The Lady Bits: A Guide to Labiaplasty

Dr. Gallus (00:02):
You are listening to another episode of All the B's with me, Dr. G. and my scrub tech Bri. Hi, I'm Dr. Kat Gallus and you're listening to All the B's, the unfiltered plastic surgery podcast with me, Dr. G. and my scrub tech Bri. Hi Bri.

Bri (00:20):
Hey everyone.

Dr. Gallus (00:22):
How's it going, Bri?

Bri (00:24):
Good. Good. It's Wednesday, we wear pink.

Dr. Gallus (00:28):
Yep. Somehow we're matching today wearing pink and black vests.

Bri (00:32):
We're matching quite a bit actually.

Dr. Gallus (00:35):
We like to do this podcast, cuz it gives us a chance to share our love of the Daily Mail and also read you plastic surgery articles and react to 'em. So we'll start by trying to remember when we started going through the Daily Mail every day. Do you remember?

Bri (00:52):
I feel like there's a little backstory. So before she opened up her OR we were at another surgical office where we operated, and everyone was per diem. So she likes her staff now, that's why we don't sing anymore. But we used to to get through surgery, we'd like sing away and people would close the door and leave us and they said we sounded like dead cats. So then when we moved over here, I think she actually wanted people to stay in the OR. So we moved topics over to the Daily Mail and we just gossiped the whole day, which our male anesthesiologist really loves.

Dr. Gallus (01:32):
I know. I feel like it gives him conversation starters for his wife. So we are helping him enhance his relationship.

Bri (01:39):
He says he's gone home and gotten some points for all of his knowledge with his kids and wife.

Dr. Gallus (01:45):
And we haven't let anybody down by not singing anymore.

Bri (01:50):
No, nobody enjoyed that.

Dr. Gallus (01:52):
So today we're going to talk about one of the most popular surgeries that Bri and I do together, which is labiaplasty. Right? We do a lot of them.

Bri (02:00):
A lot of them.

Dr. Gallus (02:02):
But before we're going to do that, we're going to talk about plastic surgery articles from the Daily Mail. It's been a huge political week, which we're not going to discuss politics, but we can touch on some politically adjacent daily mail articles. So up first there was an exclusive plastic surgeon reveals $10,000 surgery Donald Trump would have to undergo to fix his bullet damaged ear.

Bri (02:33):
$10,000 for the tip of your ear? I mean.

Dr. Gallus (02:38):
I feel like they just pulled that number out of their hat, right?

Bri (02:43):
Yeah. I feel like though, as a man, they like scars and be like, oh yeah, this is that one time that I got shot in the top of my ear. I don't know if I'd paid $10,000 to get that fixed. That's a story.

Dr. Gallus (02:57):
Right. I mean, I feel like it's a badge of honor at this point. They did talk about how complicated it was to reconstruct that area of the ear. I think,

Bri (03:09):
How do you fix that?

Dr. Gallus (03:10):
Yeah. It's not commonly done for a glancing bullet wound, but the top of your ear is actually a popular place to get skin cancer, unfortunately, especially in men because it sticks up and it's in the sun. And so there is a wealth, there are chapters written about the different ways you can excise a defect. So in this case, take a chunk out of the ear and then close it and make it look as normal as possible. So if he wants to have it fixed, I don't think it will be a $10,000 procedure. It would be consider reconstructive, but you don't want to minimize the effort we have to go through to make something that looks abnormal normal. It just was a dramatic headline.

Bri (03:59):
And the bandage movement, what did we think of the ear bandage?

Dr. Gallus (04:04):
I mean, I agree the ear is difficult to bandage as you well know. When we do ear surgery, we usually hold that bandage in by wrapping around their head. And so I don't think any presidential candidate wants to walk around looking like a Q-tip. That's generally what you look like when we have that. And I make sure that people don't have to wear that for very long. So I tell them I will take it down in 24 hours and then we switch 'em out to a headband, kind of that John McEnroe, who I'm not sure you know who that is, style tennis sweat band. Also still not very distinguished looking, but it's an option. So I mean I think he's no worse for the wear with the ear injury or the ear pillow.

Bri (04:51):
I like the ear pillow.

Dr. Gallus (04:53):
I do too. Story number two, that one's from July 19th was all about plastic surgery being the star of the show for the RNC from quote, unquote blow up doll Matt Gaetz to Kimberly Guilfoyle. I dunno how to say her last name and I probably should, but that's okay. Anyway, I feel like the star of the show or Matt Gaetz's eyebrows, honestly, that was.

Bri (05:19):
Let's talk about Matt's forehead.

Dr. Gallus (05:21):
Yeah, what's going on there, Bri, because you,

Bri (05:27):
I don't have words, but it looks like there was a lot of Botox placed.

Dr. Gallus (05:35):
Right, in the wrong places.

Bri (05:38):
Definitely giving the Spock though.

Dr. Gallus (05:41):
Yeah. So yeah, he does definitely have a Spock eyebrow going on, which is either early in his Botox journey.

Bri (05:51):
We love Botox. Don't get us wrong.

Dr. Gallus (05:54):
It hasn't all quite kicked in yet, or just Misplacement where they paralyzed the center of his forehead, but not all the way out to the lateral eyebrows, which means the lateral eyebrows can raise and the rest of it doesn't, giving you that really weird Spock look. And I feel like the no makeup makeup look is not working for him here either because he looks like he's got a ton of makeup on.

Bri (06:21):
I was going to say his skin is glowing.

Dr. Gallus (06:26):
I mean he's ready for the Bridgeton season three when they all had an insane amount of highlighter for somebody that lived in the 1800's or whenever that's supposed to be. Yeah, it's crazy. So I mean we often see kind of these Botox mishaps on the red carpet, but it was a little comical to see Matt Gaetz, as somebody comically said, embracing his gender affirming care. And I don't even know if I have anything to say about Kimberly here. It just looks, I feel like

Bri (07:02):
See the lips.

