Written by Dr. Jonathan Zelken
Another long day, another long surgery. I get a lot of requests for monsplasty, and people don’t really know what it is. I think a lot of people search things and they come up with monsplasty and for some reason ‘monsplasty’ links to my website, so I get a lot of requests – maybe a lot of plastic surgeons do – but I think more than ever people want to know about what monsplasty is, and how to make it look more attractive.
So first of all, let’s talk about anatomy.
The mons is a mound in women it’s called mons Venus or mons veneris. It’s literally a mound above the vulva and it kind of creates the anterior aspect of the vulva and melts into the labia majora. It is influenced by fat (fatty tissue), pubic hair, and the pubic bone.
A lot of times it bothers women because when they wear especially one-piece bathing suits they feel like they have a bulge above their vagina that they don’t want. They don’t like it, they don’t know why it’s there, and wonder if there is a way they can fix it.
The way I correct it is with an operation called monsplasty. Monsplasty literally means to shape or re-shape the mons or the mound of the pubic bone.
The way I do it typically falls into two categories. As far as aesthetics, I mean you’ve got the massive weight loss patients so we’re going to keep that section out of this discussion. For patients who have not lost significant amounts of weight and have mostly fatty excess above the pubic bone and on top of the vagina, we have two options.
Number one, we can do liposuction alone if there’s not too much skin, and number two, if there is too much skin or they’ve had liposuction before, we can do something about it. Whether it is radiofrequency skin tightening, or directly cutting out the skin.
I’m going to show a video that features the latter because in my practice that’s kind of the extreme end of how we would treat this. These are patients who have tried liposuction and other things and really come to me now for a definitive answer.
In this video, it’s a young patient who is kind enough to let us use her video and out of respect for her, if you guys want to see befores and afters – a lot of people don’t like that, so we don’t really show them.
It’s very personal and so what we do is simulate it for you. Now if you are interested in coming to the office we will show you all the before and afters; more importantly, I want you to see my rationale: it’s a combination of first identifying the areas that are bulging, then number two, removing the skin, and number three, doing it in a way that the scar is hidden and very very small.
If you don’t want a scar at all, it’s totally possible to do liposuction alone in many cases. Or there’s a middle ground where we can do radiofrequency skin tightening followed by liposuction and we will show that in another video. So check it out:
Not sure if I mentioned this patient is awake, though many patients choose to do the operation awake, frankly if I don’t have to do anything with the muscle, patients prefer to be awake in a lot of cases because it’s a quicker recovery. But really after filling up this area with numbing fluid and creating an even bigger mound for a short period of time, I’m able to perform liposuction.
It does two things, not only does it debulk the area but it also does something called hydrodissection, and it allows me to literally create channel pathways to make the elevation of the skin. As you can see, it’s a lot easier this is literally a mini tummy tuck but upside down. In a mini tummy tuck you’ll see the same exact excision of skin, the same exact scar, but rather than dissecting up towards the belly button I am dissecting down towards the labia majora.
Just like any other case, making sure that there’s no bleeding is essential. Making sure that I keep my dissection close to the skin surface and all of the lymphatic or the drainage channels intact is really imperative to having minimum complications and great outcomes.
The operation is largely based on liposuction but as you can see direct excision of fatty tissue is also part of my sculpture and before I close I do place a drain into this pocket because as you stand up, all the gravity in your body falls down towards your mons pubis and into the labia majora. So don’t kid yourself – this operation has a lot of swelling and if you don’t properly triangulate this tissue, meaning sew it down to the floor and put a drain in, you’re at high risk for getting a fluid collection called a seroma.
So I do a lot of things to mitigate these risks and I intentionally will evert or have the wound kind of stick out for a while so when it heals, unlike a lot of these tummy tuck scars, you see it’s not going to fall inward and create that pleat, it will stay flat. At least that’s my intention.
A meticulous five-layer closure ensues and all the techniques I do in any case are certainly followed here. This is a very cosmetically sensitive area that historically has not the best scars, so making sure that these incisions are tension free and hand-sewn by me personally are ways that I ensure the results I do and the fine line scars that I get.
In addition to meticulous closure under minimum tension, a post-operative scar minimization protocol is imperative to minimize the scar. Patients who come to me for monsplasty are coming because they want an enhanced cosmetic result in this sensitive area so why would you skimp on the scar.
I hope you guys enjoyed this video. A lot of people ask about it – this is the most sort of intimate I can get with you about this procedure. A lot of patients, as you can understand, don’t feel comfortable about showing their befores and afters online. This patient was nice enough to show us her before because of the COVID pandemic we are minimizing post-operative visits in out-of-town patients, but we are happy to show you this patient’s afters with further inquiry.
I hope you enjoyed this and if you have any questions please make sure to comment below the video on our channel, or directly message us and we’d love to see you and see what we can do for you.
Again, the spectrum for mons enhancement starts with liposuction and ends with this procedure that you’re seeing here. There’s a middle ground where you have the scarless version where you can do something called radiofrequency assisted lipolysis or body type of the mons and these results are great too, but they can take a little bit longer to see the final product.
Thank you so much.