In brief
- What it is: an intimate surgery procedure that uses autologous fat, that is, the patient's own, to restore volume to the labia majora.
- Who it is for: women with deflated or lax labia majora (hypotrophy) due to ageing, menopause, hormonal changes or major weight loss.
- How: a small amount of fat is harvested (abdomen, flanks or thighs), purified and re-injected with blunt cannulas, under local anaesthesia, possibly with sedation.
- Duration: part of the fat is reabsorbed in the first few months; the portion that takes remains in the long term.
- Safety: no major complications are reported in the published case series, but the evidence is still of limited quality.
What it is
Fat grafting (lipofilling) of the labia majora (in the literature labia majora augmentation with fat grafting) is a female intimate surgery procedure that uses the patient's adipose tissue as a natural filler. The fat is harvested with a mini-liposuction, purified and re-injected into the labia majora to restore volume, fullness and symmetry. It is the most widely used technique in published studies on labia majora augmentation.
Why the labia majora lose volume
In terms of tissue, the labia majora age in a similar way to the face: when young they are full and smooth, and over time they lose subcutaneous fat and collagen. The main causes are:
- Ageing and weight loss: the amount of fat decreases, especially after major weight loss.
- Menopause and hormonal changes: the drop in oestrogen leads to progressive thinning of the vulvar tissues and loss of elasticity.
- Deflation and laxity: the labia majora lose their "cushion" function and often leave the labia minora and the clitoral hood uncovered, exposing them to rubbing and irritation.
Indications and benefits
Besides the aesthetic aspect, restoring volume can have a functional benefit:
- Anatomical protection: the labia majora cover the labia minora and clitoris again, reducing friction with underwear during sport or daily life.
- Intimate comfort: it may reduce the discomfort caused by rubbing of deflated tissues.
- Tissue quality: fat contains adipose-derived stem cells, and studies on other areas of the body suggest a possible improvement in skin quality. For the vulva this effect is still poorly documented, and I do not present it as certain.
When it is not indicated
- Ongoing genital infections or inflammation.
- Insufficient fat in the donor areas (in this case filler can be considered).
- Unrealistic expectations, or distress about one's genital appearance that is disproportionate to the real anatomy: in these cases the consultation also serves to understand whether surgery is truly the right answer.
Fat grafting or hyaluronic acid filler?
Both techniques are documented in the literature for labia majora augmentation. The choice depends on your expectations, the availability of fat to harvest, and whether you prefer a surgical procedure or an outpatient treatment.
| Feature | Fat grafting (autologous fat) | Hyaluronic acid filler |
|---|---|---|
| Type | Intimate surgery: minimally invasive procedure | Intimate medicine: outpatient injection, non-surgical |
| Material | The patient's own fat (autologous) | Cross-linked hyaluronic acid, reabsorbable |
| Invasiveness | Requires a mini-liposuction | Injection only, no harvesting |
| Anaesthesia | Local, possibly with sedation | Local or anaesthetic cream |
| Duration of the result | Long-lasting for the portion of fat that takes | Temporary: in studies the effect is documented for up to 12 months, then top-ups are needed |
| Reversibility | No | Yes, with the enzyme hyaluronidase |
| Predictability | Lower: reabsorption varies from person to person | Higher, and the volume can be adjusted over several sessions |
| Tissue quality | Possible regenerative effect, still poorly documented in the vulva | Mainly a volumising effect |
Your pathway
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First consultation
Specialist assessment
- Discussion of your concerns, expectations and medical history
- Examination of the vulvar anatomy and assessment of the donor areas
- Choice between fat grafting and filler, and possible combination with other procedures
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Day of the procedure
Three phases in a single session
- Harvesting: mini-liposuction from an area with an adequate fat deposit (abdomen, flanks, inner thighs or knees), under local anaesthesia, possibly with sedation.
- Purification: centrifugation, filtering or washing to isolate viable fat cells from blood and fluids.
- Re-injection: the fat is distributed with blunt cannulas into the subcutaneous tissue of the labia majora, on several planes, for an even and symmetrical result.
