If Leggings Could Talk: Everything You Want to Know About Labiaplasty ၏ စာသားမှတ်တမ်းအပြည့်အစုံ

your skin. But this was just always kind of like a cloud, like a dark cloud in terms of my mental wellness, especially as I started coming into the age where I was physically active and I was having partners, things of that nature when you're very conscious, self-conscious about that stuff. Dr. Kuruvilla (03:19): Before your friend made that comment or you heard that disgusting comparison, did you ever feel discomfort and you were just like, oh, this is just how my body is and you would compensate for it or did that come later with clothing and exercise and stuff like that? Patient (03:34): I feel like it definitely clothing middle school is when I noticed okay, it's a little uncomfortable. You hear the dreaded word granny panties as a child or when you're in school and so you feel like, oh, I have to wear these other types of underwear. And so I tried to assimilate and I got a pair of the underwear that my friends had and it just was immediate discomfort and I'm like, when I wear these underwear, it looks a little bit different than when my friends are wearing these underwear. And so I think that's probably what I noticed in terms of the feel of the discomfort when wearing underwear or wearing anything that's anything restrictive, I would notice that and it would be constant adjusting or I had to stand up and move and people might've thought, oh, well this girl's very antsy. She's always moving, but it's not so much being antsy, but I'm trying to keep my circulation here because it can be very uncomfortable. Dr. Kuruvilla (04:30): And so frustrating. Like it's such a taboo topic. You can't explain yourself and you just kind of have to keep it to yourself. And I guess that leads me to my next question. I know that you have the most lovely supportive partner now, but back then, was there anybody that you felt like you could talk to about this or even a doctor or a family member or a really good friend? Patient (04:52): I had made comments about it to my mom at a point where she always told me, it's okay to love yourself how you are, there's nothing wrong with you. I definitely believe while she meant good, there were some seeds that she might have planted in terms of doubt. Like, okay, this is going to change the way you feel. You're not going to be able to feel the sensations that you would feel before. There's all of these what ifs, but the positive heavily outweighed the internal, what if this doesn't work or what if it doesn't feel right or what if I'm unhappy with it? It was all heavily outweighed by, okay, well that's going to improve my quality of life. It's going to improve my confidence, it's going to help me feel more sanitary, especially during my cycle, things like that. Because when there's more skin, there's more things you have to clean and that's not necessarily always the easiest thing to do, especially when you are in meetings all day, you're working in the office or you're commuting. It's not a hundred percent accessible all

the time to just be able to go and clean yourself the way that you feel, well, at the way that I felt I needed to be sanitary. It was always a challenge. Dr. Kuruvilla (06:01): Just things that would never people just take for granted every single day. Was your real experience of just an added, I dunno if inconvenience is the right word, but just another thing to have to care of. Patient (06:14): It was an inconvenience. Honestly, it was because it would get to the point, I don't want to be overly graphic, but where you'd have to tuck it to the side or push it behind and it's like, I didn't love that. That wasn't my favorite thing to do. I mean, I did it because I knew I needed to just adjust so that way I could be comfortable in my own skin, but it just got to the point where it, it just was negatively impacting my day-to-day, both physically and mentally. And when you have both of those together, it can be a doozy. Dr. Kuruvilla (06:43): Huge burden and you have enough to worry about when we are middle school and high school aged girls in this world. When did you have a serious thought about if this could be surgically corrected and consider consulting with somebody about it? Patient (07:00): Labiaplasty has always been something that was in my vocabulary from the time that I learned about what it was and that it was an option and that there was other people like me and other women that were afraid to take the next steps to improve their just overall quality of their life, especially if they were, like I said, the petal, I call 'em petals. Dr. Kuruvilla (07:21): I love that. Patient (07:22): Petals are different lengths and so for me, mine was at a point where it was like I have to do something at this point. And so I was like, okay, I'm 35. I'm getting to the point where those next steps in my life will be going through perimenopause and things are going to change and I would rather nip it, so to speak, before it starts evolving into its next shape. Dr. Kuruvilla (07:46): And