Demystifying Labiaplasty

We've got another great deep dive ready for you this week, listeners! On this episode Dr. Oppenheimer and Asatta Jones talk all about Labiaplasty.  
What is it? Who's getting it? What's the procedure like? How long does the recovery process take?  All these question and many more are answered in this week's episode. 
We hope you enjoy this one, we certainly enjoyed recording it. 

E-mail your questions: Thepostopp@gmail.com

Follow Dr. Oppenheimer's work on Snapchat and Instagram: @RealDrOpp
Request a consultation: www.oppmd.com

Follow Asatta on Instagram: @A.JonesWellness

Transcript

Dr. Adam Oppenheimer:

Welcome back, everyone. I'm Dr. Adam Oppenheimer, and this is the PostOPP. And I am here with the lovely Asatta Jones.

Asatta Jones:

Hey, everybody.

Dr. Adam Oppenheimer:

Thank you guys so much for tuning back in with us again. It's really been an honor to share really these stories, patient experiences, and also my philosophies. And as you saw from the last episode, deep technical dives, very deep into the nuances of the actual execution of plastic surgery.

Asatta Jones:

Yes. Listeners, if you are back with us after that super deep dive last week, thank you so much. And get ready to go deep again, because we are talking about labiaplasty today. And I am... This episode, I think I've been hyping it since the trailer maybe, but I'm really excited to talk about this procedure because I have had such a come to Jesus moment with it. And I think it's such a cool thing that you do.

Dr. Adam Oppenheimer:

Yeah. This is definitely a niche specialty of mine and really of the entire clinic of women here that take care of patients who come in for labiaplasty. It's very nuanced, it's very specific. The entire process, start to finish, really encompasses more or less three weeks from when you come in for the procedure to when you're more or less, fully healed. And so, there are happiest patients. They're healed the quickest, they've moved on from us the fastest. And I think that it's... I always say labiaplasty is liberating. And I feel like that is really the most accurate way to describe the feeling and the sentiment of our patients that come through, following with a labiaplasty procedure.

Asatta Jones:

Yeah. So tell me about your cases this week, doc. How they've been?

Dr. Adam Oppenheimer:

They've been great. So, we actually did labiaplasty a little bit earlier, and that patient did great. We do them awake under local anesthesia, and so it's really interesting for me-

Asatta Jones:

That is so surprising to me. I remember when I first heard about this, I was like, "Oh, for sure. They're knocked out and asleep. They don't wake up for a week." But no, I was proved wrong. And that's... It's so cool.

Dr. Adam Oppenheimer:

Yeah. I mean, I think it goes back to being gentle with people. And it's not just being, I say, gentleness, in all things and it's not just the physical, it's a lot of the interpersonal too. I mean, it doesn't get much more vulnerable than being up in stirrups. I guess I know that because I wanted to see what it was like, so I went up into stirrups. It was pretty intense. I mean I wasn't naked-

Asatta Jones:

You put your [inaudible 00:02:48]-

Dr. Adam Oppenheimer:

Yeah, and no one was in the room, so it was like, "Congrats. Wow. You're so brave for going up in stirrups."

Asatta Jones:

Okay. Well-

Dr. Adam Oppenheimer:

But-

Asatta Jones:

... you did the best you could and we are very proud of you for that.

Dr. Adam Oppenheimer:

Thank you. Thank you. But I mean super vulnerable. So interpersonally being gentle with them and of talking people through local anesthesia. I think that's an art form in a way, and also just getting over the inherent awkwardness of being in stirrups for... I mean a pap smear may be moments. A speculum exam is minutes, right? But the labioplasty, it can be about an hour long. And usually the first few minutes, there's a little more tension, there's muscle tension, and it's stressful for that first minute or two. And honestly, patients do wonderful and really kind just get into conversation. And it's actually distracting for everyone and we're just doing the technical work.

Dr. Adam Oppenheimer:

But I get to know my local anesthesia labiaplasty patients better than all of my other patients, because those patients really are awake when I'm doing the work. And rest of the patients are asleep during tummy tucks and breast surgery and things like that. And so, it's kind of nice. I actually like patients. Surgeons maybe are supposed to just like doing the cutting and sewing, but I'm people who need people.

Asatta Jones:

You like the clinic time.

Dr. Adam Oppenheimer:

Yeah, I like clinic.

Asatta Jones:

You like doing the rotations. Yeah.

Dr. Adam Oppenheimer:

I like clinic. So anyway, so, yeah. It's a very quick connection that we make with our labiaplasty patients. And then we send them forth in the world and they're done with us, which is great.

