|1. This patient had undergone vaginoplasty with Dr.
Meltzer three months earlier. Here is what her result looked like, prior
|2. About 90 minutes before she came to the operating
room, the lower part of her pubic hair was shaved, and EMLA cream was
applied to her vulva, under plastic-wrap occlusion. She was also given
10 mg of Valium to take orally. [Note to consumers: one 5cc tube of EMLA
probably won't be enough. This patient asked for and received three
5cc tubes -- about the right amount. Also, be sure not to take your
Valium too early -- 30 minutes before the operation actually begins
is about right. Usually this will mean just before they take you to the
|3. Once in the operating room, the EMLA cream was
removed, the patient's vulva was washed with Betadine, and blue surgical
drapes were applied. Here we see the operative site after completion of
these preparations. Surgery is about to begin.
|4. Here some of the Betadine has been wiped off, and
the skin incision lines, as well as a few alignment marks, have been
drawn on the skin with purple surgical marker. Local anesthetic is now
being injected to further numb the skin. The anesthetic solution also
contains epinephrine, a vasoconstrictive agent, which will greatly
reduce bleeding. Note that the lines drawn above the clitoris form an
inverted "V". We will see what happens to this "V"
shape a few images later.
|5. The skin is now incised with the scalpel along the
|6. Next, the skin is gently freed from the underlying
tissue. This will allow the skin to be re-draped to hood the clitoris
and create the labia minora.
|7. Here we see the results of the first part of the
operation. The skin has been freed-up, and is now ready to be
rearranged. The next step will be to bring together the skin edges that
lie between the surgeon's fingers.
|8. In this photograph, sutures placed just beneath the
skin surface have been used to bring the skin edges together above the
clitoris. The former inverted "V" now looks like an inverted
"Y" -- which is why plastic surgeons call this particular
tissue rearrangement technique a "V-Y-plasty." The use of a
V-Y-plasty to create the clitoral hood is an elegant alternative to the
older "double Z-plasty" technique used by Drs. Schrang and
Hage. Unlike the double Z, which leaves multiple vertical scars, the V-Y
leaves only a single vertical scar.
|9. Next the labia minora are created. This involves
suturing the skin edges together, and also placing sutures through
each labrum, from one side to the other, creating thin lips of tissue.
|10. In this photograph, the labrum on the left
(patient's right) has been formed, and a small drain has been placed
between the skin edges at its lowest point. The labrum on the right
(patient's left) is now being constructed.
|11. Here is the finished result. The construction of
the labia has been completed, and the vertical incision line above the
clitoris has also been closed. It is now even easier to see the inverted
"Y" shape, created by the V-Y-plasty.
|12. Here is the result 24 hours later, with the
Betadine washed off completely, and the drains removed. There is more
swelling of the labia now, and more evidence of early bruising. The
bruising and swelling will peak at 48 to 72 hours, and will take several
weeks to disappear. Nevertheless, we can get some sense of what the
final result will look like.
|13. A second photograph at 24 hours shows the
appearance with the labia spread.
|14. This is what the result looks like 10 months
postoperatively, with the labia together. I thinks the overall
appearance is very pleasing.
|15. Another view of the result 10 months
postoperatively shows the appearance with the labia spread.
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