Designer vaginas?

OB-GYNs say procedures are not necessary, may pose risks

BY JIM RITTER Health Reporter

One of the newest frontiers in plastic surgery is the designer vagina. Surgeons are tightening vaginas, enlarging G spots and trimming inner labia lips that are deemed unsightly.

A 26-year-old woman, who asked not to be identified, said she had been bothered by the large inner lips of her vagina ever since puberty. She hated how she looked in a bathing suit. Didn't like wearing tight jeans. And sex wasn't any fun.

Her plastic surgeon, Dr. Otto Placik of Arlington Heights, fixed her vagina with a "labiaplasty." Now it "looks exactly how I want it," she said.

Not many women are getting genital makeovers. But the procedures are getting starring roles on cable TV. The number of procedures is growing. And that's got gynecologists worried.

"These procedures are not medically indicated, and the safety and effectiveness of these procedures have not been documented," the American College of Obstetricians and Gynecologists is warning in a new opinion.

A woman who feels insecure about her sexual function or the appearance of her vagina "may be further traumatized by undergoing an unproven surgical procedure with obvious risks."

These risks include infections, scarring, altered sensation and pain during sex.

A woman who doesn't like how her vagina looks should be reassurred that normal genitals vary "significantly from woman to woman."

And if she's having trouble in bed, she should try counseling, the gynecologists group said.

Even many plastic surgeons are leary.

"Take caution," said Morton Grove plastic surgeon Dr. Loren Schechter, a spokesman for the American Society of Plastic Surgeons. "I would think long and hard about undergoing one of these procedures."

Plastic surgeons long have done reconstructive vaginal surgeries on women following cancer surgery, burns, car accidents, etc.

Now, women are getting genital makeovers for nonmedical reasons, in part because they've seen the procedures featured on plastic surgery reality shows such as "Dr. 90210'' and the soap opera "Nip/Tuck.''

The American Society of Plastic Surgeons counted 1,000 vaginal rejuvenations last year, up from 793 in 2005.

This represents less than 1/10th of 1 percent of the 1.8 million cosmetic procedures last year.

But the actual number is almost certainly higher. The society counted only one type of cosmetic procedure, and did not count procedures done by gynecologists and urologists.

These are among the procedures:

• Vaginal rejuvenation: This surgery to tighten the vaginal muscles is typically done on women who have given birth. It's supposed to make sex better. But it can make sex painful if the vagina is made too tight.

• G-spot amplification: The G-spot supposedly is an erogenous zone inside the vagina, although experts disagree whether it even exists. The doctor injects collagen, a naturally occurring protein, to the G spot. The spot becomes about a quarter-inch high, and as big as a quarter.

The procedure costs about $1,800 and must be repeated every four months or so.

• Revirgination: This creates a membrane across the vaginal opening to create the illusion the woman is still a virgin. It is performed on women who come from cultures that put a premium on virgin brides.

• Labiaplasty: Placik has performed this inner-lip reduction on about 25 women, who have come from as far away as Minnesota and Kentucky. It typically costs about $6,000.

One of Placik's patients said she had a labiaplasty because "the extra skin was just hanging there. It gets in the way."

The woman said no boyfriend had ever commented on her large labia.

"It was an issue with me and no one else," she said.

The woman is only 26, but already has had two plastic surgeries. In 2004, she had breast implants.

Now, she said, "I'm good to go."

Female Genital Interventions/Surgery

Throughout history, artists have been quite free to render their idealized versions of the female genitalia in drawings, paintings, and sculpture. However, the public has tended to discourage an open dialogue on this sensitive matter which has generally been considered taboo leaving many women to wonder if they are “normal.” This stigma has prevented affected women from speaking freely about their concerns; many of these whom have expressed an awareness which may date back to childhood. In recent years, the growing interest in plastic surgery has made women realize that there are many options available for addressing their treatment goals.

A variety of popularized techniques are grouped under the procedure “labiaplasty”. These are also known as labia(l) rejuvenation, beautification, remodeling, reduction, contouring, augmentation as well as pubic lift, liposuction, lipoinjection, vulvectomy, labioplasty, etc. I have described some of these below. It is unlikely that you will need all of these. Therefore a clinical exam is necessary in order to assess your particular anatomy and to determine the most appropriate procedure to achieve your goals.