Dr. Gallus (07:03):
I know unfortunately when they compare women to something that's a decade or two before them, it's hard to make that comparison. People are aging, but I would say there's just things that you can check off the box that make you look older faster. And in her case, maybe a little bit too much lip filler in conjunction with the rest of her face. The dark eyeliner all the way around the eyes, the heavy hair extensions.

Bri (07:35):
I mean, she's so naturally beautiful and I love lip filler.

Dr. Gallus (07:39):
I know. But again, please do not misinterpret this as a diss on lip filler or Botox or any facial enhancements. But yeah, the idea is to enhance your natural beauty and not everybody try to graduate to looking like a version of the Kardashians. It just doesn't come off.

Bri (07:59):
Too much.

Dr. Gallus (07:59):
Yeah, it doesn't come off well. Well, okay, so that was some daily mail plastic surgery slash political adjacent stuff. Let's move on to labiaplasty and of course the Daily Mail has a couple articles to talk about that as well. There is a story from July 8th, which we all thought was a little confusing, but Byron Bay Influencer reveals why she's spending an eye watering sum to spruce up her private parts with stars like Kim Kardashian fueling the trend. I feel like we might need to have how you can have a swear jar. We could have a jar where every time we say Kim Kardashian, we drop a quarter in.

Bri (08:42):
It comes up a lot in this office. Byron Bay. So where's Byron Bay?

Dr. Gallus (08:48):
Apparently that's in Australia, which is a huge Daily Mail focus and it's in a beach similar to San Diego. I believe our friend here is a adult industry star. So I would imagine that it is the one category of work that you might be super concerned with the appearance of your labia, right?

Bri (09:12):
Especially if it's the main star.

Dr. Gallus (09:15):
Right? Your money maker literally.

Bri (09:17):
So a designer vagina. So in an eye watering amount in Australia, what does that compare to you think here per se?

Dr. Gallus (09:28):
Yeah, it's hard to say what that would be. I think the variance and what a labiaplasty costs is, I mean as we know it averages anywhere from $5,000 to maybe $8,000 in our local area. Although we've had patients that have come down from Beverly Hills that have been quoted 12 to $15,000. So those are Beverly Hill prices and people feel miffed if they don't pay those kind of prices there. And it's probably a little bit cheaper in the middle of the country, but I think it's her way of saying she'll pay whatever it takes.

Bri (10:09):
To make it look pretty.

Dr. Gallus (10:11):
That's right, yes. It's that important to her. So I think though the article was kind of a bait and switch because it doesn't claim that Kim Kardashian has had a labiaplasty. It says that her trend of wearing tight fitting, revealing clothing.

Bri (10:29):
The leggings.

Dr. Gallus (10:30):
Yes, the leggings, the epidemic of leggings has

Bri (10:34):
It is. And then once she made SKIMS, it just was like, I mean I own half their collection.

Dr. Gallus (10:42):
So although, doesn't she have SKIMS a bra that has nipples in it already.

Bri (10:48):
Yes. And speaking of, I remember when that whole, the Khloe Kardashian, she really put notice on the camel toe trend. Do we remember that? And then there was the fake camel toe and you can have an insert to have a larger camel toe.

Dr. Gallus (11:04):
Yes. So that would be the labia majora. And so that could be, at least the procedure did not super duper catch on, but that's puffing up the labia majora, so adding fat or filler. So that's why, I mean I don't think Kim would think twice about it if that was something that she thought she needed at all. Oh yes,

Bri (11:28):
The nipple bra.

Dr. Gallus (11:28):
The nipple bra. I feel like nipples, I mean we can have a whole podcast about that.

Bri (11:34):
Free the nipple

Dr. Gallus (11:36):
For sure. Women will go through great lengths to hide their nipples and some women will go through great lengths for everyone to know that they have nipples. And I think most of us are somewhere in between. So I think, like I said in Kim's clothing, if she needed a modification to make her more comfortable in that clothing, I don't think she would just fix it. And I think that's a lot of times why patients choose labiaplasty because of the legging phenomenon. I almost feel like, I remember when leggings first started to become popular and there was a whole uproar. Leggings aren't pants, leggings aren't pants. And then we moved past it.

Bri (12:21):
I don't even know what pants are nowadays.

Dr. Gallus (12:23):
Yeah, now we went from leggings to skinny jeans and now we're getting back into wide volume pants. So I don't know that, I mean people wear leggings still, but I don't know that they're mandatory. I don't know. What do you think?

Bri (12:40):
I feel like leggings are a lot more popular and I feel like with a lot of patients that we've seen recently, the discomfort with leggings is a huge thing. Working out, basically just wearing anything tight. It's harder these days because everything is so tight. We're definitely moving into the baggy era, baggy pants.

Dr. Gallus (13:02):
Right. But I do think, yeah, super short shorts aren't going away and leggings for working out is definitely here to stay. And if you're not wearing leggings, maybe it's hot outside and you're doing an outdoor sport, you wear those hotty hot shorts by Lululemon, I mean those shorts are short. Or short, tight shorts, kind of like those volleyball shorts. It's hard to get away from it. And then in San Diego, bikinis are everywhere. I just got back from Hawaii with my teenagers and there is not a lot left to the imagination in the currently trending bikinis being worn. So yeah, there's no place to hide, I guess at this point. If you're a woman.

Bri (13:47):
Nope.

Dr. Gallus (13:47):
Anything you might be uncomfortable with is

Bri (13:53):
It's out there.

Dr. Gallus (13:54):
Out there.

Bri (13:55):
And what are some of the other reasons people consider having a labiaplasty?

Dr. Gallus (13:59):
So I think we've touched on the major ones, but having that excess tissue there can get in the way of wearing tight clothing or bikinis. And then if you're super active, because I have operated on some college athletes, having that extra tissue there can chafe and get in the way of activities. Anything from running, biking, I had a soccer player once.

Bri (14:23):
Especially surfers in San Diego. That's been a big one.