be honest, you're not going to hurt my feelings at all or anything. Was I your first consult or had you seen other consults before? Patient (07:52): No, you were my first one? Dr. Kuruvilla (07:53): Okay. Patient (07:54): Yeah, it was actually very spontaneous. We was just sitting there with my husband, we were eating dinner and I was just like, I would really like to have this procedure, and I think my husband's always known that it's bothered me and his support was absolutely the encouragement that I needed to make that phone call. Dr. Kuruvilla (08:13): He's so wonderful. Patient (08:14): It was just so supportive, so patient, so kind. His encouragement gave me the confidence to even just kind of call and just get an idea. I was like, okay, maybe I won't do the surgery right away, but it's not going to hurt to at least go in and get the information. So that way at least when I do make that decision, I have all the facts and I have a resource available that

I can use. And then I think from the first time that I called and just being greeted by the front desk team, you guys have cultivated such a warm environment here. I think that that really translates well, especially to new clients or new patients. Being in a plastic surgery industry, it's natural for men, women to feel some type of way about the way they look. And so I'm like, okay, I'm going into the bullpen really. (09:01): They're going to look at me and they're going to be like, oh my gosh, we got to get rid of this. We got to get rid of that. Chop it all off. Definitely that wasn't the case. It was much more reassuring and calming this, you're not the only person that has been like this. We've done procedures like this here before. There's really great successes. And I did do some initial research as well prior to actually calling, just kind of reading about the practice in customer experiences and overall their contentness with their procedure. And I was really pleased with what I saw. Dr. Kuruvilla (09:32): Thank you. Patient (09:33): And then like I said, from the time I had that just the phone call, I felt so comfortable with the practice that I made that in-person consultation instead of just calling and getting info, I was like, what does it hurt? Let's just book it. And I'm so glad that I did, and that was the first step towards just an overall better quality of life for me. Dr. Kuruvilla (09:54): Good. Thank you. Okay, so getting to the consult, I think a lot of women are wondering what that will look like the day of your consultation. So I'm going to walk through that and then if you don't mind just kind of chiming in if there's anything I leave out. (10:07): So when you come for a consultation at our clinic, we give all of our patients the same form to go over your health history. We really want to know medications you're on, your social habits, smoking, drinking of course as it relates to your particular surgery if you've had kids, and also just your overall support system. So that will get filled out. And then you'll meet with one of our lovely patient care coordinators and they just review your history with you, maybe fill in any gaps and then go over nitty gritty about your surgical goals. And then they come and report back to me. And then I think during that time you change into a robe. (10:44): And then we both go in together. So it's still me and the patient care coordinator that you've met as well as any family members that you bring. And then I usually review a few kind of just important things about history that I like to know, just helps me from a safety standpoint for surgery and see if there's any medicines I need to prescribe. In particular, part of our history and physical, the reason we get all of your past medical history is that there are common diseases that can affect our private areas. So usually the most common one that I hear about from my patients is herpes. And if you have herpes, it's no problem at

all. You can still very much have this procedure, I will prescribe you a prophylactic dose of your valtrex, usually already have valtrex and you know how to handle it. (11:24): I just don't want any open sores at the time of surgery. And then just other STDs, I just like to be well controlled there. You're on medications and whatever levels of vital counts or anything are all being monitored by a physician and are under control. The stress of any surgery can cause a sore, especially for the herpes. So that's why I have you take that prophylactic dose. There are some conditions that might require to be on steroids, and that's just important for me to know just from a wound healing standpoint because that can affect kind of the strength of your scars. But we do things to adjust for that. So nobody should feel like they're excluded from this procedure because of any medical comorbidities they have, and that includes any sort of sexually transmitted disease. And then I do always use this phrase that I learned from a surgeon in San Diego, Dr. Kat Gallus, and she says it's a spectrum of normal, so there's not a