment marks, have been drawn on the skin with purple surgical marker. Local anesthetic is now being injected to further numb the skin. The anesthetic solution also contains epinephrine, a vasoconstrictive agent, which will greatly reduce bleeding. Note that the lines drawn above the clitoris form an inverted "V". We will see what happens to this "V" shape a few images later.
5. The skin is now incised with the scalpel along the previously-drawn lines.
6. Next, the skin is gently freed from the underlying tissue. This will allow the skin to be re-draped to hood the clitoris and create the labia minora.
7. Here we see the results of the first part of the operation. The skin has been freed-up, and is now ready to be rearranged. The next step will be to bring together the skin edges that lie between the surgeon's fingers.
8. In this photograph, sutures placed just beneath the skin surface have been used to bring the skin edges together above the clitoris. The former inverted "V" now looks like an inverted "Y" -- which is why plastic surgeons call this particular tissue rearrangement technique a "V-Y-plasty." The use of a V-Y-plasty to create the clitoral hood is an elegant alternative to the older "double Z-plasty" technique used by some other surgeons. Unlike the double Z, which leaves multiple vertical scars, the V-Y leaves only a single vertical scar.
9. Next the labia minora are created. This involves suturing the skin edges together, and also placing sutures through each labrum, from one side to the other, creating thin lips of tissue.
10. In this photograph, the labrum on the left (patient's right) has been formed, and a small drain has been placed between the skin edges at its lowest point. The labrum on the right (patient's left) is now being constructed.
11. Here is the finished result. The construction of the labia has been completed, and the vertical incision line above the clitoris has also been closed. It is now even easier to see the inverted "Y" shape, created by the V-Y-plasty.
12. Here is the result 24 hours later, with the Betadine washed off completely, and the drains removed. There is more swelling of the labia now, and more evidence of early bruising. The bruising and swelling will peak at 48 to 72 hours, and will take several weeks to disappear. Nevertheless, we can get some sense of what the final result will look like.
13. A second photograph at 24 hours shows the appearance with the labia spread.
14. This is what the result looks like 10 months postoperatively, with the labia together. I think the overall appearance is very pleasing.
15. Another view of the result 10 months postoperatively shows the appearance with the labia spread.

© 2011 by Anne A. Lawrence, M.D., Ph.D. All rights reserved.