Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today I have Dr. Diana Breister and she is one of our board certified plastic surgeons, and she's going to talk today with us about feminine rejuvenation and specifically and so welcome Dr. Breister.

Dr. Breister (00:35):
Hi, good morning. Thanks for having me.

Monique Ramsey (00:38):
So some women, probably most women have some issues how to bring this up to talk about the lady bits as we call them, but they can feel when you get into vaginal health, I think it's becoming a little more mainstream, but it's not something that people are super confident in talking about. And so how do you make it so that it's not awkward for them?

Dr. Breister (01:03):
Well, labiaplasty is, as you probably know, it's why we're talking about it's becoming more and more popular, which is great. So more and more women, younger to older are becoming more aware of this procedure.

(01:18)
I think what happens is we don't know if our own anatomy is per se normal until you become a certain age and then you start thinking, oh wait, this is irritating me, or is this normal or is this how it should be? And a lot of OBGYNs will examine a woman and say, you're totally normal. And they are totally normal. That's the thing about labia is that they're as different as your lobes. They come in all shapes, sizes, thickness, and they're all per se normal. However normal to one person might irritate them or bug them a little. And I think becoming more aware, we wear tighter clothes, the athleisure movement, we're wearing yoga pants every day or tighter clothes. I think women have become more aware to that due to other factors. So when they finally discover that there is a procedure for this, I think they're like, wow, this is great.

(02:19)
And so then there's obviously we're all a little shy around our private parts, so there's of course going to be a little stigma or showing your body to a stranger is never super comfortable. So I find it's a big step for a woman just to make the appointment. Like, okay, I'm going to be facing this. I'm going to get an opinion about it. I'm going to have to be examined. So I'm always very comforting and reassuring just to try to get them to relax a little bit before we even examine them. I say, look, I'm a woman, I get it. This is not comfortable, but you're not alone. There's nothing wrong with you. I'll tell you that right now. But there's nothing wrong with wanting to change things too, a little bit. So I think they take a deep breath, there's a sigh of relief and then we go from there. So I think that's kind of my approach, that's my understanding of it anyway.

Monique Ramsey (03:19):
Well, I think that makes a really good point is you could apply that to eyelid surgery. It's normal to have extra skin in your upper eyelids, and we don't think twice about wanting to change that. And so if you have extra skin in your labia and you want to change that, it's really the same thing, but it's again, because it's kind of our privates and it feels funny to maybe talk about it. And so what percent of women do you think might have some degree of aesthetic or functional concern in that region?

Dr. Breister (03:53):
Well, that's a very hard question to answer because one woman might have an excess of two or three centimeters of labia hypertrophy as we call it, and it doesn't bug her at all. But then the next woman might have that exact same amount and it really bothers her. So I think they're all different. They all probably have some excess to them, and whether that excess, like I said, what percentage that is, who knows. But once a woman becomes more aware of the anatomy and once they find out that there is something to do to change it, I think that's the best part.

Monique Ramsey (04:32):
Do you think there's any reasons why women might not reach out for help with this more often? Do you think it's just because they don't know that there's something that can be done?

Dr. Breister (04:42):
I think a lot of it they just don't know. A lot of it could be an OB GYN saying, you're normal, there's nothing wrong with you, you don't need anything. I think a lot of it is women and our own, not shame, but we're kind of reticent about putting resources into ourselves. Sometimes it's elective, it's not necessary. So just with cosmetic slash elective surgery to begin with, there's a little bit of trepidation on the part of women just because of you got to get over those hurdles. And luckily in this day and age, we are getting over the hurdles. It's becoming a lot more mainstream to want to change little things about ourselves. It's not so stigmatized. But like I said, the reasons are many. They can be anywhere from irritation, pain, discomfort, don't like how they look in yoga pants, trouble with intercourse. Sometimes the labia can be several centimeters and those they get pushed in and out and that's not comfortable for a woman. So there's a number of factors that a woman could be wanting to change that.

Monique Ramsey (05:54):
Right. And I would think this is something that you could be born with where that's just your anatomy.

