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Prof. asoc. Dr. Stefan Gress

Sculpting of the Labia Majora

Professor Gress is one of the
top specialists internationally

As we age, the fatty tissue in the labia majora decreases, giving them less volume. The skin stretches and loses its elasticity, hanging down loosely. The aging process in the genital area is most clearly visible when it comes to the changes to the labia majora. The good news? This problem is easy to correct.

In most cases, the decision to undergo labia majora sculpting can be attributed to a combination of physical and psychological issues:

Functional reasons
Loss of protective function, exposed vaginal opening with frequent inflammation

Aesthetic reasons
Hesitation to get naked, negative impact on sex life, etc.

Cause and effect
In childhood and adolescence, the labia majora are tight and of an almost firm consistency. However, as we age, the skin of the labia majora can stretch significantly. As the amount of fat and the volume in the labia majora decreases, which is usually the case as we get older, the skin looks saggier, has more wrinkles, and hangs down in an unsightly way. This is not just unfavorable from a cosmetic perspective, it can also impair the protective function of the vagina, resulting in vaginal infections.

In childhood and adolescence, the labia majora are tight and of an almost firm consistency. However, as we age, the skin of the labia majora can stretch significantly. As the amount of fat and the volume in the labia majora decreases, which is usually the case as we get older, the skin looks saggier, has more wrinkles, and hangs down in an unsightly way. This is not just unfavorable from a cosmetic perspective, it can also impair the protective function of the vagina, resulting in vaginal infections.

Here is some important medical information about the function and structure of the labia:

The small (inner) vaginal lips seal the vaginal opening and prevent infections developing inside the vagina, and other conditions.
The large (outer) vaginal lips enclose the small vaginal lips and offer mechanical protection.

The clitoris is the only organ that purely serves the purpose of sexual stimulation

The labia cover and seal the vaginal opening, protecting the vagina from drying out and stopping foreign bodies and pathogens from making their way in. Additional mechanical protection is offered by the fat pads of the labia majora.

The labia minora extend from the mons pubis towards the anus, encompassing the clitoris and the vaginal opening. The part of the labia adjacent to the clitoris is also referred to as the “clitoral hood”. In terms of morphology, the labia minora are equivalent to the foreskin of the penis. They are of secondary importance for sexual stimulation.

The term clitoris is commonly used to refer to a small, pea-shaped anatomical structure located a little above the urethral opening. However, the clitoris is not spherical but rather band-like in shape, similar to a small penis, with only the tip (glans clitoris) protruding and being visible. Its shaft (corpus clitoris) extends in a deeper layer across the pubis and is thus not visible. The clitoris is responsible for sexual stimulation.

Firm and tight labia majora enclose the labia minora and resemble a closed shell.

The labia minora are completely covered by firm, well-shaped labia majora, similar to the shape of a closed shell.

Depending on whether the skin of the labia majora is saggy and whether there is an overhang of skin, or whether the (fat) volume of the labia majora has decreased over the years, there are three possibilities for corrective surgery:
1. Tightening the labia majora by removing excess saggy skin
2. Filling the labia majora with autologous fatty tissue (lipostructure)
3. A combination of both approaches

This involves the removal of excess skin by making a spindle-shaped incision along the line of reflection through to the labia minora. The labia majora are tightened/reduced by closing the wound edges. This procedure can easily be performed under local anesthesia.

Filling with autologous fat
Autologous fat gives the labia majora volume and consistency. The fat is usually removed from the outer thigh under local anesthesia, specially prepared, and then injected into the labia majora all in one procedure.
This procedure is perfect if you are looking to shape and fill the volume of the labia majora. We generally add more volume than is actually necessary as our experience has shown us that some of the transplanted fatty tissue will deplete again. However, the part of the autologous fat that is connected to the vascular and blood supply (approx. 50-60%) is permanently preserved.

Hyaluronic acid is a gel that is usually used to treat wrinkles. It is sometimes injected into the labia majora to give them more volume. From our perspective, this is prohibited.
Hyaluronic acid encapsulates itself, clumps together, and can leave permanent hard, scarred nodules. What’s more, only a little volume is necessary in most cases to get a visible result. This is comparatively more expensive.