Asatta Jones:

I have to say when I was working as your receptionist and on the phones, the patients that I immediately connected to were the labiaplasty patients because there was a level of vulnerability. But also most of the patients that called were just so ready to change their life. And that is what, to be completely transparent, that's what caused that come to Jesus moment that I had, that realization.

Dr. Adam Oppenheimer:

Sure.

Asatta Jones:

Because I didn't know anything about labiaplasty. And so, here I am looking at just the outside, the packaging. And the packaging is, here is this white man doing surgery, labiaplasty surgery on women. And without even speaking to a person that wanted labiaplasty or that desired it, I had this assumption that you are passing judgment on women and about you're perpetuating the, this is what pretty bodies should look like or this is what a pretty-

Dr. Adam Oppenheimer:

This is an ideal vagina. This is ideal labia, according to me. Right?

Asatta Jones:

Yes.

Dr. Adam Oppenheimer:

It's like the ultimate male gaze in the worst possible way.

Asatta Jones:

Yes. And that is, to be perfectly honest, I was like, "Wait, what am I... Who did I sign up to work for?"

Dr. Adam Oppenheimer:

Yeah, where's the door?

Asatta Jones:

Right. But luckily, one of the, what, I want to say, the second patient that I spoke to was a labiaplasty patient. And it was the most eyeopening experience because this is someone who, obviously not putting her business out there, but this was a woman who was in her 50s who, or excuse me, not in her 50s, she was in her late 40s. She was going through a transition in her life and she was just ready to not be uncomfortable. And I didn't know that. I did not know that was a thing. I didn't know that there were women that had difficulties exercising, that their labia does get in the way. I did not know that. That's not a problem that I experienced. So of course in my limited world, it doesn't exist, which is that's my naivete.

Asatta Jones:

But when I spoke to this woman and she was just so ready to take control of her life to the point where she's just saying, "I just want to go on a run without having to stop every five minutes and be in pain." And I was just like, "Whoa, wait a minute." It was just one of these... truly an eye opening experience. And I remember I got off the phone after booking because it was one of those like, "Oh my God, girl, let me get you in as soon as possible. Hold on. Hold the phone. Everything can wait. She needs an appointment stat." And I remember-

Dr. Adam Oppenheimer:

It's a plastic surgery emergency.

Asatta Jones:

It is. It's a plastic surgery emergency. But I do, I remember getting off the phone. And I think I went to one of my colleagues at the time, and I was just kind of like, "I just can't believe that this is something and I just didn't know about it." And it was just one of those... I don't know. I felt so dumb. I just truly-

Dr. Adam Oppenheimer:

No, I mean-

Asatta Jones:

... felt so dumb because I didn't realize that this was such a... one, this was a problem. But then I also felt dumb because I passed so much judgment on you as a surgeon, I passed judgment on you as a man. And that-

Dr. Adam Oppenheimer:

I'm glad you're coming clean about this. This is-

Asatta Jones:

Oh. Well, I mean, honesty is the best policy. I don't think I lie. I mean-

Dr. Adam Oppenheimer:

No, I'm good with that.

Asatta Jones:

... I've broken things around here that I just went straight to Jess and was like, "Hey Jess, I broke this and I messed this up."

Dr. Adam Oppenheimer:

Where's the super glue?

Asatta Jones:

No kidding. But yeah, it's the truth. And I feel comfortable acknowledging that-

Dr. Adam Oppenheimer:

That's cool.

Asatta Jones:

... because I was so wrong. And it's kind of good to be wrong and learn from that, I think.

Dr. Adam Oppenheimer:

Yeah. I mean we all have a very limited frame of reference about what it is like to have a body.

Asatta Jones:

Yes.

Dr. Adam Oppenheimer:

We have one perspective of that and that's as far as we can see in most cases. So I don't think it's even being naive, I think it's just being human. And one of the interesting things that has come about with me sharing, or really with women wanting to share their labiaplasty procedures and their healing and their stories, has been a lot of other women coming forward and saying, "Wow, I didn't realize how different our bodies are."

Dr. Adam Oppenheimer:

And I think that it's very easy to say, "Okay, there's many different shapes and sizes of a penis out there." And there's like, "Okay, this one, that one, long, short, big, small." That's fine. But why is it that for labia, there's just one conceptualization of what it really looks like. And of course, that's not the case.

Asatta Jones:

Right. And I mean to some degree, I know that we all look different and all that stuff. But to the point where it is disrupting someone's life enough and getting in the way of exercise, intercourse, walking-

Dr. Adam Oppenheimer:

Yeah. Clothing.

Asatta Jones:

... daily... clothing.

Dr. Adam Oppenheimer:

Yeah, bikinis, yoga pants, everything. Yeah.

