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One Stage or Two...

Very often during consultation, patients ask if I perform a "one" or  "two"  stage vaginoplasty.  This question is more complex than it sounds, yet the basic answer is quite simple... I perform whatever the situation calls for.  This decision should not be made until after the initial surgery, regardless of which surgeon performed the original vaginoplasty.

First, a history lesson:  Before 2000, some surgeons strongly recommended having an initial vaginoplasty followed by a labiaplasty a few months later.  Often times, patients would save money for both vaginoplasty and labiaplasty right from the start. The purpose of labiaplasty is to further define the clitoral hood as well as the labia minora. These flap adjustments were planned for a later date because a period of healing was necessary following the vaginoplasty in order to safely perform the delicate flap surgery.  Staged surgery is a tool often employed by those trained in plastic surgery.  When the popularity of the internet increased, the "recommended" labiaplasty was misinterpreted as "mandatory" by chat room discussions.

After the year 2000, the "one stage" movement began.  This change in demand was marketed by some surgeons who pointed out the obvious financial benefit of one less surgery... and the controversy began.  As this decade unfolded, vaginoplasty techniques became more standardized among surgeons. However, the idea of "one stage or two" erroneously remained a primary emphasis for patients when choosing a surgeon.

History aside, the fact remains that each patient comes with their unique body type and goals.  Some patients have optimal skin quality, healing and body fat distribution. These patients are routinely pleased after one surgery.  Others, particularly those that have lost weight or have suffered the effects of gravity, find that a labiaplasty is the final touch they were looking for.  As a result of surgeon marketing and chat room opinions, patients are often confused about my status as a "one stage" or "two stage" surgeon.  I try and explain to patients that all the major surgeons are performing essentially the same surgery, so "one verses two stage" is really a non-issue. To further relay my point, take the following example: In the last year, I have performed about 5 labiaplasties on transwomen.  Of those 5 surgeries, one was a vaginoplasty patient of mine and the others were patients who went to a “one stage” surgeon.