Labiaplasty operation by Natalia Novikova

What is labiaplasty?

Labiaplasty is the surgical correction of labia minora (small lips on the side of the genital area) or labia majora (large lips that usually cover small lips). Labiaplasty is only relatively recently available in Cape Town and Johannesburg.

What are the reasons for labiaplasty?

Some women simply do not like the look of their labia minora because they are too long or asymmetrical (one longer or bigger than the other one). In other cases, the lips can be uncomfortable during exercise or sexual intercourse. Occasionally, they may (rarely) be a cause of frequent infections, itchiness, and discharge.

Girls who are younger than 18 will be requested to see a psychologist before they can undergo the procedure. In some cases, I may request a psychological evaluation for women who older than 18. This is to ensure that the procedure is performed for right reasons, that expectations are met and that sound psychological support is provided.

How do I know whether my labia minora are normal?

All labia minora are normal. You can check to see all different shapes and types. They are all normal. However, if you are unhappy, bothered and distressed with the shape of your genitals it is advisable to see a specialist to get advice.

What are the different ways of performing Labiaplasty?

I perform labiaplasty procedures under local anaesthesia in the procedure room in Cape Town or Johannesburg. You will be instructed to apply a special anaesthetic cream no numb the skin over the area and take a tablet that will allow you to relax before the procedure. I will inject a local anaesthetic into the area to remove any discomfort during the procedure.

Labiaplasty can be done in many different ways. Common types of procedure are trim or curvilinear technique (or trim technique or “barbie” labiaplasty), V- labiaplasty or central wedge resection and de-epithelisation techniques.

Trim or curvilinear labiaplasty is when the edges of the labia minora are removed. This technique reduces the size of the labia minora. Because the end of the labia minora is excised, the area loses its natural look. Women who choose trim technique usually desire to have the darkened skin of labia minora to be removed. The lips will look pink with this technique.

V-wedge labiaplasty is done when the V-shape area is cut off is in the middle of the lips and they are re-shaped with sutures. Although the edges have a natural look as they are not cut off, there will be a tiny scar in the middle of the area which is not visible once you heal.

It’s common for the clitoris to look bigger once the lips are reduced in size because of its proportional size. In such cases (which is ninety per cent of labiaplasties in my practice) I perform the clitoral hood reduction at the time of labiaplasty.

At times women choose to remove excess skin of labia majora or big lips or have fat filling or hyalorunic acid fillers injected into big lips to imprve the look. All of these procedures can be performed at the time of labiaplasty.

I use diathermy or laser beam to perform labiaplasty. I use dissolvable sutures during labiaplasty that are hidden under the skin.

I choose the technique of labiaplasty based on patients preference on the final look they desire. We discuss in detail their anatomy, expectations, study before and after photos of my cases to decide on the technique of labaiaplasty on each of my patients.

How long does it take to recover from a labiaplasty?

Post labiplasty surgery you will be required to stay in the hospital until you are cleared to be discharged. You will likely feel sleepy and will need bed rest until the medication from the pre surgery care have worn off. You will be given something to eat and drink. You will also be given pain medication from the prescription provided by Dr Novikova. Usually you will be given anti-inflammatory Arcoxia 120 mg once a day and Stilpane every six hours. Targinact is a stronger type of pain killer (like morphine) which can be taken twice a day if your pain is still present after you take Stilpane. In some cases you will be given antibiotics. You will be allowed to go home only once you have passed urine.

At home, make use of an ice pack to help with swelling. We advise to use thin pad on your underwear. Ice pack is very helpful in the first 48 hours after the surgery and we advise you to use it at all time as it decreases / prevents swelling / bruising and helps with pain. Wear loose fitting clothes and cotton underwear during this stage of recovery and keep the area clean by taking salt baths in warm water. If passing urine stings you can pour clean water over your vagina whilst urinating. Do not rub the delicate healing tissue rather pat dry. Do not apply any creams, soaps or detergents.

In the first week after surgery you may use salt water (put a spoon of salt into sports bottle) to wash genital area after you pass urine or have bowel motion. It is important to keep area clean and dry.

It is important that you don’t become constipated especially as you won’t be as active as usual. You can take over the counter medication such us movical or use glycerol suppositories if required.

The sutures used are dissolvable and should take 6 weeks to dissolve. You should avoid strenuous exercise for 4 weeks and sexual intercourse for 6 weeks.

Dr Novikova usually sees her patients you postoperatively one to two weeks and six weeks after your operation for a check-up.

How long does the procedure take?

The procedure takes one to two hours.

When can I go home after the operation?

Once the anaesthetic wears off (usually one hour after the operation) you can go home.

What to expect after the operation?

  • Sitting and peeing during the first week after the operation may be uncomfortable.
  • Bruising, swelling and soreness are usual for up to two weeks, but these symptoms are expected to improve with each day.
  • Bloody or blood-stained discharge can be expected for 1-2 weeks.
  • The skin may be partially numb for several months after the operation. Permanent numbness is very rare.
  • Occasionally (very rarely in my experience), patients feel that the desired look is not achieved with the surgery and they want another operation.
  • The scarring is not visible once the area is fully healed as you will see from before and after photos

When to contact the doctor after the operation (danger signs)

  • If you have a fever, feel hot and cold.
  • If your pain does not go away with pain medications or is getting worse.
  • If you have unusual bleeding.
  • If there is unusual swelling or redness around the area of surgery.
  • If you have any concerns or questions you are not sure about or worry about

The chance of complications after this procedure is very small.