Dr. Breister (06:03):
Absolutely. And I think 99%, the genetic is the number one most even after childbirth. Yes. And menopause things can change a little.

Monique Ramsey (06:14):
Yeah, maybe they were fine back when you were younger and now you've had a couple kids and

Dr. Breister (06:20):
Everything, things change and things get a little deflated and things can get a little stretched out. So yes, with time and age and childbearing and menopause, those things can definitely exacerbate what was there and what was possibly fine in your thirties and forties.

Monique Ramsey (06:39):
So for the people who, young women who, and especially I think athletes, this is what I've been hearing about is that athletes, especially women who are wearing some tight clothing gymnasts or rowers or there's a lot of different athletes where what you're wearing tennis court. Yeah, no, it's fine. They have a skirt. But if you are wearing something that's super

Dr. Breister (07:04):
Form fitting,

Monique Ramsey (07:05):
Form fitting, there you go. How young would you operate on a patient who had this problem?

Dr. Breister (07:13):
I think probably 17 or 18 years old is the youngest I would consider. We just want the woman to be really a good understanding about her body and things like that. So yeah, I mean as young as I think a woman of 17, 18 years old, I've done breast reductions as well on women of that age. So it can become a problem at that age. And at that point there's absolutely no harm or no repercussions or consequences of doing a surgery like that in the right hands, obviously.

Monique Ramsey (07:47):
And so that leads me right exactly perfectly into the next question, which is why is a plastic surgeon qualified to treat these kinds of concerns instead of let's say a gynecologist or a urologist or a urogynecologist? Yeah.

Dr. Breister (08:02):
Well, the issue is mainly an excess of skin. There's not nerve issues or the urinary tract involved or other things like that. We are really not talking about internal vaginal structures. The labia is an external structure of the vulva. So that basically means that it lives on the outside. So as plastic surgeons, we have such extensive training in how to deal with skin excess, skin laxity, things like that. And we are very well trained on all areas of the body from the breast to the abdomen to ear lobes to labia. So we do get extensive training in that. And because we have that extra sense of aesthetic concern, that's who you want to be with. Now the OB GYN, they get it, they understand it, but frankly they're more geared to solving problems of that area. They're going to be dealing with infections or tumors or masses or things like that that absolutely we need their expertise certainly to the functional and medical problems that can happen for a woman. But when it comes to this, this is the labia, it is external. It is usually part and parcel of wanting it to look aesthetically pleasing. A plastic surgeon who has experienced in this area is going to be your absolute go-to.

Monique Ramsey (09:36):
So are there any reasons if you saw a patient that, is there any reason you might send that lady to another specialist or is it

Dr. Breister (09:47):
Like a contraindication or they need an evaluation by another doctor? I mean, I can honestly say maybe been once I've ever done that, and that's going to be if the woman comes to you for labiaplasty, but their actual issue is something else, maybe something internal is bothering them. They think it might be the labium, they think you might be the right doctor, but indeed they have maybe a stricture internally or they're having some other problem that fixing that or trimming that external labia tissue isn't the answer. But I can honestly say I've only seen that maybe once or twice. There's so much information now out there on the internet that most women can become educated in what the labiaplasty is and they usually wind up in the office and they're all good candidates. They're all good candidates.

Monique Ramsey (10:40):
That's what I was just going to say. Is there anything that would prevent someone from being a good candidate?

Dr. Breister (10:45):
Not really. As long as they're healthy, as long as they have the right expectations, that's obviously part and parcel of choosing your patients and making sure they're good candidates. So the only major contraindication is going to be if they have an unreal expectation. You just want to make sure that you don't want to do something that they're going to be disappointed in.

Monique Ramsey (11:09):
Now, can you explain a little bit about the actual labiaplasty surgery? What actually are you doing?