Dr. Gallus (14:25):
Yeah, the problem with surfers is you have to stay out of the water postoperatively. So the couple of surfers I had, even though you let people know that upfront, they're like, okay, now can I get in the water? And they do tend to choose their surgery in the wintertime. So then I'm like, why would you even want to get in the water? It's freezing right now, but if you're a surfer, it doesn't matter. You just put on an extra thick wetsuit and you go out there. It's just, it's not my jam. I like things hot. I do not want to get in cold water. So I would say those are the major two reasons. And then straight appearance, people are uncomfortable or insecure with how their labia looks. And even though we know that no matter what it looks like, it's all a variation of normal, it's a personal preference, you don't like the way it looks and you want it removed.

(15:15):
And then discomfort with other things like intercourse can be painful if the labia is protruding and in the way and then a history of childbirth with some sort of trauma or something going on there, that can also create a problem. And I would say the last one, not as common, but when it does happen is asymmetry. So everybody has a tiny degree of asymmetry, but in some patients one side is much larger than the other. And I tell them, and what can happen is that area is more prone to pulling and tugging and progressively gets longer. And so the problem gets worse, not better with time. And that's a fairly simple procedure to address that and just fix the one side that's bothering you. And in the way, I think we had another story to cover from the Daily Mail, intimate confessions by so many women like me are having surgery in a very private area. And while I'll never tell my partner, that was the article by anonymous. So staying anonymous about it, which I think is one of the reasons that labiaplasty is a little bit hard to talk about because nobody tells you that they've had it. Right?

Bri (16:24):
Right. I would not go volunteering that information.

Dr. Gallus (16:29):
I think I had a patient who came and told me that the only reason she had it done is because somebody told her that they had had it done. And she was like, you did? I would've never noticed. And I was like, why? If you have the surgery, there really is no way to know that you had surgery. The incision, the scarring is minimal, invisible, so you can absolutely have the surgery and once you're healed no one will notice. We also had that other patient who was kind of peeved when her husband didn't notice she had the surgery.

Bri (17:02):
Yes, I was going to say.

Dr. Gallus (17:05):
Sorry.

Bri (17:05):
What is the likelihood that somebody's partner will not find out?

Dr. Gallus (17:11):
If you're able to stay

Bri (17:13):
Depends I guess on the relationship. But

Dr. Gallus (17:15):
Yeah, I think if you could hide it for a significant amount of time, maybe two months, they might not notice. I really think guys are oblivious to a lot. So I know this because I've had patients that are concerned about filler in their cheeks and Botox and their husband's noticing. And my general rule of thumb is if you don't say anything, they're not going to notice and they tend not to.

Bri (17:41):
I did have, way before I started working with you, I worked with one surgeon and there was this lady and she had an entire facelift bandaged, like a Q-tip. She's like when her husband was picking her up, she's like, you can't let him know. And I was like, she just said she was having a small, she said she was having something on her earlobe fixed. And I was like, oh, he's going to know. How are you trying to keep this a secret?

Dr. Gallus (18:07):
Yeah, everyone tries. Not everyone's successful, but I do think, for example, if you're having this procedure and you want to keep it private, you can tell anybody that you're just having a GYN procedure or if you want to get more in depth, say you're having a cyst removed or something, and then people tap out and don't want to know anymore. So I think it's easy to not disclose it. But I think in this article, I think she goes through why she decided to keep it private and what her recovery was like and why not to say anything. She just really thought that it was kind of impairing her own self image. And if you fixate on something like that and then you try to compare yourself to others, then it's something that can be easily corrected. I do think she quotes Gemma Collins as sharing details of her tightening and rejuvenation period. Have you ever heard of her Bri?

Bri (19:07):
No.

Dr. Gallus (19:08):
Okay. She's just another B-list celebrity who does, she's British and she does a podcast and so I had no idea that she had one. But yeah, sometimes it just takes somebody talking about it, right?

Bri (19:19):
It's a lot different than having a breast aug and sharing that versus having a labiaplasty for some reason it seems,

Dr. Gallus (19:26):
Oh yeah, see, so Gemma Collins opens up, she's talked about it on an episode of Everything I Know About Me. So I think whatever is your motivation to make you feel better is motivation enough.

Bri (19:43):
So I have a few more questions about, I don't want to miss anything here. Why do you think women don't reach out for help with this more often?

Dr. Gallus (19:53):
I think because they don't know it's an option. They can't exactly identify what they don't like about it and then they think about it. But maybe you're not going to do any research. You don't know anybody that said they had it done. Even though you might know people that's had a labiaplasty, but they just don't talk about it. It's hard for us to, I mean, it's not hard for us to talk about it. We can talk about labiaplasty all day long, but

Bri (20:18):
It is very intimidating. If I didn't know and I didn't work here, it would probably be an intimidating thing to talk about.

Dr. Gallus (20:25):
Yeah, I think it's similar to if you're around that it's not a big deal to us to discuss it. Sort of like if you're a child of an OB GYN and you go to school saying vagina right away, and you're like, well, that's what they talk about at the dinner table. So I think, yeah, it's not spoken about. And for plastic surgeons, we do a lot of our advertising and promotion and education is all very photos based. Right? There's loves to go on, everybody loves to go on Instagram and see the tummy tuck reveal or go on TikTok and see before and afters or what liposuction looks like behind the scenes. But you can't really do that for labiaplasty. And so there's less talk about it in that format as well, there's less visual. I know I have this one video of where I'm operating on a artificial flower because that was the easiest way to demonstrate what's happening during a labiaplasty.

(21:26):
And it's a very popular video and it's a safe way of talking about it and advertising it, not advertising, but letting people know that, hey, this is out here. So it's a little bit harder to get access to the information. And then as with anything, there's always these horror stories and people who are just like, if you're pregnant, the last thing you want to talk to are the people in the waiting room. Everybody who's ever been pregnant is going to tell you their worst horror story about being pregnant. And you get kind of a biased view of what things are going to be like. So we have had some, I mean, I would say that's for any procedure. I've had patients who start googling stuff and looking at things on YouTube the night before their surgery, and I always tell 'em, that's a terrible idea.

Bri (22:11):
Google is not your friend. Lemme tell you.

