Many women who come to see me have already had a labiaplasty elsewhere. They come because something went wrong, and some tell me they no longer look in the mirror. It just doesn’t look normal. If that is you, know this first: what happened has a name and a cause, and very often it can be improved. This week I am sharing a short before-and-after video of the two techniques I use for exactly this problem, feathering and grooving. Watch it, then read on. What a Botched Labiaplasty looks like “Botched” is a harsh word, but it is the one my patients use. The problems I see most: * Scalloped or notched edges. The edge ripples with small bumps or has little V-shaped bites instead of one smooth curve, often from stitches tied too tight. * Uneven sides, or thick, raised, dark cut lines with ridges or leftover tags. * Holes or strands of skin bridging the inner and outer lips. Wedge labiaplasties with poor blood supply can be a culprit. * Too much removed. Part or all of the inner lips (labia minora) is gone, which surgeons call amputation. Looks great in some patients with the right anatomy but looks terrible in the wrongly chosen patient. The upper third of the inner lip shrinks back a lot as it heals; a surgeon who does not plan for that can leave a woman completely flat. How it feels It is not only about looks. A tight scar can pull during sex, exercise, or in snug clothing, and a hood scar can stay tender. Sometimes when the inner lips are reduced too much, our paper notes they normally help direct the urine stream and protect the urethra and vaginal opening, so losing them can bring dryness and a spraying stream. And there is the emotional weight: embarrassment, anger, betrayal. Feeling abnormal. Feathering: refining and resurfacing the edges Feathering is my name for repairing damaged labial edges. With an ultrafine “hair tip” and a small ball tip on a radiofrequency device, and sometimes a CO2 laser, I shave down ridges, smooth out scalloping, shrink bulky areas, soften scars, and balance the two sides. Often few or no stitches are needed. A session takes 30 minutes to over an hour, and I often pair it with small surgical trims. I have done this kind of radiofrequency repair since 2005. Thick, folded, irregular edges before resurfacing (left), Labiaplasty results (Second Picture), immediately after Feathering (Third picture), and 6 Weeks after feathering (right). A bumpy, uneven result before resurfacing, right after surgery, and six weeks of healing. No sutures. All done with radiofrequency. Grooving: creating new labial definition Feathering refines tissue that is still there. When little or nothing is left, grooving creates. Under local anesthesia, I use the fine radiofrequency tip to trace the old crease where the inner and outer lips used to meet. I deepen that line into a groove, freeing a thin edge on the inner side. Beside the new groove, that edge reads to the eye as an inner lip. Honestly, it is mostly an optical illusion: new shadow and contour, not new tissue. For more definition, a few stitches can join the outer-lip side of the groove to the new lower edge to hold the shape. I first used grooving for a few of my own Barbie Look patients who later wanted some inner lip to show, then for women whose labia were removed elsewhere. Our paper records that I described it in 2007. For years I taught it only to my Fellows rather than publishing it. Grooving. Left: almost no inner lip. Middle: right after the groove is made. Right: six weeks later, with new definition. What our published paper found Reham Awwad, Red Alinsod, Natalie Sorial, Amr Seifeldin. Labia Minora Reconstruction using a Labia Majora Flap for Female Genital Mutilation/Cutting and Botched Labiaplasty. J Clin Res Case Stud. 2024. 2(3): 1-11. DOI: doi.org/10.61440/JCRCS.2024.v2.53 Before this paper, published methods for rebuilding inner lips borrowed tissue from the clitoral hood, which is impossible when the hood has been cut away or is too small. My friend Dr. Seifeldin, a urogynecologist in Cairo, developed a different method in 2015: he lifts a flap from the hairless inner side of the outer lip and turns it up into a new inner lip about 1.5 to 2 centimeters wide. The paper presents four women treated with his flap, all of whom had undergone genital cutting as girls, and one 21-year-old treated with grooving after a Barbie Look labiaplasty, when she asked for her labia to be extended. The findings: * Everyone healed within the expected six to eight weeks, and all were highly satisfied, describing “feeling complete” and “feeling confident.” * Both women who had complained of dryness noticed better lubrication. * Pain was minimal for two to four days, managed with oral pain medicine and cold compresses. * Two had mild early swelling; one had a small spot of sticking, easily released at two weeks. No complications occurred during surgery. The limits matter: this is a small case series, only two patients