Perineal Skin Excision Surgery

About Perineal Skin Excision Surgery

The perineum is the delicate area between the vaginal opening and anus. During childbirth, intense pressure is applied to the perineum as the fetus passes through, resulting in perineal episiotomy in approximately 60–70% of first-time mothers and about 50% of multiparous women. Additionally, even without incision, natural tears occur in over 70% of cases.

After childbirth, the sutured perineum may develop excess skin due to scar formation or tissue retraction, and suture marks may heal unevenly. Many postpartum women experience concerns such as "the shape differs from before pregnancy," "sagging skin is bothersome," or "the suture marks feel tight." Perineal skin excision surgery carefully removes excess skin and scar tissue, restoring the area to a smooth and natural condition through surgical intervention.

Mechanism and Medical Evidence

Perineal skin excision surgery involves precise removal of excess skin and mucosal tissue, followed by careful suturing of the submucosal layer and surface. Absorbable sutures that are naturally resorbed in the body are used, eliminating the need for return visits for suture removal.

A prospective study published in International Urogynecology Journal (2014) evaluated postoperative psychological and sexual outcomes in patients who underwent vulvoplasty, reporting significant improvements in satisfaction with vulvar appearance and self-assessment (doi: 10.1007/s00192-013-2297-2). Additionally, a comprehensive literature review published in Aesthetic Surgery Journal (2015) (doi: 10.1093/asj/sjv023) analyzed various techniques for vulvoplasty, demonstrating that appropriate tissue removal and layered suturing contribute to favorable healing and improved satisfaction.

Procedure Flow

Consultation and Examination

The attending physician will listen to your concerns and examine the perineal area. After confirming the extent of excess skin and scar condition, the excision design and suturing method will be explained.

Anesthesia and Surgery

Since local anesthesia is used, the procedure can be performed on an outpatient basis. Excess skin and mucosal tissue are precisely designed and removed, and the submucosal layer and skin surface are carefully sutured in layers using absorbable sutures. By creating a two-layer suture structure, tension distribution and beautiful results are achieved simultaneously. Surgical time varies depending on the condition but typically takes approximately 60–90 minutes.

Postoperative Care and Downtime

Since absorbable sutures are used, suture removal is generally not necessary. Swelling, discomfort, and mild pain may occur for 1–2 weeks after surgery, but these can be controlled with prescribed medication. Light work such as desk work is possible within a few days, but intense exercise, bathing (showers are possible from the next day), and sexual activity should be avoided for approximately 4–6 weeks after surgery.

Expected Results and Precautions

With appropriate design and careful suturing, improvement in the perineal silhouette and relief from skin sagging and scar-related tightness can be expected. However, tissue recovery and final results vary among individuals. Since risks of inflammation, infection, suture failure, and recurrent scar formation are not zero, it is important to strictly follow postoperative instructions.