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First few weeks
Recovery
- Rest during the first 24–48 hours; avoid sitting for long periods in the first few days
- Return to daily activities in 2–3 days
- High-impact sport, cycling and horse riding suspended for 3–4 weeks
- Sexual intercourse after 3–4 weeks, to help the fat to take
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After 3–6 months
Assessment of the result
- The result stabilises after the reabsorption phase
- If necessary, a second session to refine volume and symmetry
Reabsorption and graft take
In the first few months after the procedure, part of the grafted fat is reabsorbed by the body. The amount varies from person to person and cannot be predicted precisely. Fat cells that develop a new network of blood vessels integrate permanently into the tissue. For this reason the surgeon may graft a slightly larger volume than needed, or plan a second session 3–6 months later.
The reference systematic review (Jabbour, 2017) reports fat volumes between 18 and 120 mL per session, depending on the initial degree of deflation.
Combination with other procedures
Fat grafting of the labia majora is often performed in the same session as other genital reshaping procedures, such as reduction of the labia minora or monsplasty. In a study of 124 patients treated with a combined approach (Cihantimur, 2013), more than 95% were satisfied with the result at one year.
Risks and side effects
No major complications are reported in the published case series. Like any procedure, however, fat grafting carries risks that you should know about before deciding:
- Bruising and haematomas in the donor area and on the labia majora, generally resolved in 7–14 days.
- Swelling in the first few weeks.
- Residual asymmetry, correctable with a touch-up.
- Uneven reabsorption, which may require a completion session.
- Micro-nodules or cysts from fat necrosis, rare, caused by fat cells that have not received an adequate blood supply.
- Infection, rare.
What the scientific literature says
The systematic review by Jabbour (2017) analysed 9 studies on labia majora augmentation: 4 on fat grafting, for a total of 183 patients, 2 on hyaluronic acid and 3 on surgical techniques. All techniques show high satisfaction rates and no major complications. The authors stress, however, that only two studies were prospective and that randomised studies are needed to define standard protocols. For hyaluronic acid filler, a multicentre study with one year of follow-up and a randomised study are now also available.
Frequently asked questions
What is fat grafting of the labia majora?
It is an intimate surgery procedure that uses fat taken from the patient herself, purified and re-injected, to restore the volume and fullness of the labia majora.
Is fat grafting or hyaluronic acid filler better?
It depends. Fat grafting uses autologous tissue and gives a long-lasting result for the portion of fat that takes, but it requires a small procedure and is not reversible. Filler is an outpatient treatment, without a scalpel, adjustable and reversible, but temporary. The choice is made together at the consultation.
How long does fat grafting of the labia majora last?
Part of the fat is reabsorbed in the first few months, to a variable extent. The portion that takes remains in the long term, but it follows the natural ageing of the tissues and changes in weight.
Is the grafted fat reabsorbed?
In part, yes, especially in the first few months. For this reason the final result is assessed after 3–6 months, and a second completion session is sometimes needed.
Is it painful?
The procedure is performed under local anaesthesia, possibly with sedation, so you do not feel pain during it. In the following days the discomfort is generally mild and is controlled with common painkillers.
What are the recovery times?
Normal activities are resumed in 2–3 days. Intense sport, cycling, horse riding and sexual intercourse should be postponed for about 3–4 weeks. These timings are approximate and defined case by case.
Is fat grafting of the labia majora safe?
No major complications are reported in the published case series and satisfaction is high. The most common risks are bruising, swelling and asymmetries; nodules and infections are rarer. The available studies, however, are still few and of limited quality.
Scientific bibliography
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Jabbour S, Kechichian E, Hersant B, et al. – Labia majora augmentation: a systematic review of the literature
Source: Aesthetic Surgery Journal, 2017 – Oxford Academic
What it covers: a review of 9 studies on labia majora augmentation: 4 on fat grafting (183 patients, 18–120 mL of fat per session), 2 on hyaluronic acid (2–6 mL per session) and 3 on surgical techniques. No major complications, high satisfaction with all techniques.
