“Plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles both to improve overall appearance and to optimize the outcome of reconstructive procedures.”

As a board certified plastic surgeon, I am capable of doing all of the above but have chosen to specialize in the cosmetic aspects of plastic surgery and have been performing cosmetic surgery in New Jersey for about ten years.  In order to make all the above clear to my patients, I call myself a plastic surgeon.  Anyone who comes to see me knows exactly what to expect and what I have been trained to do.  This all seems pretty obvious and I have never imagined calling myself anything else.

However, I have just found out that I have many other titles that I could be using that I was unaware of.  I just found out that I’m also a cosmetic gynecologist since I perform many labiaplasty procedures.  I am also a cosmetic ophthalmologist because I perform upper and lower eyelid surgery.  I’m an otolaryngologist/ENT because I perform rhinoplasty and I’m a dermatologist because I perform laser skin resurfacing.  I’m even an oral surgeon since I perform buccal fat removal through the mouth.  All these titles would look quite impressive on my business card (if they fit) but would be untrue.  They would also be quite confusing and would only mislead my patients.  I would never imagine doing this.

Plastic surgery overlaps with many specialties as we work all over the body.  However, just because I perform labiaplasty doesn’t give me the right to call myself a gynecologist with the implication that I have the same training as a gynecologist.  Just because I perform otoplasty doesn’t justify my calling myself an otolaryngologist/ENT with their required specialized training.  And, just because I remove skin cancer doesn’t make me a dermatologist with their special training.  All the above procedures are part of being a plastic surgeon and just happen to overlap with other specialties.  My training is in plastic surgery.  Calling myself anything but a plastic surgeon would be inappropriate and would only serve to mislead my patients.

So, why do so many non-plastic surgeons choose to call themselves plastic surgeons simply because they perform a procedure that happens to overlap with what a plastic surgeon does?  Why do otolaryngologist/ENT surgeons who perform rhinoplasty call themselves facial plastic surgeons and not cosmetic otolaryngologists?  Why do ophthalmologists who perform cosmetic eyelid surgery call themselves oculo-plastic surgeons and not cosmetic ophthalmologists?  Why have they created “Boards” like the American Board of Facial Plastic Surgery and the American Board of Cosmetic Surgery that are not approved by the American Board of Medical Specialties that make them sound even more like plastic surgeons.  Clearly, these specialists are not plastic surgeons, do not have the same training as plastic surgeons, and are not board certified in plastic surgery.  By calling themselves “plastic surgeons”, they are only misleading patients and making it difficult for patients to make an informed and educated choice of surgeon.  This violates one of the most fundamental tenets of a doctor-patient relationship – trust.

How can you educate and protect yourself as a patient?  If you are looking for a plastic surgeon, there are several websites that list plastic surgeons who have met the training and testing requirements to be a board certified plastic surgeon.  The American Board of Plastic Surgery is the only plastic surgery board approved by the American Board of Medical Specialties.  The American Board of Plastic Surgery website will confirm if a surgeon is certified in plastic surgery and not another specialty.  Members of the American Society for Aesthetic Plastic Surgery are board certified plastic surgeons who specialize in cosmetic plastic surgery of the face, breasts and body.  If you are looking for a plastic surgeon, check these websites.  Don’t settle.  Make sure your surgeon trained at the top institutions and make sure you’re comfortable with them in person.  In today’s confusing environment, taking the time to educate yourself is critical.  Don’t forget – not just anyone should be calling them self a plastic surgeon.

Recently, the FDA approved the use of Restylane for lip cosmetic surgery in NJ and the rest of the country.  After performing a clinical study on 180 patients to show that Restylane lip augmentation is safe and without serious side effects, the FDA added the use of Restylane in both the upper and lower lips to the label and package insert.  Restylane lip augmentation is now FDA-approved!  This only confirms what I have found with so many of my patients already.  Restylane is an excellent and safe way to create and enhance beautiful lips!  With the approval of the FDA, Medicis can now begin educating the public about the use of Restylane for lip augmentation.  I also expect that Allergan, the maker of Juvederm, will be pursuing approval for Juvederm lip augmentation very soon.  The HA fillers are very popular among our patients.  Their use in lip enhancement (when done properly) can result in beautiful lips that brighten the whole face.

One of the questions that I have been asked repeatedly about labiaplasty is “Which technique is better – the wedge technique or the edge trim technique?”  One of the reasons that the wedge technique has become popular is that it was used on the popular TV show “Dr. 90210″.  However, as is usually the rule, what you see on TV is usually not real nor the best.  I have used both techniques and it is clear that the edge trim technique is more versatile for almost any shape labia and clitoral hood, heals better with fewer complications, and has a great, more natural cosmetic result.  The real proof is that my patients love their results.