returned at six months, no standardized self-image questionnaire was used, and longer studies are needed. Encouraging, not final proof. Who is a candidate * You are fully healed. Tissue keeps changing for months; most experienced revision surgeons, me included, wait at least about three months after initial surgery. * Feathering suits edges that are scalloped, notched, bumpy, uneven, or scarred, with enough tissue left to reshape. * Grooving suits little or no inner lip when you want modest definition, up to the level of the outer lips and slightly past. For more width, a flap may be better. * You can commit to aftercare. Smoking slows healing; none of the women in our paper smoked. You have to follow my instructions for proper healing. What recovery is like * Swelling peaks in the first week; regular icing helps. We give you numbing cream for those irritated periods. Raw surfaces heal over about six to eight weeks. * The Q-tip exercise is essential. After numbing cream, you gently run a cotton swab along the healing groove or edges twice a day for four to six weeks so they do not fuse. In our paper, the one case of sticking was blamed on too little ointment. * PRP from your own blood and estrogen or exosome cream may be recommended. It can speed up and improve healing. * The look keeps maturing for months, and sometimes a second session is needed. One woman below had two treatments. Healing week by week: the botched result on Top, after resurfacing in Middle, two months later at the Bottom. Realistic expectations Revision is improvement, not a time machine. Removed tissue cannot be put back exactly as it was. Feathering smooths and balances; grooving restores the look of an inner lip; a flap adds width. I cannot fix everything, but I can fix a great deal, and I will tell you plainly what to expect. Questions to ask a revision surgeon * How many labiaplasty revisions have you done, and may I see before-and-after photos of cases like mine? * What went wrong in my case, and do you recommend feathering, trimming, grooving, or a flap? Why? * How much definition can I realistically expect? * What will daily aftercare involve, and whom do I call if I am worried? * What if the edges stick together, and might I need a second procedure? A closing word If your first surgery left you hurting or ashamed, please do not blame yourself. You trusted someone. You deserve to be heard, examined carefully, and told the truth about your options. Most can be repaired beautifully. It’s not hopeless. Here are a few more past Newsletters on Revision Surgery: * Botched Labiaplasty Revision Surgery Case Studies * Feathering for Botched Labiaplasty Repair * History of the Alinsod Grooving Technique to Create Labia Minora from No Labia FOR THE SURGEON The BEST place to learn Cosmetic Gynecology from your home and office. Anywhere. GYNFLIX Cosmetic Gynecology e-Learning For Detailed Videos Click on the Index Photo Below: For more Cosmetic Gynecology Training join Gynflix.com Gynflix is an online e-Learning platform dedicated to Feminine Wellness. Videos of topics such as labiaplasty, vaginoplasty, cliteroplasty, clitoral hood reduction, anal skin tag excision. Click here for Silver Bullet Subscription at $98 a month: Gynflix Subscription Contact Suzette Peterson at (909) 374-1000 or email her at sette.peterson@gmail.com if you are interested in Fellows Gold Subscription at $198 a month. GOLD FELLOWS MEMBERSHIP: This unique and valuable service provides access to all future surgical and non-surgical videos on www.gynflix.com.There will be 1-2 complete and unique videos per month. Dr. Alinsod will be available to discuss the intricacies and details of topics covered in the videos and answer specific questions that may arise . This is the first and only true Master’s Course for continuing education focused on cosmetic gynecology. I love hearing from my Fellows, Grads, subscribers. Text or email me. I answer questions from all around the world! NOW AVAILABLE IN SPANISH: CLICK HERE FOR GYNFLIX ESPANOL! For Cosmetic Gynecology Short Videos (free for all) go to Video Shorts on Gynflix. This is made for the Lay Public. Dozens of high def, high quality videos of actual surgeries. For Cosmetic Gynecology Before and After Video Gallery go HERE. The patient’s Story from Start to Finish. Let’s Stay Connected I’m so grateful for the opportunity to serve you, whether you’re a patient, a colleague, or someone curious about what we do. Our new Arlington location is ready to welcome you with the same compassionate, personalized care you’ve come to expect. Explore our services, my background, and our mission at: * alinsodinstitute.com * About Dr. Red Alinsod * About Alinsod Institute I’d love to hear from you—reach out with questions, feedback, or just to say hello. Together, we’re shaping a brighter, healthier future for women everywhere. Social Media: Follow my Social Media adventures below as I educate and enterta