Asatta Jones:

I mean, I was just like, "Whoa, what world were you living in?" I mean, I know what world I was living in, but I just felt so... I just felt really... I felt bad because I was insensitive to the patient wanting labiaplasty. And then I was also very judgemental on you, so it was one of these moments where I'm actually very thankful I had it. Because I tend to think I'm a good person and-

Dr. Adam Oppenheimer:

You are a good person.

Asatta Jones:

... make good judgment. But also, I'm a human being and I have an ego-

Dr. Adam Oppenheimer:

Well, we're getting better.

Asatta Jones:

... and my ego was getting big there.

Dr. Adam Oppenheimer:

We're getting better.

Asatta Jones:

Yes.

Dr. Adam Oppenheimer:

That's the idea always, for us, and for me, and for all of us, is that we can get better and widen our perspectives a little bit-

Asatta Jones:

Yeah. And learn about-

Dr. Adam Oppenheimer:

... about things like labiaplasty, which is taboo or has been taboo for a long time. And I think that it's important to, again, pull back the curtain, have some transparency about how these procedures go.

Dr. Adam Oppenheimer:

I think it maybe would be easier if I were a female provider. I think the field of OBGYN has very, very few men as physicians now, more and more over time. So, I agree. I think it makes less sense for me to have become an expert on labiaplasty. But I also think at the same time, that it requires extraordinary sensitivity on behalf of a male provider to deal with these issues. And so, I'm like, "All right. I'm going to take sensitivity up another level. I'm going to go beyond the gentleness that I normally start with, and I'm going to be even more caring and careful and thoughtful with this person who's in a very vulnerable position about their genitalia."

Dr. Adam Oppenheimer:

And so it forces me, or it inspires me rather, to do even better. And like I said, every day, we're trying to get a little bit better. I feel that way about labiaplasty as a male physician, but just also as a person and as someone who's helping women who are in a vulnerable position.

Asatta Jones:

Yeah.

Dr. Adam Oppenheimer:

But yeah, there's really two things that you mentioned. I think you focused more on the physical symptom side, which is definitely there. I think that there's two reasons though, why women come in to see me for labiaplasty. The one is for the issues that you mentioned, pinching, pulling, pain with intercourse, pain with exercise, inability to wear certain clothes, having to adjust themselves during exercise, and things like that.

Dr. Adam Oppenheimer:

And then there's just the appearance side of things. Again, I don't mean to keep saying this, but when we're talking about surgeries that change the way that we look, to what degree are they necessary? To what degree are braces necessary? To what degree is an otoplasty necessary to pin ears back on a young child who has prominent ears? To what degree is male chest surgery, when you have gynocomastia or male breast, to what degree is that necessary? A bump on your nose. These are all part of this unique world of aesthetic surgery, where we're doing functional surgeries that are also affecting self-confidence and appearance.

Dr. Adam Oppenheimer:

So, you can't really extricate the form in and of itself from the function of the body. And that's what I think is beautiful about all of these elements of plastic surgery, and specifically about labiaplasty. And so, there's the appearance side and there's also the functional side.

Asatta Jones:

Yeah. And if it brings more confidence, if they just become more open with themselves more confident, then who cares?

Dr. Adam Oppenheimer:

Totally.

Asatta Jones:

Who cares if it's necessary?

Dr. Adam Oppenheimer:

Yeah. Yeah, totally.

Asatta Jones:

And I feel like we talk about it almost every episode, what is necessary?

Dr. Adam Oppenheimer:

Yeah, exactly.

Asatta Jones:

Everybody has something, so-

Dr. Adam Oppenheimer:

Everybody has something. They didn't need that, everybody has something.

Asatta Jones:

Yeah. So, that was my misconception about labiaplasty. What are some other misconceptions that you have heard of?

Dr. Adam Oppenheimer:

I think the biggest one is related to probably male locker room antics, I guess. If I can just summarize it that way, I think that's very... Everybody knows kind of what I'm talking about when I say something like that, that promiscuity, multiple sexual partners. Something like that has to do with why the inner labia are elongated.

Asatta Jones:

Yeah. Okay so actually-

Dr. Adam Oppenheimer:

So, that's probably like... Yeah. Yeah.

Asatta Jones:

... can we clarify? Because I was so excited to talk about this episode, we just jumped right in. But let's describe to the listeners, if they aren't aware and if they haven't Googled it already, what exactly is labiaplasty procedure.

Dr. Adam Oppenheimer:

A labiaplasty is reduction of the labia minora or the inner labia, very often with reduction of the tissues on the side of the clitoris area, so the clitoral hood. Some people call that area in a medical textbook, the prepuce or labial reduplication, which are those folds on the side that may often, and very often, coincide with having larger labia. So, it's a reduction of the labia along with some of the hood tissues on each side.

Asatta Jones:

So what we were saying just a second ago, some of the misconceptions, some of that locker room talk about promiscuity leading to longer labia or something like that?