The main reason cited to support the wedge technique is that it preserves the “natural” edge of the labia.  This is clearly a misinformed concept.  The “natural” edge of the enlarged labia is usually dark, thick and irregular.  This is usually one of the reasons that my patients come for labiaplasty.  They want this thick, dark, irregular edge removed, NOT preserved!  They want their inner labia reduced to the same length or smaller than the outer labia.  The dark, thick, irregular edge would look completely un-natural in this position.  Furthermore, anyone who has examined women with naturally small labia minora will agree that the “natural” edges of the small labia minora are thinner and pinker in color.  This is what my patients are looking for; this is what is truly “natural” and this is what is achieved with the edge trim technique, not the wedge technique.  Preserving the edge is the main (and only) real reason provided to support the wedge technique and clearly, this is not most natural and not what my labiaplasty patients are looking for.

Some of the reasons used against the edge trim technique include the “bad” scar, that it doesn’t address the clitoral hood, and that it is somehow simple and less technically demanding.  First of all, being technically demanding doesn’t make a procedure better.  However, if performed PROPERLY, the edge trim technique is actually quite technically demanding because it DOES address the clitoral hood, leaves an INVISIBLE scar and gives the most natural result!  Many who perform labiaplasty, including those who use the edge trim technique, are inexperienced or undertrained.  In these cases, it is the surgeon who is causing the complications or poor results, not the technique.  This is why you should make sure you choose a board-certified plastic surgeon with impeccable credentials who has performed many labiaplasty procedures and who can show you the results.  Why a plastic surgeon and not a gynecologist?  Who do you think will give you that invisible scar and proportional result?  Plastic surgeons are experts at creating the best scars and contours all over the body, including the labia.

There are several disadvantages to the wedge technique that do not exist with the edge trim technique.  First, the wedge technique addresses fullness mainly in the central labia but doesn’t do well with enlargement further back or forward on the labia nor does it address the clitoral hood area.  This can leave many women with distorted labia.  Some surgeons using this technique will resort to the edge trim technique to make up for this deficiency of the wedge technique.  Second, the wedge technique depends on pulling together and “tightening” the labia front to back to make them smaller.  This creates an un-natural tension in the incision line that can lead to healing problems and longer recovery times.  Some of these patients develop a permanent visible notching of their labial edges (not very natural) because the wedge partially pulled apart during the healing process.  The other end of the wedge incision can sometimes cause distortion near the urethra (opening for urination).  If done poorly, it can cause problems with urination.  The edge trim technique doesn’t go anywhere near the urethra and almost never has a healing problem or notching.

In expert hands, the edge trim technique is superior to the wedge technique from both cosmetic and medical perspectives.  The edge trim technique addresses the entire labia fully including the clitoral hood when necessary while the wedge technique does not.  The edge trim technique scar is under no tension, heals under almost any condition, doesn’t cause notching deformities of the labial edges and is imperceptible.  The wedge technique has much higher rates of healing problems and visible notching deformities of the labial edges.  The edge trim technique goes nowhere near the urethra.  The wedge technique incision can go very close to the urethra and in some cases, cause complications with urination.  Finally and most importantly, the edge trim technique results in the most natural and aesthetically pleasing shape and edge while the wedge technique aims to un-naturally preserve the dark, thick, irregular edge.

Some sample labiaplasty before and after photos follow:

Only 7 weeks after labiaplasty, notice the very natural color and shape over the entire length of the labia including the clitoral hood.  No scar is visible.

6.5 months after labiaplasty.  This patient had very large labia from front to back and around the clitoral hood.  Notice the very natural and proportional reduction along the entire length of the labia.  The color of the edge is natural.  No scar is visible.

3 months after labiaplasty.  This patients had enlargement along the entire length of the labia and clitoral hood.  She wanted her labia hidden within the outer labia (closed labia).  This required proportional reduction along the entire length of the labia and clitoral hood that would be impossible with the wedge technique.

Labiaplasty patients represent some of our happiest patients with most wishing they had done this sooner.  Having performed labiaplasty in NJ for almost 10 years for hundreds of patients from all over the country, it has become clear to me that the edge trim technique provides the best and most consistent cosmetic results with the least complications (see labiaplasty before and after photos).  As labiaplasty continues to grow in popularity, it becomes very important for prospective patients to research their surgeons and choose a board-certified plastic surgeon with significant experience in performing labiaplasty.  In the right hands, labiaplasty is a safe, minimally-invasive procedure with wonderful results.