Anatomy

Anatomy
The following photos are from a book, which my staff presented to me for my birthday, called Femalia by Joani Blank. They show a wide range of normal female genital anatomy. The pertinent points of interest, aside from the large variation in shapes and sizes, are as follows.
 

The outer lips or labia are called the labia majora and the inner lips or labia are called the labia minora and these lips often extend down to the lower part of the perineum and sometimes all the way to the anus. A portion of these lips can also extend up to the clitoral hood which is usually a double hood. It is most important to stay away from the clitoris unless of course your patient is requesting reduction of the clitoris which can sometimes occur when the patient has been taking steroids which has resulted in clitoral hypertrophy.

Other pertinent points of anatomy are the mons pubis which is Latin for “mountains of Venus” and the clitoris which is the embryonic equivalent of the male penis and is packed with 8000 nerve endings
which is twice the number of its male counterparts. This might explain the female's ability to have multiple orgasms. Theoretically, if there  is a great deal of tissue covering the clitoris, sexual stimulation of the clitoris could be blunted. Below the clitoris and between the labia minora one can find the urethral opening and below that the vagina opening.

Labiaplasty:

Labia minora reduction: Reduction of the inner lips or labia minora is the most commonly requested procedure in female aesthetic genital surgery. There are two commonly used procedures which consist of trimming the excess labial tissue along the edge of the labia minora which is often actually a “Y” shaped incision line as frequently the excess labia minora extend toward the clitoral hood. This procedure is  best for more complicated or extensive surgeries or in patients who have longer labia minora. For patients with shorter labia minora, there is another procedure which involves taking a V-shaped section out of the most prominent portion of the labia then suturing the incision closed. Both procedures are usually performed with absorbable sutures. Either general anesthesia, local anesthesia with sedation, or local anesthesia with topical anesthesia prior to injection can be used.

Labia majora reduction: Reduction of the outer lips or labia majora is less commonly requested but patients with this request often complain of an abnormal bulge in swimming suits or tight jeans due to overly large labia majora. Reduction of the labia majora can be performed using a wedge excision of the excess tissue with the incision along the length of the labia minora. Less commonly the enlarged labia majora can be reduced by suction lipectomy.

Labia majora enhancement: On occasion, the patient will request enhancement of the labia majora which can be accomplished with fat injection usually after removal of excess inner thigh fat and reinjection into the labia majora using a low pressure system such as the tumescent liposuction system.

Clitoral hood reduction: Reduction of the clitoral hood is usually performed for functional reasons with the goal to allow increased clitoral stimulation for sexual pleasure, or to improve the appearance of the genital area. It is a good idea to only reduce the outer hood and to do so in a fashion whereby scar contracture would not lead to problems near the clitoris. It is important for sexual functioning that the clitoris not be encumbered by thick or scarred tissue. It is also advisable to avoid scars close to the clitoris if possible.

Mons pubis reduction or liposuction: Reduction of the mons pubis is generally requested by patients who have massive weight reduction often after gastric bypass surgery. They have ptosis and excess tissue in this area which requires direct wedge excision usually in a transverse direction. For those without skin excess, liposuction of the mons pubis is effective. If the patient is undergoing an abdominoplasty, wedge resection of the fat pad through the lower abdominal incision is effective.