Dr. Adam Oppenheimer:

Yes. Yeah. It's completely false. And these are stereotypes that are perpetuated, just like so many ignorant stereotypes that get perpetuated through history. And then all of a sudden, they're gone. And I don't know why there's that breaking point where you have one breakthrough epiphany and it permeates through all of society. And it's like, "Oh, that's okay now." Or, "Oh, we don't say that word now." And it's just like, it's really confusing as to why that even is perpetuated now, that it has something to do with sexual intercourse. It really does not.

Dr. Adam Oppenheimer:

Most of the women who I see for labiaplasty, and there's really, I guess I would say, a bimodal distribution. There're younger women who come in, maybe 18 to early 20s, that are like, "I've been waiting for this day to be 18." And that's usually where we consider doing a labiaplasty, unless there's really unique, extenuating circumstances for someone who's under 18. Maybe they're an emancipated minor as that goes, which is another separate definition, medically, or someone who's uniquely mature, uniquely motivated. But that still is rare. Most of the time, these are young women, late teens, early 20s, who are the first peak of the distribution of patients who come in. And then there's another subset kind of later, maybe late 20s, early 30s. So, there's that.

Dr. Adam Oppenheimer:

It's probably more of a continuum, I guess, but we see women who are like, "I'm this tall to ride this ride. I've wanted to do this since puberty." So I guess the answer to your question is, puberty. I mean, hormones surging during puberty, they do all kinds of things to the human body. It is when men develop breasts. I think there's not a majority of men who do, but there's not actually a small number of men who develop transient gynocomastia or breast bud development. There are multiple areas in the body that are hormonally sensitive, the genitalia, the breasts, and so it's common for men to develop during that time, some breast bud or some gynecomastia. Which goes away for the same reasons, the same circulating estrogens and hormones, the inner labia can become elongated and become problematic.

Dr. Adam Oppenheimer:

And so when I see young women who are coming in when they're 18 or 19, these are women who, since they were 13-

Asatta Jones:

Puberty. Yeah.

Dr. Adam Oppenheimer:

... yeah, 12, they were like, "I always knew something was different." And sometimes when they're coming from a place of more openness, they're like, "Yeah, my sister and I talked about this and she's like, 'Why is yours like this?'" And, or pointed it out to a mom or something like that. And so, those are some of the situations where if they're younger, the mom would come with them and be like, "Yeah, she has always been bothered by this and I support her interest in changing this."

Asatta Jones:

Could it be like genetic thing too?

Dr. Adam Oppenheimer:

I think there's always this environmental genetic interplay. This is gene plus environment equals everything and so, certainly, yes. Certainly, yes. But I think that, yeah, it's really just circulating hormones, most often at puberty. Sometimes we see changes in women around or after pregnancy. I mean, there are certainly changes to the vulva, which is the external vagina, and then the vagina itself in childbirth. And so, there are certainly changes that occur after childbirth. Sometimes we'll see tears of the labia minora in addition to the perineal tears. And there are also elongation that you can see or changes you can see after pregnancy. Sometimes that's from the outer labia getting actually a little bit smaller or a little bit atrophic.

Dr. Adam Oppenheimer:

As we age, our fat content and fat distribution changes. And so sometimes, the outer labor getting smaller can give the appearance of the inner lab getting longer as well.

Asatta Jones:

Wow.

Dr. Adam Oppenheimer:

But circulating hormones during pregnancy can also cause changes. So sometimes we'll see that. That's maybe the other half of the bimodal distribution where I'll see some older patients coming in and saying, "I had some of these changes from puberty. It didn't bother me as much. And then it seems like there's been more rapid changes." But I think that's a minority. And most patients I see are just like, "This is from puberty." And that's very similar to gynocomastia, when men come in. And I don't do really gynocomastia surgery anymore, but men would come in and be like, "Yeah, this is just the deal that I got when I went through puberty. And it's just always bothered me." And so, I think we just get the cards that we're dealt, and that's that.

Asatta Jones:

Yeah. Puberty, it's that kind of crazy roulette or the... What's the pulley thing, gambling thing?

Dr. Adam Oppenheimer:

Yeah.

Asatta Jones:

A slot machine.

Dr. Adam Oppenheimer:

Thank you.

Asatta Jones:

There we go.

Dr. Adam Oppenheimer:

Thank you. Yes.

Asatta Jones:

We're two big gamblers here.

Dr. Adam Oppenheimer:

Yeah, clearly.

Asatta Jones:

Wow. Wow. But that is fascinating, fascinating.

Dr. Adam Oppenheimer:

Yeah.