Dr. Breister (11:17):
Sure. So anatomically it's almost, I wish I had a picture. We have the vulva. The vulva is the term for basically the whole area down there. And that vulva consists of a labia majora, which are the outside lips and the labia minora, which are the inner lips. And in the 90% of these procedures are going to involve the inner lips. Those are the area, the labia that protrude a lot. Now sometimes it can involve the labia majora or the outer ones. There are procedures also that can help to reduce sometimes the size or change the shape a little bit. But 98% of the time we're going to be talking about the labia menorah, which is the inner structures that actually close off our vagina and help to create a protective closing of that area. So those structures are just trimmed very methodically. And depending on how the excess tissues arranged, most likely we do a rim trim.

(12:28)
So we're basically trimming the whole outer edge of it and then applying some little sutures that are very fine and they dissolve with time, and that's really the crux of it. Now sometimes this can also involve what we call a clitoral hood reduction. So there is tissue that is called the clitoral hood. It's a little veil of tissue that basically covers over the clitoris to give it some degree of protection. And just like anything else, there can be unlimited amounts of variations of that tissue, and sometimes the woman's labia menorah can kind of lead up into that CLI hood and that can require some tissue reduction as well.

Monique Ramsey (13:17):
Now I'm assuming this is under general anesthesia. So how long would they be under general anesthesia for this?

Dr. Breister (13:26):
So the good news is that it's a pretty quick procedure. It's about anywhere from an hour to an hour and a half at the most. We can use a light general anesthesia. Some people can actually do it under a local. My personal choice is to do it under more of a general. I find that it's more comfortable for the woman just to be asleep for that. So it's a light general anywhere from an hour to an hour and a half of a procedure. And then I'm sure you probably want to know a little about recovery.

Monique Ramsey (13:59):
Yeah, I do.

Dr. Breister (14:01):
So once the procedure is done, the most critical thing is going to be the 48 hours after that procedure. And that's going to be the most critical time that the woman is home, she's relaxing, she's laying down and she's using some ice packs. The ice can be very instrumental in helping to reduce swelling, help soothe any discomfort, and just get those tissues off to healing properly. So I'd say about two to three days of kind of strict being at home. We don't want you going to a soccer game. We don't want you walking your dog. We don't want you preparing a meal in the kitchen because that gravity and standing up just blood is going to rush to that area and there can be a problem. So the initial two to three days has to be pretty strict of doing pretty much nothing but relaxing after that.

(14:54)
If you can get through those two, three days usually, then you can start doing more things. If you need to go to work, it would be probably fine. We just want you to maybe sit on a donut cushion so you don't have direct pressure on the area. You could drive, you could run some errands, you could do daily activities after that time. Now we don't want you to be exercising vigorously till about three to four weeks. So we just want to make sure everything is sealed up, healed up. We don't want any problems with infection. So we kind of put off exercise for about three to four weeks.

Monique Ramsey (15:30):
So I'm assuming you can go home the same day.

Dr. Breister (15:33):
Absolutely.

Monique Ramsey (15:34):
The key is to stay quiet. And so what would be sort of the complications if a person completely ignored your advice, starting dealing with the dog and the kids and all that?

Dr. Breister (15:45):
Yeah, so what can happen is number one is bleeding. So that can be kind of scary. A woman can have a lot of bleeding and what's going on, they could possibly have a hematoma, which thank goodness I've never seen. But the hematoma is kind of a large collection of blood. That's the first issue that can happen. Secondly, the tissues swell so much that they pop open. So that's called dehiscence or wound breakdown. So that's going to be the number one thing that can be problematic. If someone just is kind of doing their thing, going to the soccer games, they're going to come in after three or four days, and their wounds may be totally open at that point because the swelling put pressure onto the tissue and so much pressure that the tissues couldn't hold it. So it is very critical. And then with that takes, it's a lot longer of a healing process and there's more risk of infection. And then the last thing is when a wound can open, it can become infected. I mean, any wound can become infected. That luckily is a very low incidence, but that also is a potential possibility if you're not compliant with those instructions.

Monique Ramsey (16:53):
Now, if you can't exercise for let's say three to four weeks, vigorous exercise, exercise in the bedroom, what do you advise in terms of waiting until you have sexual activity?

Dr. Breister (17:07):
Okay, so that's a great question. Roughly about four to six weeks before we want the pressure and the friction on that area. It just depends on how extensive your surgery was. But probably on average by four or five weeks, that area is healed up and ready for activity if you will

Monique Ramsey (17:27):
Clearance. So you give them clearance, I take it?

