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Vaginoplasty/Vulvoplasty Repairs and Revisions

Medically reviewed by Ellie Zara Ley, MD on December 16, 2024.

For some patients, revisions to the labia, urethra and/or vagina are a part of their bottom surgery journey. Whether you were formerly her patient or not, Dr. Ley (she/her/they) is very experienced in helping patients address surgical complications or dissatisfaction with the results of their gender-affirming procedure. At the GCC, we work closely with patients to design personalized surgical revision plans to address our patients’ unique medical and/or aesthetic concerns.

As one of the only transgender women of color to be a board-certified plastic surgeon and a leader in her field, Dr. Ley is often sought out for bottom surgery revisions. She has a successful history of helping patients with vaginal deepening and/or widening, revising the labia, clitoris, vaginal opening, urinary tract and undesired scar formations. You can read more about her revision specialties below.

Vaginal Widening/Deepening

Some patients experience loss of depth or width of the vaginal canal after vaginoplasty. This can be due to a variety of factors, including inconsistent dilation and individual healing outcomes. If you are dissatisfied with this outcome, an additional surgery using full thickness skin grafts can help increase the width and/or depth of the vaginal canal. Based on your surgeon’s assessment, we can take full thickness skin grafts from the hips, or in some cases, the mons area in the lower pelvic region. The advantage of a full thickness skin graft is that long-term evidence has shown it to be highly durable, therefore preferable to patients who are interested in using their vagina for penetrative sex. Frequent dilation is required after this surgery, similar to the frequency of dilation required after an initial vaginoplasty.

Labiaplasty Revision

If the labia minora loses definition during the healing process, meaning if they begin to appear flatter or smaller than you would prefer, you can have your labia minora revised. Dr. Ley is particularly experienced in conducting this surgery on patients who underwent a one-stage, as opposed to a two-stage, vaginoplasty, where the vagina and the entire vulva is constructed in one surgery; this is because the labia do not often heal fully when the body has to recover from both a vaginoplasty and a labiaplasty at the same time. A revision labiaplasty surgery often involves using additional skin grafts to augment the existing labia minora. We can take skin grafts from the labia majora or the hip area, depending on the extent of the reconstruction needed. Conversely, the skin from the labia can also be tightened or reduced if desired.

Clitoral Revision

If a patient’s clitoris is too large, exposed or too hidden for their liking, they can undergo a revision surgery to correct this. The clitoris can be reduced in size (“clitoral reduction”) or the clitoral hood can be made larger (clitoral hood reconstruction) to cover more of the clitoris if preferred. If the clitoris is too hidden for a patient, a revision can be performed as well to make it more apparent and reduce the amount of skin around it.

Scar Revision

Patients that are unsatisfied with the appearance of their scars from surgery due to how they initially healed can get their original scars excised. Since new scars are created independently and not a part of a larger operation––like the construction of a vagina or vulva––the body experiences less stress through the healing process. Likewise, the creation of new scars can give patients the opportunity to be more diligent about taking care of them or try new treatment options to reduce their size, texture and discoloration.

Release of Posterior Vaginal Web

This is skin that can build up and cover the bottom of the vaginal entrance, which can make dilation or penetrative sex difficult. A revision surgery can correct this if it does occur.

Urethral Revision

If you have any troubles with urination after surgery, you may be able to undergo a revision. Complications can include urine spraying, inability to urinate, urinary frequency, and others. Some patients have issues with the amount of erectile tissue leftover after surgery. Discussing the issues you are experiencing with your surgeon can help in deciding what next steps are necessary, including whether or not a surgery is necessary.