Why Are Women Getting Their Labia…Puffed?
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You never know what’s going on between the legs of other women. So, I’m going to ask you to withhold judgment while I explain a newish cosmetic procedure called the labia puff. And, yes, I realize that confusing name alone deserves judgment. Perhaps a definition will help: The labia puff (which should more accurately be called the labia majora puff) is a cosmetic procedure to plump and/or smooth the outer labia, typically using cosmetic filler (yep, the same stuff that goes in the lips on your face) or fat transfer. Doctors have been treating labia majora atrophy with filler since at least 2010, but board-certified urologist Fenwa Milhouse, MD, thinks the term labia puff came a bit later. She first heard it about 10 years ago and says the procedure has gotten more popular every year. “One day it’s going to be a household type of thing, where we talk about it the way we talk about breast implants,” she says. That remains to be seen, but board-certified dermatologist Mona Gohara, MD, says that patients in her Connecticut practice do ask her about it regularly: “Probably once every couple of weeks. It's not infrequent.”
Some of you will react to this information with disbelief. Why would anybody want a fuller labia majora? But there are others who will understand right away. Vulvas change. And there are many parts of them that can change. A quick anatomy refresher: The vulva is the external female genitalia, which includes the labia minora (the hairless inner lips on either side of the vaginal opening) and the labia majora, or outer lips, that are composed of fatty tissue and covered with hair-growing skin. Once puberty hits, the vulva’s appearance is constantly in flux. The inner and outer labia can lengthen, swell, darken, lighten, and shrink—not necessarily in that order or proportionately or symmetrically. Vulvas change temporarily throughout your menstrual cycle and during sexual arousal, and permanently due to childbirth, hormonal shifts, and however many years you’ve been on Earth. It’s not a black hole down there; gravity still operates.
And so does estrogen depletion. Most of the patients in Dr. Gohara's dermatology practice who inquire about treating their labia are over 45, some are well into their 60s. “Just like every part of our skin, the labia can sag and they can become less full,” says Dr. Gohara. “Although this is one area where we really can't blame sun exposure. But our estrogen levels dip and so does collagen, so does elastin.”
These changes make some women self-conscious, which brings us back to the labia majora puff. One 36-year-old from New Jersey, who asked to be called Melissa, told me she had the procedure done by a plastic surgeon as part of a more extensive vaginal rejuvenation surgery. “After giving birth, my minoras got longer and thicker, and my majoras deflated, so I wanted to restore volume and feel sexier,” she says.
Another woman, Anna (also a pseudonym), 42, says she takes a medication that lowers her estrogen levels, and her gynecologist told her she’s likely experiencing perimenopause because of it. “My vagina was looking like a very old, worn-out gym sock,” she says. “Not to be too graphic, but it also seems like the labia majora do a lot of the work of holding the labia minora in position.” Ultimately though, this is not a procedure to change the structure of the vulva; it’s purely cosmetic.
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What is a labia puff?
There are surgeries that can tighten the vagina or labia majora or alter the size and shape of the labia minora, but the labia puff is a nonsurgical treatment. “It’s to look a little more plump and youthful,” Dr. Milhouse says. “I’ve had women in their 20s get this procedure because they feel their labia majora are very underwhelming, and certainly peri- and postmenopausal women get it as well.”
The technique a doctor uses depends on the patient’s concerns and goals, as well as their anatomy and medical history. Board-certified plastic surgeon Usha Rajagopal, MD, says for some of her patients who want more youthful plumpness and who don’t have significant issues with loose skin or sagging, she may do the puff by injecting a hyaluronic acid (HA) filler such as Juvederm Voluma, Restylane Contour or Restylane Lift, or RHA 4. Yes, these are off-label uses, but Dr. Gohara says, “It's not uncommon to put filler in places in the body that aren’t FDA-approved. People put filler everywhere: their temples, their knees, their backs. This is just another area of the body.” (Small studies—like this one and this one—have found no reported complications in people who received filler in their labia majora.)
“Most women want volume but they don’t want, like, a huge camel toe.”
Injecting HA filler into those lips isn’t all that much different than injecting it into the ones above the belt—or anywhere on your face, for that matter. The procedure is quick (usually about a half hour) and only requires a topical numbing cream. Dr. Milhouse says that for a modest volume increase, she typically injects one to three syringes of filler in total (one syringe contains around one cc or milliliter of filler), but for more dramatic improvement, she’s used up to six (typically one syringe or less is used to plump the lips on your face). “You don’t see many people who want more than six syringes,” she says. “Most women want volume but they don’t want, like, a huge camel toe.”
The cost of a labia puff depends on the amount and type of filler used, along with where you live. Dr. Rajagopal, who practices in the San Francisco metro area, says one cc of Juvederm Voluma typically costs about $1,200, and this particular procedure usually starts at around $2,500. Results last about a year, although it's worth noting that recent MRI studies on filler used in the face have shown it lingering much longer than advertised. “Parts of it can last for well over 10 years,” Dr. Ben Talei, a board-certified plastic surgeon, has told Allure.
Most surgeons performing the labia puff use hyaluronic acid fillers because they have an excellent safety profile, and if—for whatever reason, medically or aesthetically—they or their patients aren’t happy with the results, the doctor can inject hyaluronidase to dissolve the filler.
But there are other tools for labia puffing that can be used on their own or, more commonly, in conjunction with other surgical enhancements like a labiaplasty. For example, Dr. Rajagopal has used Renuva injections to help restore volume. (Renuva is a cosmetic injection derived from purified fat cells that stimulates your body’s own fat production; it’s FDA-approved for use anywhere on the body where fat exists.) The results are not immediately noticeable but appear within a few months and can last up to 10 years. The cost is similar to hyaluronic acid filler.