Dr. Breister (17:30):
Yes.

Monique Ramsey (17:31):
You'll sign off on, okay.

Dr. Breister (17:32):
That's right. And then we also, we always let them know there's going to be healing that's still involved. There's going to be some scar tissue in that area, and that scar tissue can be tender. So it's going to be important to know that that first couple times of having intercourse can be a bit uncomfortable. So that always goes away. It's just a matter of a couple weeks to maybe a month or two before that tissue completely heals and is back to normal. Initially, it's always recommended that they use a little bit of lubrication just to reduce some of the friction, but they can usually start by about four to five weeks and usually by two to three months it's no pain at all.

Monique Ramsey (18:19):
And I feel like this could be part of a mommy makeover. So maybe a woman is thinking, I'd like to get rid of the extra skin by my tummy. Is this something that you could combine at the same time?

Dr. Breister (18:32):
Absolutely. It's a procedure that goes well with any other procedure because of it. It's short, it doesn't add a lot of time. They're going to be recovering anyway. So it's actually something that we oftentimes combine with either some facial surgery or some breast surgery or any other surgery. Hey, I want to do that the same time. It's an excellent idea.

Monique Ramsey (18:55):
Yeah, yeah. Now I want to also address, I don't know what to call it, but the area just above

Dr. Breister (19:02):
The mons. So we call that the mons pubis.

Monique Ramsey (19:07):
It can be puffy there. And for some women, is that something that you can also address while you're doing an examination or surgery?

Dr. Breister (19:14):
Absolutely. A lot of women, if they gain some weight, they find that area does become a little puffy. So liposuction is a great option for that area. I mean, sometimes if there's been a lot of weight loss and changes, sometimes that does require what we call a mons plasty, which actually lifts up the skin and removes some of the skin, which can be done at the same time as the tummy tuck. But yes, the mons plasty or the mons liposuction can absolutely potentially be addressed at the same time as a labiaplasty.

Monique Ramsey (19:50):
That's wonderful. Yeah, I haven't heard of that, but I was like, I know that's a thing. So

Dr. Breister (19:55):
Yeah, it's definitely a thing. And all shapes and sizes, it comes in all shapes and sizes. As we age, as we put on weight, it can definitely settle there, especially maybe after a C-section. So yes, it's an absolute area that I think can go along with that and be addressed as well.

Monique Ramsey (20:14):
I feel like a lot of what we're talking about, well really with any plastic surgery, but it comes down to confidence. You want to feel more confident either in your clothes or out of clothes or while you're exercising. I could think if you love to ride bikes and your labia, there's just too much of them, then this would be you're feeling more confident, you're feeling more comfortable. So what is sort of the first thing that patients will say after surgery and they see and feel that difference?

Dr. Breister (20:47):
The first one to two visits, they're still kind of swollen and it can look a little not right, right away because it's swollen or bruised. So the first few visits, I even just advise them just you don't even need to look, just put some ice on it. But after about three to four weeks when the tissue has settled down, they are absolutely thrilled. They basically walk into the office just almost with a skip in their step. There is a change. They feel more confident. It's almost like a sigh of relief. They're like, oh my God, so, so happy. I'm so happy. That's gone. It really emanates from their whole presence a lot, which is kind of strange, but it's true. We are a function of how we feel about ourselves. And if that's just a source of a little ick that you don't really like, once that's fixed, even though you're not showing that to anybody, it doesn't matter because you just feel better.

(21:49)
And that I think is the number one reason why I'm actually in this field, is just to help women feel the very best they can because I think that's just so important. It's a very rewarding surgery because of that. They feel amazing and they feel so great. And I think also it really, and this is something we're not really talking about because sex is kind of taboo in this country of ours. I don't know why, but it is, we don't talk about sex very much, but sexual confidence is super important. I mean, think about it. We all, as women, we know sex is really only as good as we feel about ourselves. So that's just an honest, we feel better about ourselves. It's better. That's a huge part of this. I think women become extremely more just confident in their sexuality. So that's a huge part that we don't really talk about, but it's major in how that changes that.