Asatta Jones:

So tell me, what's the consultation like for a labiaplasty? I know that you offer virtual consultations. Is this something that a lot of people or that people, patients should come in to see you or-

Dr. Adam Oppenheimer:

Not necessarily. And I think I'd say it's maybe 50, 50. Just to be clear, when I do telemedicine, I guess we can call it that or virtual consults, which is kind of what we know them as, I never do video chats or video consults. Because I feel like that would make things even more awkward. And so, we usually have someone send in photographs, if they're comfortable with that. Or if not, they can come in. Obviously, we have a HIPAA compliant photo upload database system for privacy purposes.

Asatta Jones:

It's a portal. You can't just be sending any pictures, willy nilly to the PostOPP email.

Dr. Adam Oppenheimer:

Yeah. No, this goes through our website for consults. And so, some people have the courage to send in photos, some people have the courage to come in and see me for consults. Sometimes it's both. But if you send in photos and you want to just do a virtual consult, we have a lot of patients maybe from South Florida or from the Carolinas or things like that and Georgia. And they'll send in photos, we'll call them on the phone. I'll talk to them briefly, just go over their health history and just make sure they know and understand the procedure.

Dr. Adam Oppenheimer:

But I think a great many of them already do know and understand the procedure. And part of my mission has been to educate people about this procedure, sharing lots of photos, sharing lots of videos. And I really am grateful for my patients for doing that, because really it's them. It's that 18 year old young woman who was like, "I was bothered since I was 12 and I didn't have anywhere to turn to about this." And a lot of other doctors will be like, "That's normal." And it's true. It's like gynecomastia is normal, longer inner labia is normal, not developing breasts, normal. So, it's just like whether or not your normal is concordant with your worldview for your body or discordant. And so if it's discordant, if the body you are given is discordant with the body that you want, enter plastic surgery.

Asatta Jones:

Right. Right. [inaudible 00:21:34].

Dr. Adam Oppenheimer:

And so, I'm really grateful for women who have decided to share their experiences with labiaplasty. And we talked a little bit about [medutainment 00:21:44] versus [meducation 00:21:46], which maybe are horrible words. We probably should just stop saying those words.

Asatta Jones:

No, no, no I like it.

Dr. Adam Oppenheimer:

They're made up.

Asatta Jones:

We can make it a thing. Lets-

Dr. Adam Oppenheimer:

They're made up words. They're horrible.

Asatta Jones:

We just got to keep trying.

Dr. Adam Oppenheimer:

I think that certainly things can fall into both. Is the human body endlessly fascinating? Absolutely. Is this very educational for me to understand more about my own body or about women's bodies in general? Absolutely. And so, I'm really grateful for the women who have shared their experiences, have shared their photos, have shared their journeys. And a lot of them are super excited to watch it. I mean, if extra tissue's been bothering you for so, so long and you finally are liberated from it, it's a very freeing experience. And I think that they're just so grateful to be past that, they almost want to empower themselves by seeing it happen.

Asatta Jones:

Right. And the only way that you can empower other people, is by sharing your experience. It's literally the only way. And I think that there might be something to the trend that you see younger women like 18 to early 20s, that they are used to things being shared on social media. They're used to that empowerment, online type of thing. And they're used to hearing stories about people from across the country and all that stuff. And so, I think storytelling and sharing stories are a little-

Dr. Adam Oppenheimer:

It's special.

Asatta Jones:

... bit more accessible to the younger generation and-

Dr. Adam Oppenheimer:

We are storytellers. I mean, that's what we do best. This is in a way, what we're doing now is telling stories about our experience.

Asatta Jones:

Absolutely.

Dr. Adam Oppenheimer:

We love to tell them-

Asatta Jones:

Absolutely.

Dr. Adam Oppenheimer:

... we love to listen to them. But yeah-

Asatta Jones:

It's just a more sophisticated version of sitting by the fire and telling stories. I really like that. And I do want to second your comment of thanking the women that have shared their stories and are giving their consent to their pictures being shared and stuff because it-

Dr. Adam Oppenheimer:

Yeah, for sure. K.

Asatta Jones:

... kind of reminds me of that, I don't want to say the insane thing I said, but the confession I made a couple episodes ago, I can't even remember at this point, but that I didn't know that black women got lip fillers. And that's because it was, for a long time, black women didn't talk about it. I didn't know black women that got lip fillers. And then sometimes the ones that did, or the Hispanic women that I know that have gotten plastic surgery, they don't share, they don't talk about it. They might be ashamed. It's a little bit of a shame-based thing.

Dr. Adam Oppenheimer:

Yeah. There's a segue happening, there's a transition happening about it. But we're still caught up with a lot of things and-

Asatta Jones:

We're getting there. We're getting there.

