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.
Since patients frequently remove genital hair, the incision line should be placed as inconspicuous as possible. Prior to the onset of widespread hair removal, physicians traditionally placed the incisions in the mid-labium. However, those scars can be very visible with absence of hair, so each incision line should now be placed closer to an inner lip in a less noticeable location. Surgery is thus performed by removal of a crescent of skin from the inside of each outer labium. If fat needs to be removed, it is excised through this incision line. The skin is closed with sutures under the skin so that the scar is difficult to see.
The woman must be educated that reduction of majora may result in more prominence of the clitoral hood and labia minora. In unusual situations, majora reduction may later lead to minora and/or clitoral hood reduction.
It is very unusual to have a complication. Bleeding is rare unless massive fat removal is done. The patient can swell considerably postoperatively, but this starts to resolve within a week. Significant discomfort is unusual. The most common complications are inadequate reduction or asymmetry of skin or fat that may need to be revised in six months. Scars are rarely an issue if closure is performed as above. Persistent pain or sexual dysfunction should not occur.
The worse potential complication is excessive skin excision, which can lead to a gaping vaginal opening causing vaginal dryness, discomfort in clothes, and an aesthetic deformity.
No series of labia majora reduction has been published. However, the patients are extremely gratified and happy if their expectations are realistic.