Monique Ramsey (22:54):
Right. Now, is there ever a circumstance where insurance is going to cover this? I'm guessing it's a hard no, but you never know. So I'm asking

Dr. Breister (23:05):
One time in my 20 plus years of being a surgeon that there has been one case that it was so exaggerated and the problem was so great that it actually was causing some really bad infections and irritations and yeast infections. So it got covered, but that was a struggle. So I would say for the most part, no.

Monique Ramsey (23:31):
Okay. Now, I looked on our website just to remind myself, and there aren't any before and after photos on the website of Labiaplasty, and I can understand why that might be the case, but I know that we've got hundreds of photos to be able to show patients. So is that something that you go over in the consultation?

Dr. Breister (23:54):
Yeah, so I'm not sure why we don't here at La Jolla Cosmetic, because I know other doctors do have those before and afters,

Monique Ramsey (24:01):
And we might have to change that too.

Dr. Breister (24:03):
I think we do have to change that. I'm going to be a proponent of changing that because yeah, it's very powerful to see the images. Not everyone wants to see 'em, but you don't have to look, but if you're interested, you need to see it because it is so powerful. So yes, there's a system called Touch MD that the ladies here can send a patient a link and get them into those before and after archives of all the different befores and afters. We go over that in the consult, but we can also send a link if they want to see those images before their consult even. So I think that's very powerful.

Monique Ramsey (24:39):
Yeah. And I think because you were talking about the uniqueness of all of us, everything in our body, but I'm certainly thinking of labia. There's got to be no two are the same.

Dr. Breister (24:51):
No two are the same.

Monique Ramsey (24:52):
I would think it would be helpful as a woman to see other labia and how, here's where they started, here's where they ended up hard to know

Dr. Breister (25:01):
The visual. What is it going to look like after? What are we talking about here? So yes, that visual is so important because you can really explain this was this issue, this is how we approached it, this is this. Now your issue or your part that we're going to address is going to look more like that. So it is very powerful in relaying what the final outcome's going to look like, and then they can adjust or make their expectations in line with what we can actually deliver.

Monique Ramsey (25:32):
Now, I don't think we talked about pain very much. Is this a painful recovery?

Dr. Breister (25:38):
Honestly, not really. With the icing, I think it provides such a nice gentle relief that I think most women get through this sometimes not even with a narcotic pain reliever sometimes just with a Tylenol. So I would say it's surprisingly not too painful.

Monique Ramsey (25:57):
And that's so good to know because it is such a sensitive area in terms of nerve endings and that kind of sensitive. So that's nice that it's, if you follow the instructions, you're going to feel fine.

Dr. Breister (26:10):
I think the recovery is probably easier than most people would imagine. As long as they do the right thing for those first couple days, they're usually going to sail through it.

Monique Ramsey (26:22):
So one of the things that a lot of women want to know is they're like, okay, yeah, I think I want to do this, but how much is it going to cost? And so I think on our website we have all the price ranges of things. So it says about 7,000 to 8,500. And so what I want to assure everybody is we can do financing for things. So sometimes people think, oh, I haven't saved up enough. But you can also, and actually one in three of our patients use financing, and that's been kind of consistent over years. So it's nice. So you can think, okay, I'm ready to address this. Maybe you put some money down and then you finance the rest over with interest-free payments or something. And so I just sort of want to let the audience know that we do have those resources and we have that on our website, and that can help make this very achievable. Yeah, because I think you bring up a really good point in the confidence that they're going to feel, and it's like, I don't have to worry about that anymore. It's all fixed. And then you just have this, so what's the price for that is much greater in terms of the value you're going to feel so good.

Dr. Breister (27:38):
It's true. And that ballpark sounds a little bit on the higher end too. It might be even a little more affordable than what you said. And we can base it on the amount of intricacy of the procedure too. So like we said, there's so there's all different. So if it's just a smaller amount and it seems simpler, less complex, we certainly try to adjust the prices of that to reflect that.