Dr. Gallus (22:14):
No. So yeah, I think if you don't make it, if you're not approachable, they're not going to ask about it. And if you don't know that there's a solution, you won't ask about it. It's very similar to cellulite and I certainly don't ask patients about it if they're not coming in for asking that again, because it's a very personal choice. So when I see patients for other procedures, I'm not like, oh, okay, and while you're under, have you considered a labiaplasty? That would be completely.

Bri (22:42):
I was just taking a look at it and thought that I could help you out here.

Dr. Gallus (22:46):
So not appropriate, because like I said, it's all variations of normal. So it really is boils down to personal preference.

Bri (22:55):
So what makes a plastic surgeon qualified to do a labiaplasty versus a patient going to see a gynecologist, a urologist or urogynecologist?

Dr. Gallus (23:04):
Oftentimes, although those surgeons work with women like a gynecologist, they don't have training in labiaplasty. So plastic surgeons sort of pioneered the surgery. We talk about it at conferences. There's tons of educational resources for plastic surgeons about the procedure. There's a couple different ways of doing it, whereas oftentimes when you go see an OB GYN, they will tell you it's a variation of normal and not to worry about it. Even I've taken care of patients who had tears in their labia and the GYN said not to worry about it. And I'm like, well, I mean it seems like that would've been a slam dunk to correct. But since it's not really in their wheelhouse, they don't offer it, they don't talk about it. So I think that makes us more qualified to address it.

Bri (23:55):
And is there any reason that you would send a patient to go see a specialist for this procedure?

Dr. Gallus (24:00):
For a straightforward labiaplasty, no. I've seen there's a category, a very, very, very small category of women who've had genital mutilation performed elsewhere, usually out of the country. That's somebody who needs to see a specialist for reconstructive purposes. I mean, we do our consults together, I always start the consult with an exam because I don't want to have a whole conversation about labiaplasty if the patient's understanding of anatomy is different and they're talking about something completely different. So I've had a few patients that came in with fairly normal anatomy and their concern was more deep seated or psychological and we've referred them back out. Like, this is not going to solve issues with orgasm or pain with sex or any of those things. And then the labia itself is the outer area of the vagina. I don't personally do vaginal tightening that I would refer to an OB GYN that does that. And so if a patient comes in with concerns about that, then we usually refer them out for that procedure or do it as a combined case too.

Bri (25:12):
And touching on that, I know the designer vagina is such a trend and I see a lot of patients coming in and they ask you, they say take absolutely everything. Why would that not be a good idea to take everything, all of the tissue?

Dr. Gallus (25:27):
Right. So we have to have that conversation about what's normal. Everything in our body, maybe save the appendix has a purpose. So the inter labia are there to provide coverage for the vaginal opening. And so that keeps things moisture, just kind of homeostasis in that area. So you can't not have labia minora, we are not barbie dolls. And so you need at least a centimeter of tissue. And I explain that, you need this minimal amount of tissue there, which is very small amount and is not noticeable, but that needs to be there. I think where there's more variation is above that, where the clitoral hood is, there is some extra tissue sometimes and you want to make sure that the labiaplasty is balancing that. So you don't want to do a labia minora resection, not address the clitoral hood and then have the patient be unhappy about a new problem, like now this is more obvious. So that's why we take a look at everything I tell them, it's like snowflakes, everybody's completely different. And so we want to tailor the procedure to the patient's preferences and point things out that can't be changed. And so we kind of the Barbie vagina where the majora come and meet in the middle with no labia or clitoral hood visible is only a percentage of the population. And for some people there's that commissure where the clitoral hood is there, even if it's minimal and there's that little space, I can't make that go away. That is your anatomy. And so I think you see me explain it all, I've marked it out for patients if they're really unclear in the consult and then at the time of the surgery I will do the markings and then have the patient look again. So we're all clear on what is being removed, what can be removed and what the expectation is.

Bri (27:24):
Is there anything that would make somebody not a good candidate to have a labiaplasty?

Dr. Gallus (27:29):
Somebody who's smoking if you're putting the cigarette out as you're walking in the door, like no, kick rocks. No. So smoking, I always feel bad bad mouthing smoking, I don't know why. Smoking sucks, there's no good reason for it. But nicotine, we know impairs wound healing. So whether you're chewing it or dipping it or smoking it or e-cigarette or vaping or whatever, just no nicotine period. Because nothing inhibits wound healing like that. And so the things that I think in plastic surgery, they're most prone to smoking related injuries are labia and anything with the nipple. So just no, I feel like the thing that catches people in San Diego and it's super active is the ability to give yourself time to take a little bit of time off, right?

Bri (28:25):
Yes. It's the most common. We can't do Pilates today? What do you mean?

Dr. Gallus (28:30):
I mean it's two weeks and I get it. I like to work out every day. I'm with you, but you need to take three days off. You need to take two weeks off from regular exercise. And those things are kind of non-negotiable. And so we've had people get real big eyes and be like, oh, Uh-uh can't do it. I mean it's such a small amount of time relative to a life. It's a one-time surgery, lifetime of not needing that again. But I get it when I do a Brazilian blowout, it's three days of not getting sweaty and I'm climbing the walls.

Bri (29:08):
But do you actually follow that?

Dr. Gallus (29:09):
I do because it won't work otherwise. If I think I can skirt the rules, I will. But yeah, with that one I do because otherwise it doesn't work. You can't get your hair wet. It's a bummer. So yeah, so I completely sympathize, but we kind of like it when people come in and are like, oh, I never work out. We're like, yes, yes.

Bri (29:30):
You could take a couple days. What would happen if they didn't take a couple days? They started moving around a couple days after surgery.

Dr. Gallus (29:38):
That's a great question. So again, just like the smoking, I don't offer these cautionary tales because I'm trying to be mean. It's because the risk is that you'll get a fluid collection or have a bleed. So you can have a postoperative bleed and have a fluid collection of blood, which would be a hematoma. And if that doesn't get recognized, it can lead to increased swelling, it can lead to wound breakdown and then the whole process of healing will take a lot longer. So it's just a little upfront sacrifice.