Why it matters: it is the reference synthesis on the subject. It also states that the quality of the evidence is low and that randomised studies are needed.
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Fasola E, Gazzola R – Labia majora augmentation with hyaluronic acid filler: technique and results
Source: Aesthetic Surgery Journal, 2016 – PubMed
What it covers: an Italian retrospective study of 54 patients treated with hyaluronic acid filler. At 12 months, mean satisfaction is 8.7 out of 10 for patients and 8.5 for the assessing physicians.
Why it matters: it describes the filler technique, the non-surgical alternative to fat grafting, and documents its duration at one year.
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Boucher F, Eychenne C, Gurriet B, et al. – Evaluation of the efficacy and safety of hyaluronic acid injection for volume restoration of the labia majora: ESOLANE study
Source: International Urogynecology Journal, 2025 – Springer
What it covers: a prospective multicentre study of 72 women with deflated labia majora, followed for one year. At 12 weeks 97% judged themselves improved, and more than 92% still did at one year. Adverse effects in 15% of cases, mild or moderate and mostly resolved within 8 days.
Why it matters: it is one of the most robust studies on labia majora filler, and gives a concrete estimate of the frequency of adverse effects.
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Fasola E, et al. – Performance and safety of hyaluronic acid-based gynaecological filler for labia majora augmentation: a randomised controlled study
Source: Life, 2026 – MDPI
What it covers: a randomised study of 76 women aged 40 to 65. At 6 months 87.5% of the treated group were improved and sexual function (FSFI index) improved significantly compared with the control group, with no serious adverse events.
Why it matters: it is the first randomised controlled study on labia majora augmentation, exactly the type of evidence the 2017 review called for.
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Cihantimur B, Herold C – Genital beautification: a concept that offers more than reduction of the labia minora
Source: Aesthetic Plastic Surgery, 2013 – Springer
What it covers: 124 patients treated with a combined approach: reduction of the labia minora, fat grafting of the labia majora, liposuction of the pubic area and possibly other treatments. At one year more than 95% are satisfied; the most frequent complication is suture dehiscence (8%).
Why it matters: it shows how fat grafting fits into an overall genital reshaping, together with other procedures.
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Salgado CJ, Tang JC, Desrosiers AE – Use of dermal fat graft for augmentation of the labia majora
Source: Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012 – ScienceDirect
What it covers: a description of a single case treated with a dermal fat graft, that is, a block of dermis and fat surgically inserted rather than injected, with a volume that remained stable over time.
Why it matters: it documents a surgical alternative to injectable fat grafting. Being a single case, its value is mainly descriptive.
For further reading with real clinical cases:
Medically reviewed by Dr Giulio Maria Maggi, Plastic Surgeon — last review:
Article written by
Dr Giulio Maria Maggi
Aesthetic Plastic Surgeon — Turin, Asti and Alessandria
Medical Director — Aesthetic Clinic (Turin)
Registered with the Turin Medical Council (Ordine dei Medici di Torino) no. 20595
Full Member of AICPE (Italian Association of Aesthetic Plastic Surgery) (verify)
Expertise and areas of interest
Dr Maggi gained his specific training in intimate medicine and surgery by working for 12 years alongside Prof. Renato Marten Perolino, urologist and plastic surgeon, at Villa Maria Pia Hospital and, privately, at Clinica Fornaca and Clinica Cellini in Turin. From him he learned male-to-female gender-affirming surgery and he was first operator in breast augmentation procedures on his patients in gender transition. He also trained internationally with Prof. José Guerrero Santos in Guadalajara and with Prof. Andrew A. Jacono in New York, for the Deep Plane facelift technique.
His main areas of focus are:
- Functional and aesthetic intimate surgery, male and female
- Deep Plane facelift
- Blepharoplasty
- Liposculpture and fat grafting (lipofilling)
- Breast surgery
- Body contouring
Clinical approach: «Prima comprendere» ("Understand first"). No promises of results: indications, risks and limits explained frankly, so that every patient can make a truly informed choice.
