GENITAL AESTHETIC SURGERY

Dr Rakesh Kalra completed MBBS from Chhatrapati Shahu Ji Maharaj University (erstwhile King George’s Medical College, Lucknow) in 1980; MS – General Surgery in 1983 and MCh - Plastic Surgery in 1986 from the same university. He is an active member of the International Society of Aesthetic Plastic Surgery (ISAPS), Faculty Member of Association of Plastic Surgeons of India (APSI), former executive member of Indian Association of Aesthetic Plastic Surgeons (IAAPS) and Former President of Indian Medical Association (IMS), Dehradun.

Know more about genital aesthetic surgery from Dr Kalra.

How do you identify a good candidate for genital aesthetic surgery? What is the type of patient you typically see for this procedure?

A good candidate for the surgery is someone whom the surgeon too perceives as one who genuinely needs treatment, and whose correction could make a vast and positive difference to the appearance of the genitals. If the malady is not obvious, the patient who desires a surgery on make belief issues, is not a good candidate for surgery. A surgeon can only change the appearance, i.e., the anatomy, but he cannot change the physiology. So, a patient with issues of performance too is not a good candidate.

Aesthetic genital surgery is a spectrum of surgical procedures, and each procedure is further customised for every patient. From the time a woman gets sexually active to the time she is past menopause, there can be a demand for genital surgery. As an example, a young woman may want trimming of labia minora, or unhooding of clitoris. But by middle-age, woman may want, besides the above, fat grafting to her labia majora, or tightening for loose vagina. Hence, there are different procedures for different age groups with different requirements.

Males usually want aesthetic surgeries in their middle age, but rarely in their youth. Re-marriages usually are the stimulus for such surgeries in both sexes. And adverse comments by the partners, regarding the appearance of genitals and performance are also common problems for which we see patients.

How can best results be derived from this treatment? Tell us about the surgical technique adopted by you?

Best results are derived if procedures are as per requirement and when the surgeon knows how to customise them, keeping the goal or requirement of the patient in mind all the time. This requires good communication skills of the surgeon, who should be able to first establish a good rapport with the patient, so that she relaxes and overcomes any shyness. The surgeon should seek out the actual requirements or demands of the patient, to sift out psychological issues and unreasonable demands. Finally, educating the patient on the various possibilities, and discussing sufficiently to make her aware of the extent of the benefits are important to be able to get the best results from this surgery.

The surgical techniques we adopt are by now well-established and lakhs of patients worldwide have been treated this way. Males have their organs lengthened by release of a tethering tight ligament, and their organs increased in width by fat grafting. Females have their extra long or hanging inner labia trimmed, the thin atrophic looking labia majora plumped with fat grafting to improve the looks. Post-delivery, tightening is done for loose vaginas. There are some sexual orgasm enhancing procedures too, like clitoral unhooding and G Spot enhancement, which are done whenever demanded.

What is the recovery time for a genital aesthetic surgery and what is the posttreatment care involved?

Surgery of genitals is the same as a surgical procedure of any other region of the body. Good healing of all suture lines in all surgeries usually occur within a week’s time, and this period is similar in this surgery as well. However, active sexual life may be possible only after another couple of weeks, depending upon a specific procedure. But in no case, abstinence is necessary for over four weeks at the maximum.

In the immediate post-operative phase, routine antibiotics, local area cleaning and creams are used. Pain alleviation is usually required for just a day or two.

Any contraindications involved that one should be aware of? Also, is there anything the patient must not do after the procedure?

The surgeon must be satisfied himself about the patient’s actual need for the requested procedure. If he thinks the demand is way beyond what the surgery shall be able to deliver, he should refrain from doing the surgery.

Any systemic diseases that the patient has, should all be taken cognizance of, just so that the anesthesia or surgery for a seemingly less pressing issue does not flare up the general disease. This means, as an example, if a patient has diabetes, it obviously must be controlled before the surgery happens.

Unhygienic conditions of the local area too are a contraindication. For example, any skin disease of the genital area, which should be thoroughly treated before an elective surgery like genital aesthetic surgery is undertaken.

Which do you consider as a most challenging as well as successful case study for this treatment, and why?

Personally, my very first case for aesthetic genital surgery was the most challenging one. It was also my most successful case. A young lady from abroad came in requesting aesthetic genital surgery more than two decades back, at a time when there was no existing literature or text book description of any sort for this surgery. Her demands were clearly noted, understood, mutually discussed and steps of surgery innovated custom-made. What followed was one of the most gratifying results and the patient was extremely pleased, and so was I at the success.

Plastic surgeons are like tailors, who, with changing fashions, can design a new draping, and cut and sew according to demand. This basic training helped me give extremely good results in my most challenging case.