Bri (30:10):
Okay. Can you explain, let's explain the surgery. What happens during surgery?

Dr. Gallus (30:16):
Okay, so when the patient comes in, Bri usually applies topical numbing cream after she takes photos and then we let that sit for about 10 minutes. This topical numbing cream's very effective. It's pretty strong, it's not, the stuff you get at CVS takes about 10 minutes. We use the same numbing cream, topical formulation for numbing the face when we do lasers and whatnot. So we've all had the sensation of not being able to feel our face. We know it works. And then after that's been in place for about 10 minutes, I go in, wipe off the numbing cream, mark out the areas that we're going to resect, and then I show the patient that and then I inject with local anesthetic. And most of the time the patients don't even feel that local anesthetic going in. So I'm injecting right into the labia with the local anesthetic.

(31:06):
That's a lidocaine, lidocaine marking mix. And then we let that sit for 10 minutes, cuz it takes some time. We don't want to start too soon. And then as you know, you come in and prep the area and then I get started. We tend to do this with the surgery, I do it with a scalpel and then use Bovie cautery, which is just a form of cautery to, it's an energy used to coagulate any bleeding or blood vessels. We've been asked about laser labiaplasty. That is usually when you're using a laser as your cautery device, which we have, it's just not as effective as a regular cautery. And so I think it's a little gimmicky and that's why I just use standard cautery. So after I resect the tissue, then I end up suturing the two sides of the labia together. They're like leaves. And I do that with absorbable sutures. So there's two layers of absorbable suture that are dissolvable that you can't see, and one outer layer that is absorbable and dissolvable that you can see. And that is usually gone by the time you see me at one week post-op. But as you mentioned, can be itchy. That's a normal process with healing anywhere, but especially annoying when it's your labia.

Bri (32:21):
And a lot of people lately have been thinking they have a yeast infection,

Dr. Gallus (32:26):
Which is

Bri (32:27):
But with a different itchiness.

Dr. Gallus (32:29):
So it is a potential problem using minimal antibiotics, cuz you don't need that many, so just the day of, limits the yeast infection potential after surgery. And then I do prescribe everybody Diflucan, aka, fluconazole. It's that oral medication you can take if you get a yeast infection, but it's usually itchiness combined with discharge. Patients that we know get yeast infections frequently, I start them on Diflucan before surgery. But you're right, lately we've had a handful of patients who are unable to separate normal itchy with itchy yeast infection. So they take the Diflucan and then it doesn't really get better, but there's no harm in taking the one Diflucan. So we learn from those patients and we just start advocating, Hey, if you take the Diflucan, it doesn't feel like it's getting better, you can try hydrocortisone and feel like we just have a long list of things that we go over now with everybody. So cover all the bases.

Bri (33:30):
And we added some after, aftercare, dermoplast that helps with itchiness, right? A little bit some stuff, and some numbing cream.

Dr. Gallus (33:37):
Yes, with some numbing cream. Because again, I think we also had, when we do, a lot of these things tend to come in three, but I think the third patient who went home and then had a lot of pain, I feel like was younger and was skipping out the door because it was so easy and she didn't feel anything. And then an hour later she called back and was like, wait, what this hurts.

Bri (34:03):
We're like, yeah. She's like, did I just have surgery?

Dr. Gallus (34:05):
I know. I was like, yeah, we know it's coming. So I do try to make that process as smooth as possible for people. I do warn patients, but it's a little like liposuction. You tell people it's going to hurt and they're like, yeah, yeah, it's liposuction. And then they're like, oh my god, that really hurt.

Bri (34:22):
You're like, I feel like your husband had a great way of explaining it. What was like, why do people think that not having a rod shoved in between your skin would not hurt.

Dr. Gallus (34:31):
That's right. Repeatedly. I dunno. Nobody thinks about it that way.

Bri (34:36):
No.

Dr. Gallus (34:37):
Yeah. So liposuction is full contact surgery and labiaplasty is too. So even though we do everything we can to make it as comfortable for you, we know at some point that numbing is going to wear off. We have patients put ice, we give them an ice pack and a pad and there hopefully they brought underwear. We warn them about that. Please bring underwear.

Bri (34:57):
Not a thong.

Dr. Gallus (34:57):
Not at thong. And then you go home with that ice pack and then the additional injection of numbing medication gets you home, gets you taking that first pain pill, gets you settled, change out your ice pack so that hopefully it's not a big drop off in the numbing wear off.

Bri (35:16):
Side note, pick up your pain meds.

Dr. Gallus (35:19):
Oh yeah, I know, there's no downside to picking up your pain medication.

Bri (35:23):
Just in case. Just in case. It's better to have them than to not have them and need 'em and then be behind your pain.

Dr. Gallus (35:32):
I know. And again, people are like, oh no, no, don't prescribe me that. I won't need it. Just take it. And then you have it there to ward off evil spirits if you need it.

Bri (35:40):
Exactly.

Dr. Gallus (35:41):
Because at two o'clock in the morning when you decide you need it, it's going to be terrible to run out to a 24 hour pharmacy and get it.

Bri (35:49):
Exactly. What kind of anesthetic is used during this procedure?

Dr. Gallus (35:54):
So I mean you could do the procedure under general anesthesia if you wanted to, but it would be extreme overkill and I think not worth the risk or the expense for that matter. I will do the labiaplasty procedure under general anesthesia if a patient's doing something else. We've done that in conjunction with those patients heal super fast because whatever other surgery they're having basically means that they have to take it easy for those first few days. But yes, generally it's the local anesthetic. So we offer an MKO, the mommy knockout pill, right?

Bri (36:27):
Couple of margaritas.

Dr. Gallus (36:28):
Yes. These little margaritas, sublingual pills that you can take. It has Midazolam, also known as versed, ketamine, which has potentially a bad wrap thanks to Matthew Perry's demise, but

Bri (36:42):
It's not Matthew Perry dose.

