By: David Newland - It's a fact that in every society, a person's appearance may be critically important to his or her self-image. From ancient times, both men and women have modified their faces, hair and bodies temporarily, or permanently. The motive: enhance their beauty, attractiveness, status or confidence. The methods have ranged from simple makeup and hair arrangements, through tattoos, scarification, circumcision, and — more recently — plastic surgery.

Various forms of surgery, including face-lifts, breast or pectoral implants, and liposuction are available to both sexes today. Over the past decade or so, a relatively new form of female body modification has gained some popularity. Its technical title is labiaplasty, and it involves the removal of part of the labia minora, the inner lips of the vaginal opening.

For some women, this simple surgical procedure is a welcome release from physical pain during intercourse that can arise if the labia are overly protrusive. But for many more, labiaplasty is a solution to a feeling of embarrassment about one's own body image.

Toronto plastic surgeon Dr. Robert Stubbs has performed more than 100 labia reduction surgeries since he began offering the procedure in 1989. "Ladies don't like the word big applied to either their vagina or their labia," says Stubbs. The solution he offers was dubbed the "Toronto Trim" by one newspaper reporter. He says the satisfaction rate "equals or matches breast augmentation." The operation is done by simply cutting away tissue from the labia minora, and then over-sewing the raw edge. The procedure takes less than two hours and healing time is a relatively short six weeks.

But some plastic surgeons don't find this traditional technique ideal. They say the natural colour and contour of the edge are eliminated as the usually dark edge is replaced by a suture line of more lightly coloured inner labia tissue. Dr. Gary Alter, a Beverly Hills plastic surgeon, developed a refinement on the surgery that now carries his name. "Alter Labia Contouring," involves cutting a wedge out of the labia, "like a pie slice," according to Dr. Alter, and then bringing the edges together. The result, says Alter, is smaller labia minora which maintain the normal contour and colour of the original. Like the "Toronto Trim," Alter's procedure is fairly quick to perform and heals fast.

Nevertheless, there are still some risks to any cosmetic surgery to the sexual organs, including possible loss of sensitivity, scarring, and — the most serious — excessive bleeding. Woman who decide the benefits outweigh the risks can count on forking over about $3,300 CDN for the standard procedure, and $5,500 to 7,500 US for contouring.

The development of expensive cosmetic surgeries is a symptom of a highly sexualized, and very appearance-focussed society. Alter says that over the past 20 to 30 years people are more aware of what they consider the aesthetic ideal. "There's a lot of pornographic movies and it's just more visual," he says. According to Alter, labiaplasty can be very rewarding surgery. "You have women with a lifelong history of being self-conscious, and then they leave and they're so happy and their lives have changed." And some research has also shown that a woman's self-esteem improves after successful cosmetic surgery.

Nevertheless, labiaplasty remains somewhat controversial, especially among those who suggest it's being done in reaction to culturally received norms that are essentially void: why should a "different" appearance be perceived as undesirable? A recent article in the Sydney Morning Herald makes that question particularly poignant. It suggests that women may be requesting labiaplasty after seeing photographs of nude models -- which have been digitally altered to minimize the prominence of the genitalia. Life imitates art, indeed

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