Pubic fat is often seen as a congenital deformity, which will not resolve with weight loss alone. The woman complains of an unsightly bulge or protrusion with loss of self-esteem, often leading to avoidance of wearing tight clothes or bathing suits. If there is no excess skin or if a lift is not necessary, then pubic liposuction alone can eliminate the fat deposit. Usually liposuction is performed through small stab incisions in the groin creases. The upper labia majora are usually also suctioned.
The epidemic of female obesity along with massive weight loss has resulted in the common complaints of an excessive mons pubis fat deposit and descent of the pubic hair, introitus (vaginal opening), and labia majora. The large mons pubis fat deposit is often also associated with large, protuberant labia majora due to fat excess with skin stretching. Weight loss rarely results in elimination of these deformities, so surgical treatment is required.
Traditional reduction of an enlarged mons pubis fat pad with skin descent has been a horizontal skin excision and fat resection with a skin lift. This has often been combined with an tummy tuck. However, a skin lift usually is not adequate since the pubic area often descends again. A second unsuccessful lift is often tried which can cause an unnatural shortening of the pubic hair. Surgeons have also performed a vertical excision of pubic skin, which can lead to an unsightly “T” scar in the pubic region.
A natural-appearing mons reduction and lift can be achieved with a horizontal skin excision below the hanging abdominal skin line; liposuction of the mons pubis, upper labia majora, and groin fat; and fat excision of the residual deforming fat pad. It is imperative that the tissue of the pubic skin flap be sutured to the underlying muscle to prevent recurrent pubic descent.
Recurrent pubic lift surgery is very uncommon. Occasionally, the patient may have some concavity of the pubic fat pad.
The patients are generally extremely happy with elimination of the pubic protrusion. It is uncommon to have an unhappy patient as long as the postoperative result and limitations are explained and shown to the patient.