Labia majora sagging: incision, hyaluronic acid, or fat? Pros and cons of three approaches

Concerns about the labia majora differ depending on whether excess skin is causing sagging or reduced fullness is causing deflation. The appropriate method changes accordingly. To reduce excess skin, surgical incision is the main option; to compensate for deflation, hyaluronic acid or fat injection are the primary choices.[1][2]Each method has advantages and disadvantages, and research on them remains limited.

How do you tell the difference between sagging and deflation?

The main reasons the labia majora loosen are age, decreased female hormones after menopause, and significant weight loss.[2]As fat inside decreases, fullness is lost and the area appears deflated.[2]

On the other hand, if skin is noticeably excess, it can affect not only appearance but also cleanliness, sexual function, and daily movement.[3]Whether the condition is closer to sagging or deflation determines whether the approach should be to "reduce" or "add."

Who is a good candidate for surgical incision?

For people with excess hanging skin, surgery to remove the excess skin is central.[1]It is sometimes performed together with surgery on the labia minora; in a large analysis, 33 people underwent labia majora reduction surgery in addition to labia minora surgery.[4]

However, surgical incision reduces excess skin and does not restore lost fullness. Some experts believe that if the concern is deflation of the labia majora, adding volume is a better approach.[5]

Within the scope of this review, we found no research that examined the results of labia majora incision surgery alone in detail. Prospects for effectiveness and complications need to be discussed individually during a consultation.

Hyaluronic acid augmentation: advantages and considerations?

Hyaluronic acid is a method to add fullness without incision. A 2016 report documented use in 54 people, showing improved appearance, few complications, and the advantage that it can be dissolved and reversed.[1]

Research also compared hyaluronic acid with calcium hydroxyapatite (an injectable material containing a component found in bone). At 90 days, 80% of those receiving hyaluronic acid reported very good results compared to 50% with the other agent.[1]

Considerations include that the effect may wear off in a few months, and high volumes can increase cost.[2]Though rare, severe infections (sepsis or necrotizing fasciitis) after injection have been reported, and the procedure requires an experienced physician.[1]

How does fat injection differ?

If one's own fat takes successfully, it can last a long time.[6]However, deflated labia majora may require approximately 60 mL of fat per side.[2]

Because injected fat is partially reabsorbed, the volume that remains varies, and there is a risk of nodules (fat necrosis).[6]The period to avoid strenuous exercise or sexual activity averages around 4–8 weeks.[6]

How do you choose among the three methods?

When deciding, it helps to think in terms of three factors: "excess skin," "reduced fullness," and "available downtime."

A rough guideline is: incision surgery if skin is excess and hanging; hyaluronic acid if deflation is the main concern and incision is not desired; fat if longevity is prioritized and downtime is available.[1][2][6]There are also reports of combining methods, such as injecting the labia majora after labia minora surgery.[6]

What should you confirm during consultation?

Choosing a method for the labia majora cannot be decided without direct examination. The degree of excess skin and reduced fullness differs from person to person.

During consultation, confirm with your physician your condition (whether it is closer to sagging or deflation), the type of agent or fat volume to be used, the recovery period, and how complications will be managed.