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Reply: Growing Body of Evidence Supports Safety of Female Genital Cosmetic Surgery

Placik, Otto J. M.D.

Plastic and Reconstructive Surgery: June 2016 - Volume 137 - Issue 6 - p 1056e–1057e
doi: 10.1097/PRS.0000000000002203

880 West Central Road, Suite 3100, Arlington Heights, Ill. 60005,

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I am honored to have Dr. Sisti, a surgeon who is well acquainted with labiaplasty and coauthor of a comprehensive review,1 comment on our investigation.2 He discusses two studies of male preferences regarding female genital appearance. These findings confirm the results of an earlier article we have published regarding cultural expectations for the female pudenda as reflected in the media and specifically in the archetypal men’s magazine, Playboy.3

Dr. Sisti similarly echoes the observations of others who also stress the aesthetic goals of labiaplasty as being the preeminent motivating factor for women seeking labiaplasty.4 It is clear that the popularity of the procedure is not limited to the United States; reports from experienced surgeons such as Triana and Robledo,5 Mayer,6 Gress,7 Oranges et al.,1 Veale et al.,8 Giraldo et al.,9 Felicia Yde,10 Choi and Kim,11 and others (e.g., from Colombia, Argentina, Germany, Italy, England, Spain, Brazil, and South Korea), indicate that this specialty is an international phenomenon and has wide appeal to a variety of differing cultures. Dr. Sisti’s commentary resonates with my impression that surgeons experienced in labiaplasty will testify that the vast majority of patients express a high degree of satisfaction that is equal to or exceeds nearly any other aesthetic procedure. Despite the demand and the safety of the operation as documented by the aforementioned physicians, there are many who question the practice; some have even labeled it misogyny.12 To this end, a 2008 interagency statement (published by the Office of the United Nations High Commissioner for Human Rights; the Joint United Nations Programme on HIV and AIDS; the United Nations Development Programme; the United Nations Economic Commission for Africa; the United Nations Educational, Scientific and Cultural Organization; the United Nations Population Fund; the United Nations High Commissioner for Refugees; the United Nations Children's Emergency Fund; the United Nations Development Fund for Women, and the World Health Organization) sponsored by the World Health Organization, considers genital surgery to “fall under the definition” of female genital mutilation.13 Critics commonly condemn the field by citing that the associated grooming habits (hairlessness) of individuals requesting these procedures indicates an underlying unhealthy desire to seek a prepubescent appearance; however, these cynics also fail to acknowledge the overall tendency and consistency of this practice with women seeking hair removal from other anatomical regions such as the face/lips, axillae, or legs.

I am confident that ongoing reports by investigators such as Dr. Sisti will corroborate the safety of female genital cosmetic procedures conducted by skilled practitioners and bring these into the mainstream. Similar to Dr. Sisti, I believe it should be in the skill set of plastic surgeons. It is my hope that, with time, it will eventually gain acceptance as a procedure that is not unlike breast reduction.14

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The author has no disclosure to report and no funding was received to assist in the creation of this communication.

otto J. Placik, M.D.

880 West Central Road, Suite 3100

Arlington Heights, Ill. 60005

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1. Oranges CM, Sisti A, Sisti G. Labia minora reduction techniques: A comprehensive literature review. Aesthet Surg J. 2015;35: 419–431.
2. Placik OJ, Arkins JP. A prospective evaluation of female external genitalia sensitivity to pressure following labia minora reduction and clitoral hood reduction. Plast Reconstr Surg. 2015;136:442e–452e.
3. Placik OJ, Arkins JP. Plastic surgery trends parallel Playboy magazine: The pudenda preoccupation. Aesthet Surg J. 2014;34:1083–1090.
4. Hunter JG. Labia minora, labia majora, and clitoral hood alteration: Experience-based recommendations. Aesthet Surg J. 2016;36:71–79.
5. Triana L, Robledo AM. Refreshing labioplasty techniques for plastic surgeons. Aesthetic Plast Surg. 2012;36:1078–1086.
6. Mayer HF. Vaginal labiaplasty: Current practices and a simplified classification system for labial protrusion. Plast Reconstr Surg. 2015;136:705e–706e.
7. Gress S. Composite reduction labiaplasty. Aesthetic Plast Surg. 2013;37:674–683.
8. Veale D, Naismith I, Eshkevari E, et al. Psychosexual outcome after labiaplasty: A prospective case-comparison study. Int Urogynecol J. 2014;25:831–839.
9. Giraldo F, González C, de Haro F. Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast Reconstr Surg. 2004;113:1820–1825.
10. Felicia Yde A. Labial surgery. Aesthet Surg J. 2007;27:322–328.
11. Choi HY, Kim KT. A new method for aesthetic reduction of labia minora (the deepithelialized reduction labioplasty). Plast Reconstr Surg. 2000;105:419–422.
12. Jeffreys S. Beauty and Misogyny: Harmful Cultural Practices in the West. 2014.New York: Routledge.
13. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Eliminating Female Genital Mutilation: An Interagency Statement. 2008. Geneva: World Health Organization; Available at: Accessed May 4, 2016.
14. Hunter JG. Commentary on: Labia minora reduction techniques: A comprehensive literature review. Aesthet Surg J. 2015;35:432–433.
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