Whether you call it botched labiaplasty, labial amputation, or avoidable unintentional female genital mutilation, unless there’s a robust amount of loose clitoral hood skin to bring down as a flap, a woman who had her labiaplasty performed by a surgeon untrained in the fineries and rules of genital plastics was pretty much out of luck as to re-establishment of any sort of anatomic barrier to her flat, smooth, exposed and open vulvar vestibule secondary to the amputation of [practically] all labial tissue.
Fillers and fat transfer to the area of the amputated labia minora has been unsuccessful secondary to the anatomy (tissue planes) in the area, which disallow fillers and fat from staying put in the area into which they have been injected. No successful procedure to re-fashion lips out of remaining available mucosa and skin has been designed. The only hope for reconstruction is if there remained a generous amount of clitoral hood skin which could be brought down as an island flap to cover the denuded labial area and fashion a semblance of new labia, an expensive option even if permitted by the remaining anatomy.
Recruiting patients for Trial: A first step in new hope for these amputated women has been devised and designed by Dr. Goodman after hearing about attempts to do so in the U.K. Utilizing presently available FDA approved oral lip implants made (by the Texas-based company SurgiSil) from lightweight medical grade silicone, they are tubular and tapered at the ends (called “PermaLips™” in the U.K. and “Perma™ Facial Implants” in the U.S.). Dr. Goodman has stacked and sutured together two 5X65 mm implants to provide a degree of elevation. The implants may be inserted into a narrow tunnel dissected underneath the skin just outside of the amputated junction of the inner mucosal, and outer epithelial skin to provide recognizable anatomic pillars where the amputated labia once resided. At a width of 5 mm, a length (including taper) of 65 mm and a height of 10 mm, they are consistent with the anatomical dimensions of a normal woman with small/modest-sized labia.
Dr. Goodman emphasized that the procedure involving usage of facial lip implants in a different but in many ways similar anatomic area is experimental (what is termed off-label usage), but feels that the trial is safe and potentially worth it as the implant material has proven to be non-reactive and, if inserted properly, does not migrate significantly in similar tissue (upper and lower facial lips, where these implants are presently used.) To improve the potential for success by enriching the tissue, Dr. Goodman plans to pre-treat the area with 2-3 months of estrogen + testosterone cream, and is considering the additional use of PRP (platelet-rich plasma) as a pre- or co-therapy to encourage tissue growth and blood supply.
Dr. Goodman is hoping to keep costs down (understanding that implants + materials costs alone = $1400/case) during a trial period during which he plans on reconstructing several women, following their progress over a span of 1 year from surgery utilizing this brand-new technique. For patients involved in litigation, costs may be recovered through the litigation process. For more information, and to register for the trial, call Dr. Goodman’s office at 1 (530) 753-2787, or e-mail Nicole at firstname.lastname@example.org.