Labia Minora Reduction

This procedure is requested by women who state that their labia minora (inner lips) are excessively large. This may affect one or both sides. Women report that they are uncomfortable or sore while exercising or competing in sports such as bicycle riding. Others are embarrassed and refrain or are hesitant to undress in front of a potential intimate partner. Another frequent complaint is discomfort in tight garments. Many individuals report being embarrassed by the appearance of their labia in well-fitting clothing such as bathing suits or lingerie. Large labia minora may interfere with sexual activities preventing stimulation of the clitoris during sex. Excessively large labia which are repeatedly subject to trauma may become irritated, painful, and ulcerated. Some women report an increased incidence of urinary infections due to difficult hygiene considerations. Enlarged labia may be congenital (present at birth) or made worse by repeated pregnancies or prolonged or particularly traumatic labor and delivery. A labia reduction (labiaplasty) procedure can be performed to reduce the labia minora.

Various techniques are available for treating prominent labia minora. The standard approach utilized by many gynecologists and plastic surgeons is a simple removal of leading edge of the labia, thereby shortening and reducing it. The edge is then repaired. This is the least complicated technique and is easily completed in the office. Another method recently popularized by Dr. Alter called the "Alter labia contouring" procedure "the new labiaplasty". In this surgery, the excess labia are reduced by removing a wedge (pie shaped piece) of labia and closing the remaining tissue resulting in smaller labia. This produces a scar across the labia rather than running the length of the leading edge. This is indicated for women in whom the central one third of the labia minora is largest.

This surgery is commonly completed under local anesthesia using oral sedation and can be performed in our fully accredited surgical center. General anesthesia is available if requested but is not necessary. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested. The incidence of complications is low and manageable. You can resume light duty work in 5 days. Sexual intercourse is restricted for about 4-6 weeks.

Labia Majora Remodeling

The outer hair bearing lips (labia majora) of the genitalia can be affected by redundant skin or bulky tissue. Women describe being embarrassed by a visible bulge in snug clothing such as active wear or bathing suits. Labia majora hypertrophy (overgrowth) may be due to a congenital condition, aggravated by pregnancy, or generalized aging. Early or less severe degrees of labia majora hypertrophy without skin laxity can be managed with liposuction if the primary problem is fatty or “puffy” labia. More advanced hypertrophy can be treated with labia majora reduction which is accomplished by excising an elliptically (football) shaped section from the inner or hidden surface of each labia majora. The incision is concealed in the valley between the labia minora and majora.

These procedures tend to require to more surgery than a labia minora reduction and are therefore frequently performed under general anesthesia in our fully accredited surgical center. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested. The incidence of complications is low and manageable. You can resume light duty work in 5 days. Sexual intercourse is restricted for about 4-6 weeks.

Labia Majora Augmentation

Atrophic (sunken, empty, deflated) appearing labia majora may be a consequence of genetic factors, weight loss, or aging. This results in a loss of the youthful fullness of the labia majora. Augmentation of the labia majora can be achieved by lipoinjection (fat grafting from the abdomen or thighs). This is collected using liposuction techniques.

This surgery is typically is scheduled for 1 hour and performed under monitored or general anesthesia. It is commonly combined with other female genitalia cosmetic surgery procedures. If performed as an isolated procedure, you should be able to resume sexual activities in about two weeks.

Mons Pubis Liposuction and/or Lift

Following massive weight gain and subsequent loss or a prolonged pregnancy, it is not uncommon for a woman to report dissatisfaction with her loose, sagging, or prominent mons pubis. Rarely patients may be born with an excessive fatty deposit in this region. Patients describe a visible pubic fullness or mass which is clearly evident when wearing pants. Many women complain that the bulge makes them look like a man. Liposuction is a convenient method of extracting and diminishing the volume of the pubis. Occasionally there is an associated skin laxity which creates the illusion of an aged or collapsed appearance due to loss of support. A lift or suspension of these tissues is accomplished by excising an elliptical (football) shaped piece of skin immediately above the pubic hairline. This elevates and rejuvenates the genitalia in combination with liposuction. It is frequently completed in massive weight loss procedures such as tummy tuck but can be done as an isolated surgery subsequent to an abdominoplasty. These areas can be rejuvenated and lifted by excising excess skin above the pubic hair and removing excess fat in the pubic region. The pubic liposuction and pubic lift procedure may be combined with a tummy tuck or requested after having a tummy tuck.