Dr. Adam Oppenheimer:

And that reminds me of, do you know when you can have a rhinoplasty as a young woman? Actually, at 16.

Asatta Jones:

So, that's the age.

Dr. Adam Oppenheimer:

And it's kind of now totally 100% okay. Right? You have a bump on your nose, 16, 17, your facial bones are finished developing. And so, that's not really taboo. It's not taboo to-

Asatta Jones:

Well, it's normal now, if you go away for the summer and your friend's face looks a little different. And you're just like, "Oh, okay, whatever."

Dr. Adam Oppenheimer:

We pin children's ears during otoplasty at age five or age six, and so I'm not sure that's taboo. There is something about it being genitalia that makes labiaplasty above and beyond taboo. And so, I think we're getting past that. It's very interesting for me to see, especially on social media, what nudity is censored, what nudity is art? What nudity is sexual? What's OnlyFans content versus Guggenheim Museum content, versus photography versus boudoir. You'll find that there's a lot of boudoir photos that are not censored. But you'll find that some version of OnlyFans photos would be censored. Those accounts are deleted. The Guggenheim and the photographers that are doing it as art in black and white. You put something in black and white and maybe that's what we should do, is to-

Asatta Jones:

I was just going to say-

Dr. Adam Oppenheimer:

... decrease our risk of censorship, just make it black and white.

Asatta Jones:

... if the pictures are getting censored, just put a nice filter on it, some black and white, and-

Dr. Adam Oppenheimer:

Black and white will do it.

Asatta Jones:

... and it'll be fine.

Dr. Adam Oppenheimer:

So I mean, I think that some of the reticence for accepting labiaplasty has been that it's just been taboo to have genitalia be part of the plastic surgery world. And again, it goes back to what I was saying last episode, if I hurt women, if I hurt patients, if this was something that left them with an injury or nerve injury or sensation loss, which by the way is not something that I've ever experienced in over now 300 labiaplasties, zero women have problems with orgasm, changes in sensation, difficulty with pain, with intercourse, known as dyspareunia. The number's zero. And so, this is the upsides of lab plastic compared to even breast augmentation are even higher. Like I said, these are our happiest patients, happier than the tummy tuck patients.

Asatta Jones:

So, is that a question you get a lot in the consultation, what's the recovery process like?

Dr. Adam Oppenheimer:

Yeah. What's the timeframe for when I can go back to activities. And-

Asatta Jones:

Is that the top question?

Dr. Adam Oppenheimer:

I feel like that is the main question, I think. And usually the answer is some version of three days, where you're just laying low-

Asatta Jones:

Oh, okay.

Dr. Adam Oppenheimer:

... where you're not really getting up and around, ice packs, and just resting. And then about three weeks until you can go back to the gym. And then sometimes we'll say six weeks before you can resume intercourse. So, that's the rough recovery phase. So, it's from three days to six weeks.

Asatta Jones:

Okay. So, you come in, you... or not really. You come in, you submit your photos for the consultation.

Dr. Adam Oppenheimer:

If you're comfortable or come in, exactly, like you said.

Asatta Jones:

Or come in, right. The patient will chat with you for an hour consult.

Dr. Adam Oppenheimer:

Usually it's less. The ladies will talk first-

Asatta Jones:

Nice.

Dr. Adam Oppenheimer:

... for maybe five or 10 minutes. This is one of those very specific procedures. And it's more like, I guess if I were to compare this emotionally with a surgery, it would be the gynocomastia surgery. But if I were to compare this technically with a surgery, it would be eyelid surgery. There's a small fold of extra skin above the eyelid. You pinch that extra skin out, very high value real estate, the whole eyeball thing happening.

Asatta Jones:

It's very important.

Dr. Adam Oppenheimer:

I'm sure there's a doctor word, the globe. So-

Asatta Jones:

That's on you, buddy.

Dr. Adam Oppenheimer:

The globe. The whole eyeball thing, it's like, did you go to medical school? Yes, I did. So it's very similar, technically, very high value real estate. The clitoris, the vagina, the labia themselves, these are all very delicate tissues with very high nerve endings, the highest nerve endings in the body, actually. But that would be how I would see it.

Dr. Adam Oppenheimer:

And so when you have your eyelids done, you're not as specific about say, how much or how little skin you want removed. You need enough skin to close your eye, but you don't want so much skin that you still have that extra fold of tissue. And that is pretty much the labiaplasty. It's a little bit of this Goldilocks, not too hot, not too cold, just right phenomenon that is everywhere in my plastic surgery world.

Dr. Adam Oppenheimer:

And so, you need to leave a small cuff of the labia minora in order to have competence of the vagina. The labia minora are basically the gatekeepers of the vagina. And they separate out the internal environment from the external environment. They close and cover over the urethra as well. And then the clitoral hood tissues, you need to leave the right amount of that so that you still have coverage over the clitoris so you don't have overly sensitive contact on the clitoris itself.

