Our Summary

The research paper is about a surgical procedure for transgender women called penile inversion vaginoplasty (PIV). This operation is often performed but sometimes, patients need additional procedures to get the result they want.

In this study, the authors looked at the use of fat grafting to the outer lips (labia majora) of the new vagina to enhance the outcome after PIV. The researchers looked back at the medical records of all the patients who had this operation performed by one surgeon between 2014 and 2019.

Out of 182 patients, six (or 3.3%) later had fat grafting to the labia majora. The main reason for doing this was if the labia majora were too flat (83% of cases). All the fat grafting procedures were done at the same time as other procedures to revise the new vagina.

The study didn’t find any differences in age, health history etc. between the patients who had fat grafting and those who didn’t. However, they found that those who had fat grafting were more likely to have had issues with narrowing of the vaginal opening (introital stenosis) and prolonged inflammation of the tissue (granulation tissue) lasting more than six weeks after the initial surgery.

The authors concluded that fat grafting is a safe and effective way to improve the appearance of the labia majora after PIV. Having prolonged granulation tissue and introital stenosis might mean a patient is more likely to need fat grafting, possibly because of increased scarring and shrinkage at the surgical site.

FAQs

  1. What is penile inversion vaginoplasty (PIV)?
  2. How often is autologous fat grafting used in post-PIV revisions?
  3. What factors may predict the need for labial fat grafting after PIV?

Doctor’s Tip

A helpful tip a doctor may give a patient about vaginoplasty is to be aware of the potential need for labial fat grafting to improve results and address any defects in the labia majora. Patients should also be mindful of possible complications such as prolonged granulation tissue and introital stenosis, which may indicate a higher likelihood of requiring fat grafting. It is important to follow postoperative care instructions and attend follow-up appointments to address any concerns or complications promptly.

Suitable For

Patients who undergo penile inversion vaginoplasty (PIV) may benefit from labial fat grafting if they experience flattened labia majora or other aesthetic concerns postoperatively. Additionally, patients who have prolonged granulation tissue or introital stenosis may be more likely to require labial fat grafting to achieve satisfactory results. Overall, labial fat grafting can be a safe and effective method to improve outcomes after PIV for transfeminine and gender-diverse patients.

Timeline

Before vaginoplasty:

  1. Consultation with a surgeon to discuss the procedure and expectations.
  2. Psychological evaluation and clearance for surgery.
  3. Pre-operative assessments and tests to ensure the patient’s health is suitable for surgery.
  4. Preparation for surgery, including fasting and pre-operative instructions.

After vaginoplasty:

  1. Immediate post-operative care in the hospital or surgical facility.
  2. Recovery period with pain management and monitoring for complications.
  3. Follow-up appointments with the surgeon for post-operative care and monitoring.
  4. Possible need for revisions or additional procedures, such as labial fat grafting, to improve results and address complications.
  5. Continued follow-up care for long-term outcomes and satisfaction with the surgery.

What to Ask Your Doctor

  1. What are the potential complications and risks associated with vaginoplasty, including the need for revisions such as labial fat grafting?

  2. How common is it for patients to require additional procedures like labial fat grafting after undergoing vaginoplasty?

  3. How will I know if I need labial fat grafting after my vaginoplasty surgery?

  4. What is the recovery process like for labial fat grafting, and how long will it take for me to see results?

  5. Are there any specific factors or conditions that may increase my likelihood of needing labial fat grafting after vaginoplasty?

  6. What are the expected outcomes and benefits of undergoing labial fat grafting after vaginoplasty?

  7. How experienced are you in performing labial fat grafting procedures, and what are your success rates with this technique?

  8. Are there any alternative treatments or options to consider for improving the appearance of the labia majora after vaginoplasty?

  9. Will I need to undergo any additional consultations or evaluations before deciding to proceed with labial fat grafting?

  10. Can you provide me with before and after photos of patients who have undergone labial fat grafting after vaginoplasty to give me a better idea of the potential results?

Reference

Authors: Patel V, Morrison SD, Gujural D, Satterwhite T. Journal: Aesthet Surg J. 2021 Feb 12;41(3):NP55-NP64. doi: 10.1093/asj/sjaa431. PMID: 33400769