These procedures are most commonly performed under general anesthesia in our fully accredited surgical center. In individuals concerned about postoperative discomfort, a pain pump can be inserted but is not typically requested. The incidence of complications is low and manageable. A drain may be required. You can resume light duty work in 7-10 days. Sexual intercourse is restricted for about 4-6 weeks.

G-Spot Amplification

The G-spot is an erogenous zone located on the upper wall of the vagina approximately 1/3 of the distance from the vaginal entrance to the cervix. When stimulated, it is considered responsible for triggering vaginal orgasms. Injection of a filler material (either collagen or hyaluronic acid i.e., restylane) has been credited with making the area more accessible. This has been shown to result in enhanced sexual arousal and gratification.

This procedure is performed using topical anesthesia and involves injection of filler materials which are identical to those placed into the face.

OVERVIEW

As you can see, an important part of this examination is the evaluation of the underlying anatomy. The procedure of choice is a complex decision process determined based on your desires, anatomy, practicality, and wound healing. During the consultation we may determine that other procedures are better suited for your optimal outcome. It is also possible that although an appropriate plan has been determined at the time of the initial consultation, it may need to be adjusted intra-operatively.

Insurance may cover the labiaplasty surgery if you have any physical discomfort or functional conditions. It is best to come with a letter documenting and supporting your complaints after evaluation by your gynecologist. Should you seek insurance predetermination of benefits, we are happy to assist you in obtaining preauthorization. However, we do request a consultation fee which can be credited towards your surgical fees.

The length of the surgery depends upon the type of procedures selected. The procedures are most commonly performed on an outpatient basis.

The procedure can be done in several different places (hospital, office surgical suite, or surgicenter) and the prices vary accordingly.

There are risks to crossing the street or flying in an airplane and, of course, there are risks to any surgical procedure. These risks can occur regardless of surgeon or technique. These include but are not limited to: infection, hematoma, discomfort at rest with or without clothing or sexual activity, wound separation, excessive scarring, asymmetry, unfavorable healing, numbness, pain, adverse reaction to medications/injectables/implants, palpability, need for secondary surgical revisions, and inability to guarantee a specific functional and or cosmetic result.

Silicone Gel Breast Implants Approved by FDA

This is great news for all women interested in having any kind of breast augmentation. On November 17, 2006, the Federal Drug Administration (FDA) approved the use of silicone gel breast implants for all women aged 22 and over.

Dr. Placik’s experience with silicone gel implants

Since 1990, I (Dr. Placik) have performed silicone gel placements for well over 15 years.

In 1994, I drafted a letter regarding the safety of silicone gel filled implants in nursing women which was published in the prestigious medical peer reviewed journal JAMA.

In 1995, I joined the practice of two plastic surgeons that had been previously carried out silicone breast enhancements since the 1960’s (over 40 years). Since 2000, I have been the sole plastic surgeon (in our practice) managing the care of all of our patients with silicone gel implants and have extensive experience with them.

From 2000 until the present, I have acted as the Primary Investigator for the Investigational Review Board at Northwest Community Hospital’s Adjunct Study Protocol for Mentor silicone gel filled implants. This has allowed me to continue to place these implants under the strict guidelines set forth by the FDA following the 1992 moratorium on silicone gel filled implants for cosmetic breast enlargement.   While other plastic surgeons refused to participate due to the burdensome paperwork and bureaucracy, I have been overseeing the care (including surgical removal and replacement of implants) on individuals who had silicone implants placed prior to 1992 for cosmetic breast enhancement.  After 1992, I have been carried out silicone breast enlargements for breast reconstruction after disease or injury.