Autologous fatty tissue is the only suitable filler that is available free of charge and does not cause any reactions to foreign bodies. Even though some of the transplanted fatty tissue will deplete again, around 40-50% of it does, however, heal permanently. When overcorrecting, the desired volume can be achieved then and there in the first procedure. Sometimes it can be necessary to repeat the procedure. On average, around 20 ml fatty tissue is required on each side to sculpt and boost volume.

The ideal treatment for you will be determined following a physical examination as part of your consultation at our practice.
Before the surgery
You should stop taking medications that affect coagulation, e.g. aspirin 100 mg, etc., 14 days prior to the surgery. Please completely shave your genital area.
The procedure is usually performed under local anesthesia, meaning no special preparation is required (if it is being performed under general anesthesia or twilight sedation, you should fast, i.e. refraining from eating, drinking, and smoking, for six hours prior to your surgery).

Avoid mechanical friction as much as possible for six weeks after the procedure. Please also note the following:
After the surgery
After the surgery, you can rest at our practice.
Please do not drive home or back to your hotel yourself. Get someone to pick you up or we can call a taxi for you. Cool the area and rest. You should walk as little as possible. You may experience a mild burning or pressing sensation, especially during the first night. This is normal. The sensation typically disappears or greatly improves after the first night. On the first postoperative day, the wound is checked and the dressing is changed at our practice.
After the third day, you can start showering again, but may only use clear water and no soap during the first week. The sutures are absorbable and do not need to be removed. Absorption of the suture may sometimes be associated with severe itching, which can be alleviated by using special creams or ointments.
The surgery will only affect your daily activities for a short time. Depending on your profession, you may be able to return to work as early as two to three days after surgery. It is very important that you try to avoid any friction and forces acting on this area for six weeks following the procedure: no sexual intercourse, jogging, cycling, horse riding, etc.! Likewise, tampons may only be used again after this period of time.
Immediately after surgery, you should wear close-fitting underwear that you can pull firmly upwards to apply some pressure on the area. This helps prevent excessive swelling and reduces the risk of postoperative bleeding. Then from the first day after surgery, you will feel more comfortable wearing loose clothing.
To optimize the healing process, you should place a compress between the labia minora so that they do not touch. You should do this over a period of two weeks.
You will be provided with the cell phone number of Prof. Gress so that you can contact him any time should you have any questions or experience an emergency.

You can see sample images under the following access: HERE

Prof. Gress has published most of his medical publications with Springer Verlag.

His textbook on correcting the outer female genital region entitled „Aesthetic and Functional Labiaplasty“ was published in 2018.

This book describes his techniques for reducing the labia minora, primarily the “composite reduction labiaplasty”, and techniques for correcting the labia majora and the mons pubis. This textbook is now the standard for colleagues in this field throughout the world.

Publications by Prof. Gress:

(click for further information)

All important questions

 How many appointments do I need?

 Personal advice and information



 Laser or scalpel?

 Your contribution to the healing process





 Sexual intercourse

 Traveling from afar



 Showering, water, soap


 Scar creams

 Sauna, sun bed



 Final result

 Sutures, stitches

 Simultaneous correction of labia minora and majora

 Costs for sculpting of labia majora


Best Results

by specially developed, internationally leading surgical technique “Composite Reduction Labiaplasty”

Greatest Experience

With the most operations in
the female genital
area worldwide

Media Partner

First point of contact for international media for all questions relating to intimate surgery

Experience makes the difference

  • More than 6700 procedures in the female genital area
  • Over 20 years of experience
  • Inventor and developer of the “Composite Reduction Labiaplasty”
  • Internationally recognized top specialist
  • Author of the international textbook “Aesthetic and Functional Labiaplasty” (Springer Publishers)
  • Professor and Lecturer in Plastic Surgery

„Pioneer of female genital surgery“

„The Vagina Picasso“

„The labia pope of Germany“

In the most important national and international specialist societies

American Society of Plastic Surgeons

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen

International Confederation for Plastic, Reconstructive and Aesthetic Surgery

International Society of Aesthetic Plastic Surgery

The Aston Baker
Cutting Edge
Aesthetic Surgery

2018, New York

Faculty Member
The greatest honor for
a Plastic Surgeon

The internatioProf. asoc. Stefan Dr. Gressanl Textbook
written by Prof. Gress

Published in January 2018 by Springer Verlag, it has developed into an international bestseller and standard work in plastic surgery