Another option is an autologous fat transfer, which is when a doctor extracts a patient’s fat from a transfer site (usually the stomach, butt, or thighs) using liposuction, purifies it, and then injects it into the outer labia. It's also known as “fat grafting.” The procedure is more expensive than getting an HA filler (it starts at around $5,000) but lasts longer because the fat that survives the transfer will remain for up to 10 years. Dr. Milhouse hasn’t done a fat transfer to the labia majora, mostly because she thinks the results are less predictable. “With HA filler, what you see is what you’re going to get,” she says. “With fat transfer, it’s going to look super volumized at first, but maybe a third or more of that fat will not survive long-term.” (Doctors typically over-inject with fat transfers to account for the fat cells that don’t stick around.)
Other doctors disagree. “My preferred approach to restore or enhance labia majora volume is with autologous fat transfer,” says board-certified plastic surgeon Adam Kolker, MD. “You may require more than one treatment session to achieve optimal volume, but there's lower risk of an allergic reaction or immune response than you have with injectable fillers. And unlike fillers, fat can integrate into the existing tissue incorporating local blood supply, providing more natural and longer-lasting volume enhancement.”
What are the risks of getting a labia puff?
Injecting filler anywhere in your body comes with risks—both temporary (swelling, bruising) and longer term (asymmetry, lumps). In response to an increasing number of patients asking her about cosmetic treatment options for their labia, Dr. Gohara says, “I scoured the literature.” Her takeaway: “The complications are the same complications you can get with any filler… results can be uneven, you can get lumps, you can get granulomas—which are these balls of inflammation that can be tough to get rid of.” So did she decide to perform ‘labia puffs'? Ultimately, no. “This is an area involved with intimacy, whether with yourself or a partner, so complications could have far more impact on your quality of life than they would when placing filler in other parts of the body.” She also has concerns about the increased blood flow in this region. “The labia are more vascular than most other areas where you’d inject filler so would presumably have a higher risk of vascular occlusion [blockage of a blood vessel], which can lead to tissue death,” she says. “This is the most devastating complication for any filler procedure.”
Dr. Milhouse agrees that this a risk, though a rare one, and in her opinion the safest option is to be treated by a doctor trained in urology or gynecology. “Worst-case scenario, if something goes wrong, you want to be in the hands of someone who knows this anatomy, has experience doing surgery on it, and can get you out of trouble,” she says.
For puffs done with HA filler, Dr. Rajagopal says there’s little downtime when all goes well; a patient might experience swelling or some bruising the first week after the procedure. Once tenderness goes away (usually within a week, maybe up to two), they can resume sexual activity or even get waxed.
Fat transfer is a two-step surgical procedure so it requires local anesthesia, which means it comes with additional risks, including anesthesia complications such as allergic reactions. There’s also the possibility of scarring, fluid buildup, or a fat embolism, which is when fat is accidentally injected into the bloodstream and can cause blockages or injury to your lungs. For most patients, it’s a minimally invasive surgery and they are back to normal within a week or two.
In Dr. Gohara's view, a ‘labia puff’ is “certainly not a no-way-in-hell procedure. But you have to know who's doing it and what the complications are.” And there's one person who definitely shouldn't be holding the syringe: you. Yes, some women are injecting themselves with filler for what might be called a DIY labia puff. I texted with one of them, who asked to remain anonymous, and she told me she was a health-care professional and did her own puff because her labia majora looked “deflated” and she couldn’t afford to have them re-inflated in an office.
To be clear, absolutely no one recommends trying this at home. The DIY route for any type of cosmetic injectable is extremely risky, not least of all because someone buying supplies online has no idea if the product they are using is legit or labeled correctly.
Why are labia puffs becoming more popular?
We're pretty sure we have the answer: 84% of American women say they groom their pubic hair regularly and 62% say they’ve removed all of their public hair at some point, according to a 2016 survey of 3,316 people. More women are able to see their labia clearly—and start judging them against the beauty standards of the day. “If we were all hairier, this would not be a thing,” says Dr. Milhouse. “In fact, this whole sector of cosmetic enhancements to the vulva, including labiaplasty, would probably not be as popular.”
Where do those standards come from? Usually pornography. “These days, we’re more in tune with our private parts than ever, which I love,” says Dr. Milhouse. “By the same token, we’re judging ourselves against porn and other images, which have a certain aesthetic.” In pornographic images and adult films, the women often have inner labia that are small and hidden by the outer labia, which are typically smooth, hairless, and…if not puffed exactly, at least plump.
“If we were all hairier, this would not be a thing.”
You may think it’s sexist and antiquated to change (or simply want to change) your vulva to make it look more like the current beauty standard, especially when you think about where that standard originated. But if you’ve ever dyed your hair to cover grays or gotten a laser facial to get rid of dark spots, is that really that much different? (As Dr. Gohara puts it: “If you choose do a labia puff, I have a healthy respect it. You just have to be careful.”) Those other aesthetic choices can feel empowering and give you confidence, but they’re still shaped by external societal and cultural forces, just as the labia puff is.
Ultimately, most of the women who are getting this procedure say they do it to feel better about themselves, so they can enjoy their bodies more. While the labia puff doesn’t anatomically enhance sexual pleasure (there are other treatments for that), Dr. Milhouse says it can have a real psychological impact, giving women the confidence to relax and enjoy themselves more in bed. “People say, ‘Why do you even care what you look like down there?’ But when someone knows they look a certain way, they feel a certain way,” Dr. Milhouse explains. “I had a patient who, after her procedure, was like, ‘I’m getting turned on just looking at myself and thinking about what I had done.’” How many people who’ve gotten filler in their face can say that?
Additional reporting by Allure editors
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