Asatta Jones:

So, the patient really just has to have the desire to have labiaplasty. They don't need to worry about anything.

Dr. Adam Oppenheimer:

There's no measurement, like-

Asatta Jones:

There's no legwork or any-

Dr. Adam Oppenheimer:

... Oh, how much... Yeah. How much... Let's measure to see. No, that's-

Asatta Jones:

None of that's on that.

Dr. Adam Oppenheimer:

That would be like if this were some kind of male clinic, they'd be like, "Can we please measure this, once and for all?" But it doesn't matter at all for women, it's just, you have extra tissue that either A, bothers you physically and, or B, bothers you-

Asatta Jones:

Aesthetically. Yeah.

Dr. Adam Oppenheimer:

... emotionally, aesthetically. And so, you can have either, or, or both. And usually, there's both, and then that's it. And so for me, for the exam, it's all of about four seconds and I'm basically like, "Yep, you have... Yes. You understand your body. Yes, you would be a good candidate for this." And then every once in a while, I will say, sometimes I'll examine someone, I'll be like, "You have clitoromegaly.", which is enlargement of the clitoris, which can happen in some women, usually from taking external steroids like testosterone. And you can have enlargement of the clitoris, which basically can be more exposed and make it look more imbalanced than what you would want.

Dr. Adam Oppenheimer:

And so, some women will have that and they'll be like, "I want a labiaplasty." And I'll say, "Actually, this is the clitoral-

Asatta Jones:

It's not what you-

Dr. Adam Oppenheimer:

It's the gland's clitoris itself that's enlarged. And there's not a great operation, certainly not one that I perform, to reduce the clitoris. But by and large, women, they know their body. There's a lot of photos now online, again, thanks to them. And also just the opening of our collective eyes to bodies in a non pornographic way, in a medical way. And that has allowed a lot more people to educate themselves about this whole process. And so usually, I'll examine them and I'll be like, "Yeah, there's exposure. Your inner labia are hanging down low, lower than your outer labia. Or they're beyond your outer labia.", which we sometimes call, labial show, where there's show of the inner labia beyond the outer labia. That's a big concern that women have, that they want reduced. So that at least when they're standing, that all that they can see would be outer labia.

Asatta Jones:

Outer labia.

Dr. Adam Oppenheimer:

And Yeah. Then I'm just like, "Okay, great. Yeah, we can do this. Here's the approach that we take for using all absorbable buried sutures and making the closure really delicate."

Asatta Jones:

Wow. Okay. So, let's talk about the day of surgery. As a patient, what can I expect? I know that I have the option to go to sleep or stay awake. And I know we mentioned that a majority of your patients opt to stay awake and watch-

Dr. Adam Oppenheimer:

Probably like 90.

Asatta Jones:

... the surgery live, which is kind of cool. Which is kind of like the most, I think, of the most badass thing you could do. You're just like, "Yeah, I'm watching myself get a surgery. How tough am I?" That's so cool.

Dr. Adam Oppenheimer:

Yeah. I would say there's probably zero men who are like, "Let me watch my vasectomy."-

Asatta Jones:

Exactly.

Dr. Adam Oppenheimer:

... live under local. Because they do that under local as well, a lot of the time.

Asatta Jones:

Yeah. And it's two seconds. But I know some friends that have had their vasectomy done, because they're done with their families and stuff. And they were just like looking away, cringing.

Dr. Adam Oppenheimer:

0% of men are watching their-

Asatta Jones:

Big babies.

Dr. Adam Oppenheimer:

... vasectomies. Totally. Totally. No, I would say 95% of patients will have the surgery under local anesthesia. I see them again in pre-op. Very often, I don't examine them. If they've sent in photos through a virtual consult, I already have a sense of what the plan is from the photos. So, I don't examine them that morning until they go back into the operating room. We use a topical numbing cream actually, that we put on a pad, like a maxi pad first. So, that helps decrease pain in that area, like topical lidocaine that women may have had for laser hair removal or IPL or something like that.

Dr. Adam Oppenheimer:

And then we bring the patients back, they go up into stirrups. One of the ladies, my nurses sets up the field and then we use a little cryo spray, a little liquid nitrogen spray right before we do the injection. So, the skin is kind of extra cold and the shot doesn't hurt as much. And then very delicate suturing, polite conversation.

Asatta Jones:

Enya in the background.

Dr. Adam Oppenheimer:

Enya in the background.

Asatta Jones:

Nice. So, they're able to-

Dr. Adam Oppenheimer:

And the fireplace up.

Asatta Jones:

... go home. The fireplace up on Netflix.

