Youthful labia majora (outer lips) have fullness, but overabundant fat bulging can be congenital. Obesity also causes labia majora fat and skin enlargement. After pregnancy, weight loss, or aging, the majora can lose fat but have excess skin with wrinkling. This causes the majora to hang lower with more redundancy. Excessively protuberant or low-hanging labia majora can cause an unsightly bulge in clothes, often with a central crease from the vaginal opening. Thus, the protuberance can be from either an overly fatty, full majora or a fat deficient, stretched majora with excess skin, or a combination.
Women wish to recreate the youthful full labia majora. Labia majora can be reduced depending on the cause: excess fat or skin, or a combination of both. The woman is also evaluated for significant pubic descent and pubic fat, which could affect the approach for the majora surgery and results (see next section). Labia minora and labia majora surgery can be performed simultaneously with the minora performed first.