After November 17th 2006, when the silicone gel implants were recently approved for cosmetic breast enhancement in women aged 22 and over, I completed both the Mentor and Allergan physician certification programs as mandated by the FDA.

Previous safety concerns satisfied

In 1992, the FDA restricted silicone gel implants to breast reconstruction and for a few other women for whom saline implants were a poor choice.  This was prompted by the public perception during the 1970s & 1980s that silicone implants seemed to have a tendency to rupture and leak. Some people questioned whether these leaks were causing other medical conditions or diseases. In the 14 years since 1992, many studies have been done on the safety of silicone implants, and none has established any causative connection with any disease whatsoever.

Improved implants

The silicone implants now approved for general use have somewhat thicker shells than those used before 1992, and are filled with a thicker silicone gel. They come pre-filled in a variety of sizes, and are securely sealed so that there is virtually no chance of any leakage.

What is silicone?

The word silicone with an “e” at the end refers to a group of chemical compounds that vary in thickness from liquid to gels to a rubbery consistency. They contain, among other things, silicon, with no “e” at the end, which is an element, like nitrogen, carbon, or iron. It’s the second most common element on the planet, after oxygen. When combined with oxygen it forms silica, the most common substance on earth. We know silica in familiar forms, such as sand, quartz, and crystals. Silicone is used in many everyday items such as hand lotion, hairspray, soaps, processed foods and chewing gum.

The type of silicone gel used in breast implants has a consistency like jell-o, or thicker in some, so that it stays in one piece. If an implant shell were to rupture, the silicone gel would not run out like syrup or water, but would stay put. However, ruptures are now very unlikely.

Advantages of silicone gel implants

They closely resemble breast tissue and have a natural look and feel. They have fewer tendencies to ripple, in any way that could be seen or felt, than saline implants do. They also weigh a little less for each size than saline implants.

They come either round or teardrop-shaped, and with a smooth surface or a textured one. They can be inserted from the same incision locations as saline-filled implants. Those locations are:

• In the armpit (transaxiliary)
• Below the breast, in the crease (inframammary)
• Below the nipple, where the skin changes color (areolar)

Since the silicone implants come pre-filled, the incision must be slightly longer than for saline implants, but is still small and well hidden. For more information about the implant procedure, see the breast enlargement page.

The two companies whose silicone gel breast implants have been approved (because they’re the only two companies who have met all the FDA’s demands as to documentation and proof of safety), are Mentor Corp. and Allergan Corp. (formerly called Inamed Corp.), which are both in California.

The implants manufactured by Mentor Corporation are called MemoryGel™ implants and have been in use for nearly 20 years, according to the Mentor website.

MemoryGel™ implants feature a cohesive, gelatin-like substance that acts as a solid rather than a liquid. It holds together uniformly while still retaining the natural give of breast tissue. From: http://www.mentor4me.com/breast-augmentation/breast-implants.aspx

Allergan Corporation, the other manufacturer of the FDA’s approved silicone breast implants, offers its Inamed® silicone breast implants with strong confidence as to their safety and effectiveness:

Allergan has a global reputation of providing safe, effective and high quality breast options for over 25 years. Now, the FDA has evaluated and determined that INAMED® Silicone-Filled Breast Implants are safe for use in breast augmentation and reconstruction surgery. From: http://www.breastimplantstoday.com/silicone

Breast augmentation popular

Saline-filled implants have been effective and increasingly popular with American women. Now that we can choose either saline or silicone implants, breast augmentation is sure to become even more in demand. According to both the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society of Plastic Surgeons (ASPS), about 300,000 women opted to have breast augmentation during 2005. And further, almost 58,000 women had breast reconstruction. Many studies have shown that all types of breast enhancement bring psychological and physical benefits to those women who elect to have them done.

Breast Augmentation
Breast Lifts

If you would like to learn more about silicone gel breast implants, please call or email us. Dr. Placik offers initial consultations where he will listen to your concerns and desires, answer your questions, and suggest possibilities for helping you to reach your goals. Contact us today.

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