Dr. Gallus (36:43):
Yeah, very small dose, and Zofran. And so it really is having a couple margaritas, it makes you a little woozy relaxed. You can take that. Certainly we don't mind, but if you do take that, you need a designated driver to get you home. And so more than half of our patients choose not to take it. They just want to drive themselves home and not have to talk to people about this procedure. So if you don't take that, we do have pronox available,

Bri (37:13):
But most people don't use it.

Dr. Gallus (37:15):
We haven't had anyone use it. Once you get going and you realize it's not going to hurt, you don't need the pronox. But just like the pain meds, we'll have it in the room and it just sits there to ward off evil spirits. So it's not an issue. And then the topical numbing cream, like I said, it's not the stuff, it's not Emla that you get at CVS. It's compounded. It's 23% lidocaine, 7% tetricaine or the reverse of that, I can't remember, but it's strong. It's good.

Bri (37:41):
I've had it all over my body.

Dr. Gallus (37:44):
That's right. I know. It's crazy because you'll do something for your face and then an hour later your face will still be numb, so. So that works very well. And then standard lidocaine and Marcaine. Lidocaine is fast acting, short acting, so it kicks in really fast and then goes away pretty fast. And then Marcaine is a little slower to onset but last longer. And that's the same one that I use at the end of the case to make sure that they have a little bit of pain relief moving forward to get them home and settled. So that's about it. I mean I feel like the MKOs make a difference if people are nervous or anxious about it. And most everybody else is good with local. And then because you're awake, you get to chat with us. It's like

Bri (38:29):
You get to hear all of our gossip.

Dr. Gallus (38:30):
We discuss anything and everything. Some of our patients are like our old center and they put in AirPods and tune us out.

Bri (38:38):
Some read a book,

Dr. Gallus (38:41):
Somebody watched Real Housewives or, yeah she was watching Real Housewives, right?

Bri (38:46):
Yeah.

Dr. Gallus (38:46):
Some people listen to music or they just chitchat with us during the procedure. Sometimes when patients do take the MKOs that get sleepy and they take a little nap and then it is a little boring for us because we can't chitchat. We're trying to let them sleep. And then I would say one of the more boring cases was the patient whose sister, so the patient didn't speak English, so her sister was our translator.

Bri (39:11):
Couldn't say very much.

Dr. Gallus (39:13):
Yes. So they chit chatted the whole time in another language.

Bri (39:17):
I was trying to text everything out to her and all her questions during the procedure on the phone.

Dr. Gallus (39:23):
Oh, that's somebody else. Yeah, we bridge language barriers all the time, I guess.

Bri (39:28):
Yes.

Dr. Gallus (39:28):
Labiaplasty.

Bri (39:28):
I know.

Dr. Gallus (39:30):
It's easy. We do having the patients interact with us. It's fun. We had somebody who traveled from out of state, we've had people try to convince Bri to move to Montana.

Bri (39:41):
I almost did. I was this close to Yellow Stoning it up and then I found out it snows.

Dr. Gallus (39:49):
Yeah, I felt like that should have been the lead.

Bri (39:53):
This should have led with that for sure.

Dr. Gallus (39:56):
It snows and it's freaking cold. Yeah, so I think that's kind of the anesthetic angle of things we like to think we're entertaining. Whether you have the MKO melt on board or not.

Bri (40:09):
I think we are speaking from personal experience, I think we're hilarious. But touching on what you said earlier, so you can combine a labiaplasty with other procedures.

Dr. Gallus (40:22):
Yeah, we can do it with a breast procedure, tummy tuck, liposuction, kind of any procedure. I would say the one that influences it's not, you can definitely do it and I do it together, cuz sometimes people want that upper area, the super pubic area liposuctioned, but if you do liposuction of the torso anywhere and labiaplasty, liposuction of the torso area because you're in compression is going to leave the lady bits swollen afterwards. And so you've already operated on that area, so things are swollen. And then I've added liposuction in the surrounding areas so you get a little bit more swollen. But it goes down within that three to five day range you normally would expect.

Bri (41:04):
And I know you have a couple different techniques to performing a labiaplasty, and I feel like this has been a very commonly asked question, but what technique do you prefer?

Dr. Gallus (41:13):
I prefer the trim technique. So the two main techniques used are trim and wedge. And the trim is sort of following along the natural curvature of the labia. And that I think gives the nicest result and gives a nice symmetry. It removes in patients that have the extra skin. It can sometimes be more pigmented, darker or more corrugated, so more wrinkly. And so it takes all of that out and leaves them with the more ideal tissue behind. And I think it heals consistently and just very well with no evidence of an incision. The wedge procedure is taking out kind of a slice of pizza from the center and then closing it. And the plus side is that you're not operating on the edge of the labia, but that center piece is prone to breakdown if not done carefully. And there's some variability in the blood supply that you have to be cognizant of, at least you need to at least be aware of that when you're doing that procedure. And if there's a wound breakdown, it's kind of a pain because then you have a hole basically in the labia. So I'm not as big of a fan of the wedge procedure and I think it's a little harder to make things as small as possible, which is generally what my patients are requesting.

Bri (42:35):
And does any of that affect sensation?

Dr. Gallus (42:39):
No. So that gets back to the itching. Neither procedure will affect sensation. I think if there's any risk to sensation, it would be with related to that clitoral hood balancing surgery that I mentioned. But again, if that's done properly, which you're literally just taking the skin off, then we know the nerves travel deep to that area and are not affected. So everything heals just fine. And the two sensations that come back generally with healing are sharp shooting pains and itching and for whatever reason with this procedure, itching is, you know things are coming back, and that there's not going to be any numbness or change in sensation, cuz you're going to itch.

Bri (43:18):
Yeah. I feel like lately it's been a sensitive question to ask and then nobody wants to ask it. And then I get an email and I'm like, will it affect the sensation during intercourse? And I'm like, we're all girls. You can ask.

Dr. Gallus (43:29):
Right. I know. I feel like it's funny what people are willing to ask and then what they aren't willing to ask and then ask you behind the scenes. And we do try to head all of that off and then bring it up. It won't change sensation during intercourse. So in that way I'm not going to guarantee it's going to enhance anything either. So that's a conversation you can have.