Monique Ramsey (28:05):
Would you say when you're combining something like the clitoral hood reduction or maybe a Mons lipo.

Dr. Breister (28:14):
Or lipo?

Monique Ramsey (28:15):
Yeah, so that's going to change the quote.

Dr. Breister (28:17):
Yeah. We always try to give price reductions when combining procedures. So that's always a better value. If you can do two things at one time, just one anesthesia then, and it's just a lot simpler. So the price will actually reduce when you combine things.

Monique Ramsey (28:37):
And when I used to be in the office and I would back up the coordinators if somebody was gone and I would code a patient, that first hour of the operating room is the most expensive hour. And same with anesthesia. It doesn't double for two hours, one and two, it's just incrementally goes up. So it really does lend to maybe you do want your eyes done at the same time, great, we can do that. And like you said, it's a one recovery. You're at home anyway. You're resting anyway. Putting ice in two places is fine.

Dr. Breister (29:06):
Yeah, no, it's a great thing if a woman's kind of been thinking about it, but they also want their eyes done or breast augmentation, it's just an ideal time to combine that.

Monique Ramsey (29:17):
Now if somebody's listening who doesn't live locally, how do you deal with that in terms of the consultation and traveling and instructions for surgery?

Dr. Breister (29:27):
So obviously we do Zoom consultations, and then we would probably want to at least get a picture via a HIPAA confidential photo transportation, just so we could take a look at the picture. They could do a pre-op on the phone. We could discuss the intricacies beforehand on the phone, and they could basically come in town. I'd probably recommend they stay here for about five or six days after the procedure just to make sure everything is well on their way to healing. And then they could get back to where they want to be. Probably need a ring cushion to sit on the plane if they're flying or in a car and it would work out just great.

Monique Ramsey (30:07):
Well, that's nice to know. So yeah,

Dr. Breister (30:10):
Someone's out there and they live somewhere else and they want to come to sunny San Diego,

Monique Ramsey (30:15):
A little rejuvenation vacation for the rejuvenation areas in more ways than one. So if you're listening today and you have questions about scheduling or financing or we've got reviews on our website from our patients, and we've got almost 10,005 star reviews now. It's incredible. But we've been surveying patients for years, and I think that's so important for people to know that here's a person who had Dr. Brister as her surgeon, and here's how happy she is. And you can read real reviews and between that and I think before and after pictures and the consultation, just meeting you and knowing how approachable you are and how easy you make it. And I think we as women, for years, I had a female gynecologist because I just felt more comfortable. Not that a man can't do it, it's just for me, it was a comfort level. And so having you to be able to, you're so approachable and easy to talk to and you get it, you're a woman and you can relate. So we'll provide links to your bio. And I was thinking the other day when I saw we were going to do this episode, there was an art exhibit. Do you know what I'm talking about?

Dr. Breister (31:30):
Yes, I do. I'm envisioning it in my head. What they took molds or something of they took molds, many different types of vulvas.

Monique Ramsey (31:38):
And so this whole art exhibit, a huge wall with white casts of women's private parts. And it was like, what a cool thing. And so we'll put that in the show notes, we'll figure out what it was, but it was kind of

Dr. Breister (31:53):
Neat. That was really cool. And it just showed the uniqueness of every single woman's body.

Monique Ramsey (31:59):
Right, right. So anyway, I thank you for today. Did we kind of cover everything?

Dr. Breister (32:06):
I think so. I mean, I think we touched on really a lot of different really important points. And the main point is just, hey, if you're feeling like you've been a little bit not liking that area, I just recommend you do it because it's really worth it. It's really not that difficult to get through, and it's really fairly affordable. So I think it's a great, great procedure.

Monique Ramsey (32:32):
Yeah. So, alright, well thank you Dr. Breister. It was fun. And we will see you all on the next one.

Dr. Breister (32:40):
Alright, Monique, it's a pleasure.

Speaker 1 (32:46):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla cosmetic is located just off the I-5 San Diego Freeway in the Ximed building on the Scripps Memorial Hospital campus. To learn more, go to lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis, THE AXIS. io.