specific anatomic look that is anatomically normal. It's a spectrum, and I like to hear exactly what it is that bothers you about it, how long you've been thinking about it. I also will ask sometimes I think if there's some redundancy, it's the clitoral hood because a lot of times those two procedures are done together. (12:35): And then I think I usually say, okay, I'm going to jump the exam now. Are you ready for that? Are you comfortable? And you're in a robe? And so I will usually lean you back into the chair. I do have you do a butterfly position that I think women who have had kids are probably familiar with where you just kind of butterfly your legs out. And then I will dictate some of my exam findings to my patient care coordinator who usually isn't looking, they're sitting at a desk and taking notes. I don't even think they can really see, but it's important to have chaperones in the room. And usually I will take a ruler and do some measurements. There's a few ways to describe the type of hypertrophy. If it's like the prox, the upper third, middle third or lower third, that's enlarged. And then I just kind of describe my exam and I think that's it for exam, and I just have you kind of close the road back and we review the plan and go over risks to the procedure. Patient (13:28): That's exactly how I remember everything. Very good experience, I will say with my client coordinator that I had. Dr. Kuruvilla (13:34): Good. Patient (13:34): I can't recall her name at the top of my head, but she was very patient and very calming and reassuring that we would figure out everything we needed to in terms of the scheduling and the payment and all of that. I'm a natural learner. I want to know the ins and outs of everything and how things work and how I want to give me the details. That's kind of just how my personality is. So you were very good at communicating that information to me, saying, okay, women can range when they, I think you called it hypertrophy or something like that. Dr. Kuruvilla (14:09): Yeah, hypertrophy. Yeah, Patient (14:11): Hypertrophy. Okay. I still said it wrong, but it's good. Dr. Kuruvilla (14:14): I like it. Patient (14:15): You had said that that can vary in terms of how long or how many centimeters, and so when you explain that and you're like, okay, so here's where you're at. I was like, wow, I'm at this length and I feel so uncomfortable. I can't imagine being even longer and struggling with that. You don't feel as womanly because when you think of a bulge down there, it's typically a male anatomy, not your female anatomy. Dr. Kuruvilla (14:40): Yeah. I feel like you've echoed my philosophy. I feel like information is power, and even if patients come to a consult and even if they don't book, I do feel like I've somehow helped them by giving them some information and also maybe validating their concerns. Patient (14:56): Yeah, exactly. Dr. Kuruvilla (14:58): Okay, cool. That's very helpful. Going into the day of procedure, what were your biggest fears? I know you said you were way nervous the day before and morning out. Patient (15:06): Yeah. My biggest fears were not so much the procedure itself because I thoroughly, I had even watched gone on YouTube and I was watching not specifically anything that you had done, but just the process, the procedure in itself so I could learn just as much as I could about what to expect. Your office was very, very good, I will say about being very clear and transparent about what to expect in terms of healing, which was really helpful for me to have a realistic frame of reference. Dr. Kuruvilla (15:35): Thank you. And I think my goal, I guess my primary goal or hope for this podcast was that I feel like people here labiaplasty under local anesthesia and they just cannot grasp that, and I can understand why as a consumer or the patient, you're like, well, you're the doctor. Of course you're going to tell me it's not bad. Of course you're going to tell me that I can handle it, but can I really handle it? So I was hoping you could kind of walk me through and you could be honest parts that were painful if you had to do it again, were you okay with under local? Would you prefer under some sedation, and how did it compare to what you expected? Patient (16:12): Day of? There really wasn't anything that stood out to me negatively in terms of like, oh, I don't know if I could ever do this again because a hundred percent I would do it every time and any timeline. I wish I would've done it sooner. There really wasn't anything I can think of that made me feel uncomfortable or made me feel scared or unsure or uncertain. I had full confidence, full confidence in what you were going to deliver, and I knew that I could feel your passion as a provider. Being a medical provider, that's something you enjoy doing, and I think