Dr. Adam Oppenheimer:

On the TV. Yep.

Asatta Jones:

So, the patient's able to go home that same day.

Dr. Adam Oppenheimer:

Yep.

Asatta Jones:

And then just come back a week later.

Dr. Adam Oppenheimer:

Yeah.

Asatta Jones:

Just chill.

Dr. Adam Oppenheimer:

We give them an ice pack, we give them non-stick gauze, the lovely mesh postpartum panties that we sometimes affectionately-

Asatta Jones:

Oh, those are... Yeah, those are great.

Dr. Adam Oppenheimer:

... know as, granny panties, and we have a full recovery kit with all the ointments, additional ice packs, more pads, everything else. So, there's not a lot of guesswork that people need to do for coming here. And we also dispense medications which are pain meds. And we give patients a yeast infection meds just in case. We don't use a lot of antibiotics. And we actually prep the skin with baby shampoo instead of betaine and other preps.

Asatta Jones:

Very gentle.

Dr. Adam Oppenheimer:

We find that when we were prepping with... Years ago, when we would use betaine, which is a bacteria static skin prep for surgery, is that women would be much more likely to get yeast infections because it would kill the normal lactobacillus flora that's there. And it would open up for other microbes to basically take over that environment. And so, we use baby shampoo. And then we send people on their way with those recovery kits.

Dr. Adam Oppenheimer:

And they hang out at home for a few days. Usually they come in to see one of the nurses at one week. If they want, they come in and check in back with me at three weeks. I'd say maybe half of patients even bother to do that. They're just like, "Thanks for-"

Asatta Jones:

I'm fine. I feel great.

Dr. Adam Oppenheimer:

Yeah. "Thanks for doing..." like I said, in the breast surgery, "Thanks for being excellent during that hour and a half that I needed you. I don't really need you anymore." And that's great.

Asatta Jones:

That is so cool. In my short time as your receptionist, I had the pleasure of watching patients come in during their consultation and then for their final post-op. And it's just the glow up is so life changing. And it's like we talked about on that previous episode, it's the ripple effect. It's the ripple effect in the pond that just continues on, and it changes their lives.

Dr. Adam Oppenheimer:

Yeah. And these are our happiest patients.

Asatta Jones:

It's kind of cool. Yeah.

Dr. Adam Oppenheimer:

And that may be as surprising to you to hear, it's maybe a little surprising to me in a way also, but it doesn't change the fact that they are. They're just thrilled to be on the other side of something they've really wanted for a long time.

Dr. Adam Oppenheimer:

And a lot of patients are driving themselves to the facility that morning and driving themselves home. And I think that while it may be transiently uncomfortable to be up in stirrups and to have a little needle poke at the edge of the labia, which is very sensitive, I think that there's much less apprehension with that than there would be of going under, as you say, or being put to sleep, as you say, for an anesthetic. And so for a lot of women, not needing to phone a friend, not needing to have a chaperone, it simplifies the process for them in a meaningful way.

Asatta Jones:

Yeah. Yeah, because logistics are real thing. Oh, wow. Dr. Oppenheimer, thank you so much for chatting with me. Can we talk more about labiaplasty? Yes, we can. Will we, listeners?

Dr. Adam Oppenheimer:

I feel like I always can. That was a rhetorical question.

Asatta Jones:

Yeah. I don't think we-

Dr. Adam Oppenheimer:

I'm like, "Allow me, Asatta." You're like, "Nope. Rhetorical."

Asatta Jones:

We got to wrap it up. But we might have a part two coming up maybe next season. We'll see.

Dr. Adam Oppenheimer:

Oh, next season.

Asatta Jones:

Yeah.

Dr. Adam Oppenheimer:

Cool.

Asatta Jones:

I like the sound of that.

Dr. Adam Oppenheimer:

Yeah. Me too.

Asatta Jones:

Listeners, thank you so much for listening. If you have any questions for us, if you have any questions for Dr. Oppenheimer, please send them our way. The email is thepostopp, Post O-P-P, @gmail.com. Also, please follow and like the show on whatever podcast platform you're listening on. Leave us a review. We love, love to read some reviews. And yeah, we'll be back next week. Dr. Oppenheimer, anything you want to say to listeners?

Dr. Adam Oppenheimer:

Thank you guys again. Thanks for tuning in, listening into some of the more technical elements of the procedure. And yeah, thanks again to all of the patients that I've taken care of for labioplasty that have not only trusted me, but also paid it forward into the world and shared their experience with others to try to again, demystify and make transparent what it is that we're really doing. So, thank you. Thanks for trusting me.

Asatta Jones:

All right. We'll be back next week.

Dr. Adam Oppenheimer:

All right. Ciao. Bye.