REVISIONS, REDOS AND BOTCHED GENITAL PLASTIC SURGERY

​By Michael Goodman, MD
Copyright 2019. All rights reserved.

Sadly, it’s not rare that I encounter patients who’ve had a labiaplasty or vaginoplasty performed by another surgeon with less-than-satisfactory results, so much so that they wish to have the outcome revised, modified, “saved” or otherwise “redone.”

By far the wisest choice for a revision is the surgeon who did your original work (it’s certainly much more financially favorable)—so long as that surgeon is well-experienced and well-respected in their field. Not all results are ideal, and your surgeon—if they are reputable, experienced and secure in their talents—certainly desires for you to be satisfied. They should go out of their way, for little or no cost, to revise your results to your satisfaction, provided a minimum of 3-4 months (and usually 6 months) has passed from your original operation and healing is at 100%. Often it just takes a little “shave,” of a small edge or polyp, or removing a modest amount of tissue to achieve better symmetry.

Unfortunately, however, many unsuspecting women let relatively inexperienced gynecological surgeons operate on them with disastrous results. Poorly performed (or “botched”) procedures are usually done at the hands of gynecologists; most plastic surgeons will not do vulvovaginal plastic work unless they have been specifically trained in vulvovaginal aesthetic work, but many GYNs (even though they’re not specifically trained in vaginal tightening or aesthetic labiaplasty) think that just because they know the anatomy they can figure out on their own how to do a vulvovaginal procedure. In many cases, they remove far too much (or too little!) tissue and/or close with too-large-caliber, too-tight and poorly placed sutures, and frequently leave a hypertrophic clitoral hood untouched, which does not leave to an aesthetically pleasing result.

Different Types of Revisions & “Redos”

Reduction revisions (performed when not enough was taken off) and shaping revisions are relatively easy and successful—when performed by a well-experienced plastic or cosmetic gynecologic surgeon. (I’d recommend at least 100 cases before I would trust a surgeon with a patient’s major reconstructive revision.)
More difficult are situations where far too much was taken off. It is impossible to “put some back” or build new labia from nothing; however, if there is enough redundant tissue above in the clitoral hood area, a “flap” of hood skin may be brought down and anastomosed to the sides of the vaginal opening to fashion a rudimentary, aesthetic and functional labia. Additionally, a relatively few surgeons around the world are experimenting with medical grade silicone implants under the skin in areas of labial amputation.
This type of revision, as well as other complicated revisions, should only be performed by a well-experienced surgeon adept and experienced in performing plastic revision surgery… and this usually does not come cheap. Many surgeons charge more for a redo than a first-time labiaplasty, as redos are usually harder and more time-consuming (and fraught with failure) than the original surgery. For this reason, it is so important to choose the right surgeon in the first place; this is definitely not a time to skimp or to go with any doctor who “accepts insurance” or charges much less because they are just starting out. Such doctors are rarely equipped to properly perform your surgery, especially if your anatomy is challenging.

There are also times when the best course is not surgical at all, and the best outcome is found in working with hormonal (estrogen + testosterone) massage, sexual counseling therapy, non-invasive laser or RF work, implants or tissue transfer. 

Suture Material and the place of PRP (Platelet-Rich Plasma)
​
The choice of suture material is important, ant your surgeon would benefit from reading the operative report from your original surgeon, if (s)he is not performing your revision. Occasionally, a woman will “reject” certain types of suture, and it may be preferable to avoid this in your re-do. Ask your prospective surgeon about this. Experienced docs will understand what you are asking.

Platelet-rich plasma is derived from a process that separates serum and platelet fraction of your own blood, the fraction that promotes tissue growth and formation of new blood vessels (neovasculogenesis). While no evidence-based research is yet available in peer-review literature, knowledge of its role in tissue healing suggests that it may be helpful on promoting healing in difficult situations, and many revision surgeons use it in selected surgeries.

---