What care is required after the operation?

  • Avoid sitting immediately after the operation.
  • Apply an ice pack every 4-6 hours within the first 24 hours while awake. Place an ice-pack over a thin pad, NOT directly onto the skin
  • You will be prescribed non-inflammatory medications to take for 3 to 5 days after the operation. The medications will help with pain and decrease the swelling. The medications will not cause drowsiness.
  • Constipation might complicate recovery so laxatives may be needed.
  • You should avoid sexual intercourse for 6 weeks.
  • You should not use tampons for 6 weeks.
  • It is important to keep the area of surgery clean and dry. You will need to wash every time you have open bowels or pass urine.
  • You will be prescribed an antibacterial ointment to apply to the scar area twice a day for 2 weeks, and antibiotics to take for a week after surgery only if your risk of infection is high
  • You can perform light exercise one week after the surgery, and your regular exercise 2-4 weeks after surgery
  • I review my patients 1-2 weeks after surgery in 4 weeks after surgery

How much does labiaplasty cost in South Africa?

Visit the procedure fees page for the cost of the labiaplasty procedure.

Where to find labiaplasty treatment in South Africa?

I perform the labiaplasty procedure in cities in Cape Town and Johannesburg. In Cape Town, I operate in Cape Town Mediclinic in Gardens and in Johannesburg I operate from Intercare Day Hospital in Sandton,

What is Dr Novikova’s experience in performing labiaplasty?

I have performed many labiaplasties and is skilled in various techniques of the labiaplasty procedure. I have participated in workshops and meetings on aesthetic gynaecology and is certified by European Society of Aestethic Gynaecology. I am a pelvic surgeon and endoscopic (minimally invasive surgeon) with many years of experience in the field. Each labiaplasty is different as no one has the same anatomy and I adjust my technique based on patients desires, concerns and their anatomy. I will share before and after photographs during the consultation. My team which includes my practice nurse Angela and scrub nurse Wendy and myself are always available to answer your questions and provide pre-procedure and post-procedure support to make the recovery as easy as possible.


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Clitoral Hood Reduction

Clitoral hood reduction is an aesthetic procedure which is often performed in combination with a labiaplasty or other genital cosmetic procedures. The clitoral hood is the fold of skin around the clitoris. It is comparable to the foreskin for men. Clitoral hood reduction is limited to the removal of excess skin covering the clitoris. This operation does not involve any surgery on the clitoris itself, but only on the skin covering the area. It is an aesthetic procedure which is often performed in combination with a labiaplasty or other genital cosmetic procedures.

When is clitoral hood reduction performed?

This procedure is done mainly in combination with labiaplasty when there is excess skin over clitoris to improve cosmetic result. It is unlikely to have any functional effect. Occasionally patients may have improved clitoral sensation, but this is not a common outcome and should not be aimed for. Very rarely women request the procedure because of frequent infections and unpleasant smell because of excess skin in this area, which will be corrected with this surgery.

How is clitoral hood reduction performed?

It is usually performed in combination with labiaplasty with one of the two techniques depending on patients’ anatomy. Skin will be removed either parallel to the clitoris (on the sides) or on the top (half moon like a cut).
This procedure is generally performed under anaesthetic and rarely under local anaesthetic.

Where is the procedure performed?

Dr Novikova performs clitoral hood reduction in the operating theatre.

How long does the procedure take?

The procedure may take about 30 minutes on its’ own, but it is usually part of labiaplasty.
Patients can go home once they recover from anaesthetic

What are the potential complications?

As any surgical procedure, this operation carries anaesthetic risks as well as surgical risks. The chance of complication is small and it includes infection, bleeding, scarring and decreased sensation. For this reason, as with all gynaecological procedures we recommend, it is carried out by a fully qualified gynaecologist.

What is postoperative care?

Postoperative care is similar to labiaplasty. Avoid sexual intercourse for 4-6 weeks. Keep the area of surgery clean by washing with water in a shower. Dr Novikova prescribes antibiotics and antibacterial ointment to prevent infection and advises her patients to avoid heavy physical exercises, bathing, public pools and saunas for 4 weeks.

What operations are carried out on the clitoris itself?

In some separate cases, the following operations are carried out: clitoropexy to retract or suspend the clitoris, clitoral reduction to reduce the size, which is done in cases of various congenital diseases associated with a large clitoris, clitoral lysis of adhesions resulting from lichen sclerosus (white patchy skin).

What is Dr Novikova’s experience in performing the procedure?

Dr Novikova has performed many Clitoral Hood Reductions and is skilled in all aspects of gynaecological surgery. She is a highly experienced and qualified gynaecologist and has been trained and certified by the European Society of Aesthetic Gynaecology.


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Meet the only certified aesthetic gynaecologist in South Africa, Dr Natalia Novikova.

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