Bri (43:54):
With your partner if you tell them.

Dr. Gallus (43:56):
Right, they might not notice. The other question we get is if I'm on my period either for the consultation or for the actual procedure and we're like

Bri (44:07):
Everyone starts it the day of their procedure. It's just the way it works. Patients are like, I'm not supposed to start for a week, but for some reason everyone always starts it the day of their procedure.

Dr. Gallus (44:18):
So if we had to work around people's periods, we would never get anything done, that's what we say. So it doesn't matter. You just need to let us know. So I don't think you're just suddenly spontaneously bleeding.

Bri (44:31):
That did happen. She was like, oh, you're bleeding. She's like, oh no, I'm just on my period.

Dr. Gallus (44:34):
That's right. Yes. That was my one post-op patient didn't mention it, and I think she was two weeks out, so I wasn't expecting any blood and I had this look on my face and she's like, oh, I had my period. I'm like, oh, thank God. And then I think every time I saw her after that, she was on her period no matter what. I think I saw her later for Botox and filler and she's like, I just want you to know I'm having my period. Even though you're not even looking there.

Bri (45:01):
It's fine. I just want you to know.

Dr. Gallus (45:04):
Happy to provide that service for you.

Bri (45:06):
It's this office, everyone cycles up. Just the way it goes.

Dr. Gallus (45:11):
We usually blame Megan.

Bri (45:13):
True. So how long does this procedure take from start to finish?

Dr. Gallus (45:19):
I tell people they're in our office from anywhere from an hour and a half usually I would say an hour and a half, sometimes two hours, just depending on the amount of tissue I'm resecting. And we try not to rush it along. Right? We're not a conveyor belt of labiaplasty, so we want to make sure we mark the times we don't put the local in and then say, okay, I'm sure it's been 10 minutes, let's get started. We'll write down the time so that we know, okay, we're giving you the appropriate amount of time. Because otherwise if you ask a surgeon if it's been 10 minutes, that's 30 seconds to us, we're ready to go.

Bri (45:56):
I'd like to give her the benefit of the doubt, but I know her so I know that's not true. She was like, oh, it's been 15 minutes. Right? I was like, it's been three. It's fine.

Dr. Gallus (46:06):
Three minutes. So wait.

Bri (46:08):
Look at the board?

Dr. Gallus (46:11):
So that's why we know that, yeah, that alone, that coming in, getting the local, the two levels of local, maybe also taking the oral sedative, if you take that, we're not going to give you the pills and then get started. We want that to kick in. So that whole process right there takes a half an hour and then it takes us about an hour to do the procedure, and then your ride has to come if they need it or get you situated, go to the bathroom one last time before you get on the road, that kind of stuff.

Bri (46:36):
What is the general recovery time for a labiaplasty?

Dr. Gallus (46:40):
So I tell patients three days of trying to lay as flat as possible with your butt elevated or your pelvis elevated on a pillow. If you can pull that off, then the whole recovery process is sped along. And then it's two weeks a no heavy lifting, no strenuous exercise. When I see patients at one week, they're about 50% of their way to healed. They have some residual swelling, but it's not as uncomfortable as it was in the first couple of days. And then at two weeks most people have turned that corner and have very little swelling and we're just letting the whole healing process do its thing at four weeks. Most patients are actually healed and look great, which is when I see them, if there's any residual swelling, I tell them I'll see them again at three months and then by then you're definitely good to go. So I do like to tell patients four to six weeks before you're completely good to go for sexual intercourse, for using tampons for peloton, paragliding I believe is a request one time

Bri (47:47):
Don't paraglide right after your procedure.

Dr. Gallus (47:50):
Not a week after. So those things are all doable, definitely at six weeks surfing, but sometimes it's as early as four weeks. And that's why I see you at four weeks because why spend another two weeks in the penalty box if you don't need to be, unless you don't want to have sex, then I'm happy to write you a note for however long you want.

Bri (48:11):
Yeah, you've for an extra couple weeks.

Dr. Gallus (48:13):
Yeah, an extension.

Bri (48:16):
Yeah, sorry.

Dr. Gallus (48:19):
Only foot massages.

Bri (48:23):
That's what you tell the husband. Sometimes the husbands come with and they're like, what can I do to help her? And I'm like, you got to do the dishes. You need the housework, you got to help with the kids, make sure and pick her up dinner and this is going to go on for two, three weeks at least. And they're like, are you for real? I'm like, yeah.

Dr. Gallus (48:39):
We can even write you a note.

Bri (48:41):
I know. I'm going to answer this question. What patients when they see the difference, everyone's like it's life changing. I feel like this is the most people say the most life-changing procedure because it's huge. It's huge. I mean, along with a lot of other plastic surgeries, but people's confidence is just changed when they have this procedure.

Dr. Gallus (49:04):
Yeah, I would agree with that. People are super excited about it once they're all healed up and wish they had done it sooner or known about it sooner.

Bri (49:12):
Why did I wait all this time? And do you, financial wise, are labiaplasty is covered by insurance? Is it pay out of pocket? Is there special financing?

Dr. Gallus (49:24):
I feel like that's one of the most Googled question is, is it covered by insurance? I know I wrote a blog about it and it had a lot of hits. That's a popular question to ask Google. Overwhelmingly the answer is no. Because again, most patients are doing it for basically an appearance reason and it's hard to demonstrate a functional problem. So insurances don't cover it, aren't interested in covering it. Add that to the fact that OB-GYNs, who would be your gatekeeper for insurance for these procedures, don't strongly feel that it's a necessary procedure. So yeah, it doesn't get covered.

Bri (50:03):
And do you offer, what kind of financing options do you have here in office?

Dr. Gallus (50:08):
Oh yeah. So our coordinator, Megan is awesome. Going over all the details for that. That's why I look a little awkward because I was like, I don't know, ask Megan.

Bri (50:18):
Megan's the gatekeeper.