that's important when you do find a surgeon is someone that truly enjoys their craft and making people truly feel better in their skin. I think that helped ease all of my mental fears. in terms of physical, like I said, I kind of was like, oh my gosh, they're going to cut this piece of me off. That's kind of always been part of me, and I had silly thoughts. Do I bury it? Do I have a little funeral for it? Dr. Kuruvilla (17:11): Yeah, we shoulda have had a ceremony. Oh man. Patient (17:13): Goodbye. So it's just like you think, oh gosh, am I going to be okay? Am I going to be so sad when it's gone because a part of me is missing. Dr. Kuruvilla (17:23): It is. Patient (17:24): And no, I can confidently say I don't feel sad that it's gone. Dr. Kuruvilla (17:30): I feel like there was a moment where we showed it to you and you were like, bye. Patient (17:33): Yeah, no, I did. I definitely, like I said, I want to know the details, so it would not have surprised me if I was like, can I see what's over there? Dr. Kuruvilla (17:39): Yeah, you definitely peeked over there. Patient (17:41): And then just seeing it. I was just like, oh my gosh. All these years of discomfort, all these years of shame, not shame, but embarrassment because I'm not ashamed of who I am. I just was a little embarrassed by it. Dr. Kuruvilla (17:54): There's a huge emotional component to this thing that you've had your entire life and you've been thinking about doing this your entire life, and maybe it always felt like this far off nebulous time, and here it is, it's happening lasting kind of about the day of procedure and don't be afraid to be a hundred percent honest. This is where I want patients to hear it. I do do the topical numbing medicine, and then I do that initial needlestick with the local. Did you feel that needle stick? What was that? Patient (18:22): I didn't. Dr. Kuruvilla (18:22): Okay. Okay. Patient (18:23): I was actually pleasantly surprised. Not that I thought it was going to make this big, huge needle. Like I said, I've had epidural, so I know needles, but this really was not even the topical numbing did such a great job. Well, did its job so well that I didn't even feel those pricks. What I do remember is you were very vigilant about, do you feel this? Do you feel this? It wasn't like, I am just going to give her this numbing, and I know she won't feel it. I'm not going to check on her. She's good to go. It was, do you feel this? Do you feel that? We're going to check here. We're going to check there. So it was a pleasant experience in terms of preparing for it. I didn't have any pain at all with that pain. Not even a little bit. Dr. Kuruvilla (19:04): Nothing. Patient (19:05): Yeah, it was Dr. Kuruvilla (19:06): Okay. So the actual procedure itself, you didn't feel pain. Patient (19:09): None. Not at all. Dr. Kuruvilla (19:09): Okay. I think that's huge. I think that's really huge for patients to hear. Patient (19:13): Gosh, I physically and emotionally felt so much lighter. Dr. Kuruvilla (19:18): Good. Patient (19:18): Once I knew it was gone. Dr. Kuruvilla (19:19): Okay. And then moving into recovery, I know that you were, I feel like maybe day one you were like, okay, I'm feeling it. Can you I guess, walk through the recovery and how that discomfort compared to what you were expecting just for patients to understand. Patient (19:35): In terms of pain, I really didn't feel anything that first day because the numbing agent that you used, I think there was a topical one, and then there was also a long lasting one that would go throughout that 24 hours. And I'll tell you that made, at least for me, it made it, I don't know if it makes a difference for everyone. I mean, I've only had the surgery one time, but I can tell you that I didn't have a lot of nerve pain. I think there was really only one point where it was a little uncomfortable, a little itchy, and that was when the stitches were really starting to heal and getting, I think there were dissolving stitches. Dr. Kuruvilla (20:09): Yeah, I do. Dissolvable stitches was around that time that they, day seven or so Patient (20:13): Started to dissolve and I was like, okay, it's a little bit of an itch or a little pinch here or there, but really nothing substantial. Dr. Kuruvilla (20:19): I think that's super reassuring for patients to hear just that recovery is smoother and more manageable than they expect, especially because I think we really try to individualize our recovery protocols, and I think people might ask, why would you do this under local medicine A costs? It's cheaper to do that than under general anesthesia (20:37): B. I do have a lot of patients who just don't want to tell anybody that they're having this procedure, so they want to drive in the day of and drive home afterwards and just have it be that private experience. I would like to say that while we do perform the majority of these under local numbing medicine, if that is too anxiety provoking for the patient, we can absolutely offer it under general anesthesia, light sedation, or I just prescribe you an anxiety medicine to take the day of surgery. I think you might've taken that just to kind of take the edge off. Patient (21:05): That's right. Yeah. I think you gave me, it was something that I had to have someone drive me home because I was taking that. It was another layer of cover. I'm glad I did that too, because I was a little, like I said, I was nervous. Dr. Kuruvilla (21:17): Understandably so. Patient (21:20): Simmered down quite a bit once I got here. Dr. Kuruvilla (21:22): And then you've already shared this, but you have had an increase in comfort level in your appearance since the surgery. I remember even maybe your, I don't remember what appointment was I saw you in, but you're like, I've already been wearing a swimsuit and I can tell there's yes. Patient (21:35): Oh my gosh. After you have C-sections, your body, our bodies change,

