Why are women always apologizing for their bodies? Should you feel guilty about wanting plastic surgery in midlife? And what actually happens during a labiaplasty?

In this Between Two Labia episode a subseries of the podcast filmed in my office I sit down with Dr. Dahlia Rice a board-certified plastic surgeon and owner of DMR Aesthetics Chicago.

Dr. Rice started her career doing autopsies and teaching human anatomy before becoming one of only 1,400 female board-certified plastic surgeons in the United States.

There's a misconception that labiaplasty is only cosmetic women trying to mimic unrealistic porn aesthetics.

But the reality is that many are functional. Some women can't wear jeans or bike comfortably because of an elongated labia minora.

Dr. Rice emphasizes finding a surgeon who does these procedures regularly and understands the anatomy. Being too aggressive can damage the clitoral arousal tissue that sits right behind the labia. Recovery sounds intimidating, but while there's significant swelling that Dr. Rice calls "Frankenpussy," the area heals quickly. You'll need to elevate your hips as much as possible during the first week and use lots of ice, but it's not as horrible as you might think.

We also discuss medical tourism. A good deal on plastic surgery abroad sounds appealing, but Dr. Rice explains what happens when complications arise and you're back home with no one willing to help. The US has more expensive procedures because of stringent training and regulations, but when things go wrong overseas, you can fall through the cracks. Insurance won't cover it, and finding a surgeon to fix someone else's work becomes a challenge.

Dr. Rice and I talk about why representation matters in plastic surgery. Only 20% of plastic surgeons in the US are female, even though over 90% of patients are women.

We discuss how cultural understanding affects outcomes from knowing the right placement for eyelid creases in Asian patients to understanding how different cultures communicate about complications.

Highlights

50% of labia are naturally asymmetric, but social media and porn have created unrealistic expectations of what "normal" should look like.
Plastic surgery as a board certification specialty has only existed since the 1940s, even though reconstructive procedures have been performed since ancient times.
There's now cadaver fat available as an alternative to using your own fat for transfer, which eliminates issues with poor "take" in older patients.
Korean skincare focuses on prevention and low inflammation from a young age, while Americans take a "guns blazing" approach when we suddenly panic about aging.
Pigmentation naturally darkens during menopause regardless of your ethnicity or background.
Plastic surgery has shifted from focusing on what men want to what women want for themselves and their own comfort.

If you're considering any aesthetic procedures in midlife, take time to find a surgeon who understands the anatomy and does these procedures regularly. Ask to see their work, understand the recovery process, and set realistic expectations about outcomes.

What other topics would you like to see from me? Who would you like me interview next? DM on Instagram.

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