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Precision Labia Minoraplasty: An Update on the Barbie Look
Red M. Alinsod, M.D.
January 11, 2015
Introduction/Objective: Labiaplasty techniques have developed in a divergent
manner in the past decade with plastic surgical specialties usually preferring
wedge type of methods and gynecologists performing more curved linear
excisions. Presented is a 10-year overview of the more radical precision
curvilinear labia minoraplasty commonly referred to as the “Barbie Look.” This
slang terminology refers to the excision of most if not all of the labia minora so
that it lies below the level of the labia majora. Originating in Southern California,
the Barbie Look labiaplasty is performed for selected patients who want the
ultimate in comfort, removal of dark edges, and the sleek and smooth
appearance of their vulvovaginal region.
Materials and Methods: Over 600 consecutive non-randomized labia
minoraplasty surgeries were performed and charts reviewed for the period of
Jan 2005 to Jan 2015. Patient safety and satisfaction were evaluated as well as
the evolution of technique during the past decade. Patients were given the
choice of how much labial tissue would be excised and removed based on their
preferences and their concepts of beauty. When only the labial edges would be
removed (e.g. removal of only the dark edges) and the labia minora was still
above the level of the labia majora this was termed a “Rim Look.” When there
was a greater degree of labial removal but purposely leaving a small amount of
labia minora left this was termed a “Hybrid Look.” The “Barbie Look” was
reserved for purposeful removal of the entire labia minora down to the level of the
labial crease (the junction of the labia minora and labia majora). This degree of
exactness and precision could not be achieved with any of the current wedge or
Z-Plasty methods due to the undue tension on the suture lines. Pinpoint
radiosurgery for ultra precise tissue excision and feathering was developed and
used throughout the series. No lasers were used. For practical purposes, the
Hybrid and Barbie Look labiaplasties are very close and similar and typically
result in the minora, or what is left of it, to be below the majora. For the purposes
of this review the any labiaplasty performed resulting in the labia minora to heal
below the level of the labia majora was termed a “Barbie Look.”
All labisplasty surgeries were performed in the office under local anesthesia,
using clitoral and labial blocks, mild oral sedation, and mild oral or IM narcotics,
and an antiemetic. No IVs were used. All patients were encouraged to drink
fluids and have a normal breakfast. All patients drank 500-1000 cc of liquid
before the case started. The average amount of Bupivacaine with epinephrine
used for labiaplasty was 4-7cc, which eliminated tissue distortion. The Ellman
RF device using a pinpoint hair tip was used to precisely excise labia minora.
Debulking of labial tissues was performed aggressively so that patient discomfort
was minimized once healed. Patients who wanted to eliminate the pulling and
tugging and painful intercourse caused by large or floppy labia minora chose this
technique. It was also the preferred choice of patients who wanted to achieve a
youthful, less bulky, and less prominent look or their genitals. Closure was
performed in 2 to 3 layers using absorbable sutures and tied very loosely.
Mattress, subcutaneous, and interrupted suturing was used based on patient
anatomy. Any irregular or asymmetric regions were excised or resurfaced to
produce the best symmetry and balance possible. Simple labiaplasty, usually
accompanied by clitoral hood reduction, averaged two hours to complete and
three hours of surgical suite time. The average post op recovery time was under
15 minutes and all patients were able to walk home from the office. The average
patient used mild narcotic pain medications for 1-2 weeks. Post op follow up was
done at 2 and 6 weeks. All patients had pre and post op photos taken.
Results: 600+ cases reviewed showed exceptionally high patient satisfaction
rates of over 98%. 2% wished they had chosen a less aggressive approach and
wished more labia was left over. There were no major complications or
hospitalizations. There was minor suture line numbness lasting several months
but no nerve damage or nerve pain observed after wounds were healed. There
was increased daily comfort in all patients and reduced dyspareunia in those that
were bothered by labial traction during sex. There was no change in the patient’s
ability to achieve orgasms in general. Minor complications included wound
breakdown requiring resuturing (2%), urinary tract infection in 2-3%, nausea from
medications (5%), and vaginal discharge due to suture breakdown. No increase
in yeast infections or vaginitis was observed. Less than 3% requested revision
surgery. Those who requested revision surgery wanted what labia was left to be
reduced even more due to an initial conservative approach. For example, Hybrid
Look patients wanted to be more Barbie Look in 2% and 1% wanted more
prominence in what labia was left over.
Analysis and Conclusions: The average Barbie Look labiaplasty patient is not
the professional entertainer many in the media or public opinion portrays it to be
but are normal women of all ages. The large majority of patients wanting labial
reduction surgery in our practice wanted their labia minora to be below the labia
majora folds. This “Barbie Look” has grown in popularity in the West Coast of the
US. The procedure requires extreme precision and careful suturing and
knowledge of retractability of labial tissues. The Barbie Look is able to remove
the dark edges that give patients a more aged appearance and frictional irritation.
Removal of all of the darkened edges is not possible using the wedge approach.
In our practice it was extremely rare for women to demand that they keep the
dark edges of their labia minora and found it puzzling that women who were
opting for elective labia minoraplasty would purposely choose to keep their dark
edges. The claim that wedge labiaplasty surgery can maintain the natural
corrugations and irregularity of the labial edges better than curved linear
excisions are true. However, this request was non-existent in our cosmetic
gynecology practice. All women, when given a choice, wanted the dark labial
edges removed and edges smoothened and less corrugated looking. The Barbie
Look labiaplasty has been able to achieve these goals and is a safe surgical
procedure producing extremely high patient satisfaction rates with no major
complications when done in the office under local anesthesia and using
radiosurgical precision methods. The key to successful surgery has been
precision RF excision and loose layered suturing with fine sutures. It is safer and
cheaper than surgeries done in a surgery center of hospital. Though certainly not
the procedure of choice for all patients, the Barbie Look labiaplasty technique
should be a part of the surgeon’s armamentarium when specializing in aesthetic
vulvovaginal surgery. Proctored and extensive training is highly recommended.
Before Labiaplasty
After Labiaplasty