Dr. Gallus (50:19):
When they ask about scheduling or money in the consult, Bri and I, our faces go blank. We're like,

Bri (50:25):
Huh? I'm like, I just work here.

Dr. Gallus (50:28):
I just say, Megan tells me what I'm doing. You have to run the schedule by her. I don't know. Do you do it on a Friday? I don't know.

Bri (50:34):
We don't know. We just show up.

Dr. Gallus (50:38):
I try to say Wednesday, but yet here I am recording a podcast on a Wednesday and we have, what, three labiaplasties.

Bri (50:43):
Three labiaplasties tomorrow, next week we have them on Tuesdays and Wednesdays. Now they're just all over. They're shoved wherever they can go. It's labiaplasty on a Monday and have to start wearing pink every day.

Dr. Gallus (51:00):
Right? Yeah. So I think with regards to financing, Megan is our go-to, but yes, we offer CareCredit and Alphaeon and she can walk you through all of that, what the monthly payment would be, all of those things and help you in any way possible with kind of navigating that. And then with regard to scheduling, which is usually the other question that the patients ask, we used to try and tend to do 'em on Wednesdays. We wear pink on Wednesdays. We thought it was fitting, but we're modifying our schedule a little bit now and we have another associate coming on board. And so things will change around. And so trying to probably try to land on a day that works best for patients too. And people do really prefer that Friday for labiaplasty because then you can get the whole weekend off and potentially go back to your hopefully work from home job on Monday.

Bri (51:52):
And what do you recommend for people that are coming not only out of town from an hour drive, but I know we've had people fly in drive from far away. What do you recommend for that? What kind of accommodations? Is there anything you suggest?

Dr. Gallus (52:06):
Yeah, I feel like we just had that conversation today with someone who decided she needed her labiaplasty two weeks before leaving the country and

Bri (52:15):
Schedule your vacations.

Dr. Gallus (52:17):
Yes. Okay, so for sure, I think a public service announcement, if you're going to plan a vacation, then back that up so you don't come in and say, oh, I really want to do my labiaplasty this summer, but I'm going to Cabo in two weeks. And then I get back and then I go to Hawaii three weeks after that. So you're like, okay, well then just after all of that, you can

Bri (52:40):
Call me in the winter time.

Dr. Gallus (52:43):
And also we're jealous that you're going all these places.

Bri (52:45):
I know.

Dr. Gallus (52:46):
So yeah, you want to make sure that you're not planning any beach vacations for sure, within four weeks of the surgery. And then if you're coming from out town, we prefer that you stick around for a week at least when I usually see people. And then two weeks would be ideal, one week as a minimum, and then I usually set up a virtual appointment for that four week mark so we can talk about things.

Bri (53:10):
So on these virtual appointments, are they just saying everything's good or are they having a spread eagle and show you?

Dr. Gallus (53:17):
It depends, but a lot of times if they're in a safe place, I'll have them show me I'm flashed a lot. Yeah. I mean, I have done that. The nurses are the worst. They'll be on shift and they just go into a closet somewhere and do the virtual appointment. You're like, okay, well, we could have scheduled it on a day off or something, so you could be in the privacy of your home, but it's fine. Go into a bathroom stall and let me know what's going on. Fine. As long as I can connect with you and make sure that everything's going okay, I'll take whatever. I know it's inconvenient to travel around. If you could teleport me in and I would take a look at you, that would be great. I don't like traveling for stuff.

Bri (53:59):
Post-ops are important.

Dr. Gallus (54:01):
But they are important. Yeah.

Bri (54:03):
So my last question, what do you do to not make this procedure awkward, besides have me in the room?

Dr. Gallus (54:11):
I mean, I think if you don't make it awkward, it's not awkward. I was going to say everybody has labia, but not everybody. So half the population has labia maybe more than half, honestly, on any given day. Right? So yeah, I think it's normal human anatomy. It doesn't have to be uncomfortable. I would say if let's say you're, I think I've seen one teenager who maybe in the consultation as they were setting up was uncomfortable having me do the exam. And I said, Megan appropriately talked to the mom and said, that's fine. We don't have to do an exam, we're not doing surgery.

(54:58):
If the patient isn't comfortable having me examine that area, then they're not going to be comfortable with the whole concept of modifying that area. But what we did do was I said, just bring her in and we can just talk about it. If she wants to see pictures, we can look at pictures. And then that's just food for thought. She's educated, and then when she's older, if that's something she chooses to do or she gets to a point where she's comfortable having an exam down the road, then you can do that. I'm not going to tell somebody no, I'm going to offer the opportunity to educate them, but that's also absolutely not a good candidate for surgery. So if you're feeling awkward about letting me see the labia or what your concerns are, then maybe you're not at that right mental state to go ahead and proceed with the procedure. But for most of us, it's just not awkward. We don't care if you're on your period.

Bri (55:53):
Office if all girls.

Dr. Gallus (55:54):
All vaginas. Yeah, it's no big deal.

Bri (55:59):
And where can we look at before and after pictures?

Dr. Gallus (56:01):
You can look on our website. We have a handful of them up there. Not a ton, just because it's hard to get pictures. I don't want to be a gateway for 14-year-old boys or whatever. You do have to click the I'M 18. I am authorized to look, but we have more in office. So the patients have graciously given us their permission to show these because I think it helps patients understand before and after. And again, you get a little bit of a variation of what things can look like to start with and to finish with. And so I think that's super helpful to look at before and afters in some cases. But yeah, that I would say our photo gallery has before and afters of labiaplasty. If you have questions or need info about any of that, you can check the show links for more information about how to reach out to us and ask even more questions. Send us your labiaplasty questions. We'll answer 'em on TikTok or whatever.

Bri (56:56):
Yes.

Dr. Gallus (56:56):
We're good with that.

Bri (56:58):
Send them all.

Dr. Gallus (56:59):
That's it for today.

Bri (57:01):
We'll be back.

Dr. Gallus (57:05):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @restoresdplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, apple Podcasts, Spotify, or wherever you like to listen to podcasts.