Labiaplasty continues to increase in frequency among the American Society for Aesthetic Plastic Surgery (ASAPS) members. From 2015 to 2016, labiaplasty increased by 23% according to the 2016 Cosmetic Surgery National Data Bank Statistics by ASAPS.1 During this time, more than 35% of all plastic surgeons offered labiaplasty as a part of their practice.1 As with many procedures, multiple variables exist when planning and performing labiaplasty. The primary reason for presentation ranges from unacceptable appearance to discomfort in clothing and often leads a surgeon towards a more or less aggressive technique.2 The tools for patient education vary from verbal discussion, drawings, before and after patient photographs, or labiaplasty origami.3 Labiaplasty origami is a simple and effective hands-on 3D reference for central wedge labiaplasty and clitoral hood reduction.3 We aim to evaluate the ASAPS membership to identify the current trends for labiaplasty. An online questionnaire was distributed to all active ASAPS members (n = 1628). The survey was composed of 12 questions regarding surgeon demographics, preferred labiaplasty technique, and self-reported outcomes (Appendix A). SURVEY RESULTS There were 213 members who responded to the survey (13.1% of the active membership) with 79% male and 21% female. 85.5% reported they perform labiaplasties. Respondents have been in practice for <5 (2.9%), 6-10 (9.9%), 11-20 (28.5%), 21-30 (37.1%), and >30 years (21.6%). They report performing labiaplasty over the last <1 (4.7%), 1-3 (7.3%), 3-5 (12.6%), 5-10 (36.1%), and >10 years (39.3%). The majority of respondents perform 1-10 per year (65.6%) followed by 11-20 per year (18%) (Figure 1). Primary presentations for consultation were concern with appearance (93.7%) and pain or discomfort with clothing (57.8%) (Figure 2). The preferred technique was reported as wedge (31.8%), trim (30.7%), variable based on presentation (26.9%), and combined trim and wedge (7.4%) (Figure 3). The main patient education tools utilized during consultation were verbal discussion (92.6%) and drawings (62.1%) (Figure 4). The majority used general anesthesia (32.3%) followed by local with oral sedation (27.9%) (Figure 5). The main complications reported were dehiscence (54.5%) and asymmetry (37.6%) (Figure 6). The majority reported <5% revision rate (87.6%) and 90%-100% patient satisfaction rate (81.1%). Figure 1. View largeDownload slide Survey results for question 5 (189 answered, 24 skipped): How many labiaplasties do you perform in an average year? Figure 1. View largeDownload slide Survey results for question 5 (189 answered, 24 skipped): How many labiaplasties do you perform in an average year? Figure 2. View largeDownload slide Survey results for question 6 (190 answered, 23 skipped): What is the primary presentation for the labiaplasty consult? Figure 2. View largeDownload slide Survey results for question 6 (190 answered, 23 skipped): What is the primary presentation for the labiaplasty consult? Figure 3. View largeDownload slide Survey results for question 7 (189 answered, 24 skipped): Which labiaplasty technique do you use primarily? Figure 3. View largeDownload slide Survey results for question 7 (189 answered, 24 skipped): Which labiaplasty technique do you use primarily? Figure 4. View largeDownload slide Survey results for question 8 (190 answered, 23 skipped): What patient education tools do you utilize during consultation? Figure 4. View largeDownload slide Survey results for question 8 (190 answered, 23 skipped): What patient education tools do you utilize during consultation? Figure 5. View largeDownload slide Survey results for question 9 (186 answered, 27 skipped): What method of anesthesia do you use primarily? Figure 5. View largeDownload slide Survey results for question 9 (186 answered, 27 skipped): What method of anesthesia do you use primarily? Figure 6. View largeDownload slide Survey results for question 10 (178 answered, 35 skipped): Which complications have you experienced after labiaplasty? Figure 6. View largeDownload slide Survey results for question 10 (178 answered, 35 skipped): Which complications have you experienced after labiaplasty? DISCUSSION Labiaplasty continues to increase in popularity. The outcome of the procedure not only improves the overall aesthetic appearance but also affects both the functional and sensual lifestyle of the patient. Labiaplasty may be performed with minimal levels of anesthesia, minimal complications, and exceedingly high levels of patient satisfaction. Tailoring the surgical plan to the patient’s overall goal and patient’s specific physical concerns is critical to achieving the optimal result. A variety of methods are available for illustration of the preferred technique and to assist in managing patients’ expectations. The surgeon’s ability to succinctly convey critical information involving the technique, degree of improvement, potential complications, and expected postoperative recovery is key to achieving the patient’s aesthetic and functional goals. The methods include using simple illustrations with before and after pictures, video animation, and structural representation such as origami.3 Voluntary response bias is inherent with regard to online questionnaires. The survey results tend to overrepresent surgeons who have strong opinions regarding labiaplasty. This is highlighted with 85.5% of respondents reporting performing labiaplasties as a part of their practice. Another potential limitation is the low response rate of 13.1% with 213 respondents of the total 1628 active ASAPS members. Compared to the average response rate of 10%-15% for an external survey, our response of 13.1% is well within the expected parameters.4 This survey provides a snapshot of the trends that are emerging among the ASAPS membership currently providing labiaplasty. Despite the increasing popularity, this procedure remains infrequently practiced by plastic surgeons. A significant portion of the respondents (78.5%) performs less than 10 labiaplasties per year. Recent literature continues to show the safety of the procedure with low complications and high patient satisfaction.5,6 It is unclear whether the low numbers of annual procedures are related to patient concerns, surgeon comfort with the procedure, or other potential concerns. We hope to further examine this relationship in future studies. CONCLUSION We present the current trends among active ASAPS members regarding primary concern during consultation, preoperative patient education, type of anesthesia, and preferred labiaplasty technique. Trim method and wedge method were the preferred techniques at similar rates, 30.7% and 31.8%, respectively. Members report a low revision rate (<5%, 87.6%) with excellent patient satisfaction. As labiaplasty continues to rise in demand, the members of ASAPS’ experiences and techniques continue to evolve. Supplementary Material This article contains supplementary material located online at www.aestheticsurgeryjournal.com. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Cosmetic surgery national data bank statistics. Aesthet Surg J . 2017; 37( suppl 2): 1- 29. 2. Miklos JR, Moore RD. Labiaplasty of the labia minora: patients’ indications for pursuing surgery. J Sex Med . 2008; 5( 6): 1492- 1495. Google Scholar CrossRef Search ADS PubMed 3. Abbed T, Mussat F, Cohen M. Origami model for central wedge labiaplasty: a simple educational model with video tutorial. Aesthet Surg J . 2017; 37( 10): NP132- NP136. Google Scholar CrossRef Search ADS PubMed 4. Fryrear A. What’s a Good Survey Response Rate?. Available at: https://www.surveygizmo.com/resources/blog/survey-response-rates. Accessed April 17, 2018. 5. Lista F, Mistry BD, Singh Y, Ahmad J. The safety of Aesthetic labiaplasty: a plastic surgery experience. Aesthet Surg J . 2015; 35( 6): 689- 695. Google Scholar CrossRef Search ADS PubMed 6. Sharp G, Mattiske J, Vale KI. Motivations, expectations, and experiences of labiaplasty: a qualitative study. Aesthet Surg J . 2016; 36( 8): 920- 928. Google Scholar CrossRef Search ADS PubMed © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Aesthetic Surgery Journal – Oxford University Press
Published: May 26, 2018
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