and I don't always like to show my stomach, but I still want to look attractive or sexy if I'm having intimate time. And so I will wear these one piece things. They're teddies, I think that's what they're called. They look kind of like swimsuits, and I always love them, but I was always afraid in the past, taking a, if I were to take a picture or stand a certain way, that my anatomy would fall out and hang from the side, and I would hate that. And so I never wore them. I loved them, but I never got to wear them. And then I remember after I'd fully healed, I tried one on and I was just so shocked. It was just like, it's not there anymore. It's gone. Dr. Kuruvilla (22:20): You could just be carefree finally. Patient (22:22): I don't have to worry about adjusting it or moving it or cutting circulation off. I can wear these things. It's flat. It's a flat, it's not bulging there anymore. And it just immediately felt, made me feel a lot more feminine. Dr. Kuruvilla (22:36): Just like a new kind of type of freedom. I'm sure too. It's just no longer a concern anymore. Patient (22:41): Yeah, it really opened up my options in terms of being able to wear more athletic wear, which will in turn allow me to be able to exercise more because I won't have to strap everything down just to get some movement in. It's just I can walk now. I can walk longer distance. And that to me was one of the biggest things is I can't walk that long because after a while, it's going to start chaffing and moving and shifting, and it's not like I can just be like, hang on guys, lemme just adjust this real quick in the middle of the field or the trail. I couldn't do that, and so I found myself not going or saying, ah, I don't want to go. Y'all go ahead without me. Now, I don't have to miss out on things that I love doing because of how I'm shaped. Dr. Kuruvilla (23:31): So this has just improved your health from a mental health standpoint as well as a physical health in terms of increased activity levels and exercise, and Patient (23:39): It's all connected, whether we're blatantly aware that that is connected or not. For me, it was just this, I don't know, paradigm shift that, wow, it doesn't have to be discomforting. You don't have to be in pain all the time anymore. Why did you wait so long? Why are you so afraid? I'm so glad that I did this. Dr. Kuruvilla (24:01): If another woman is listening and quietly thinking, that's me, what would you want her to know? Patient (24:06): Don't be afraid to take the next step towards a better life for yourself physically. If you're thinking about it and it's something that's bothered you or you felt shamed about it, don't feel ashamed by it. Use that as fuel. Use that as motivation. Use my words as motivation to have that procedure done, because like I said, my only regret is not doing this sooner. I can only imagine how my early twenties would've been had I gotten this done earlier. Any last tidbit of encouragement is if you're even considering it, if you've even considered having this procedure, maybe you didn't even know that this was a procedure that you can get, and now you're like, Ooh, I'm going to look it up. Do it. Look it up, check it out. Make it at that consult. It doesn't hurt to get the information, and I promise you, your life will be so much better if you do proceed with making that change for yourself. Dr. Kuruvilla (25:02): That is beautiful, and I can't thank you enough for being so brave to talk about this, and I don't think I can convey the honor that I feel that you picked me to help you get through this, and yeah, I guess I'm kind of speechless. I really appreciate that. Patient (25:15): Yes. Dr. Kuruvilla (25:16): And I know that a lot of women listening to this are going to feel less alone because you have been selfless enough to talk about and tell your story today. I hope that they feel more empowered, so if you are listening and want to learn more, I always say just start by getting information, which you already kind of, that was the theme of this episode. Thank you again so much. I really appreciate it. Patient (25:36): Absolutely. Thanks for having me. Announcer (25:42): Basu Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. To learn more about the practice or ask a question, go to basuplasticsurgery.com/podcast. On Instagram follow Dr. Basu and the team @BasuPlasticSurgery. That's BASU Plastic Surgery. Behind the Double Doors is a production of The Axis, theaxis.io.