The American Journal of Cosmetic Surgery

Vaginal rejuvenation and cosmetic vaginal surgery is one of the latest trends in urogynecology, gynecology, and plastic surgery. There is some confusion regarding what the term “vaginal rejuvenation” means, the surgical techniques and indications for this type of procedure, and how it may or may not differ from standard vaginal reconstructive techniques. There are also questions whether any scientific data are available to support the use of these procedures to enhance sexual function.

The current paper attempts to answer these questions and reviews the literature regarding this topic. The worldwide literature was searched using PubMed database and reviewed for relevant studies on the effect of prolapse and/or vaginal relaxation on sexual function and whether repair improves any dysfunction present.

It is well documented in the literature that pelvic organ prolapse affects sexual function and that when repaired, sexual function improves as confirmed by validated sexual-function questionnaires. Damage to the vaginal walls and pelvic floor following traumatic childbirth may result in vaginal relaxation that may affect sexual function. The damage may not be severe enough to cause true prolapse or incontinence, but it may affect sensation and ultimately female sexual function. Vaginal reconstructive techniques that are designed to repair the caliber of the vagina are termed “vaginal rejuvenation” surgery. Repair of any anatomic changes affecting the caliber of the vaginal canal and perineum have been shown in recent studies to improve sexual function as well. Many women with complaints of vaginal relaxation are also found to have various stages of prolapse, and it is very important to recognize and repair these defects simultaneously as well.

Prolapse, albeit a more severe form of vaginal relaxation, when repaired, seems to improve sexual function in many studies. Recent studies also show that vaginal rejuvenation or repair/tightening of the caliber of the vagina prior to the development of prolapse may improve female sexual function. Further studies are warranted in this field.

Conventional body contouring techniques such as liposuction, although now far less invasive, still require extended periods of recuperation and the use of compression garments. Several noninvasive techniques for soft tissue, adipose, and dermal treatment have been reported in the literature as also producing circumferential measurement reductions in patients. These results can now be correlated to evidence-based scientific methodology versus anecdotal reports.

Patients were treated using the VASER Shape (Sound Surgical Technologies, Louisville, Colo) as part of routine practice. Circumferential measurements were made before and after treatments.

Two hundred and four patients were treated in 741 treatment sessions at 12 centers in the United States beginning in June 2010. When measured immediately after treatment, the patients experienced a 0.8-in circumferential reduction in the abdomen and a 0.5-in reduction on the thighs. Circumferential reduction continued over the course of treatments, resulting in reductions of more than 2-in and 1-in, respectively, in the abdomen and thighs. In no cases were any analgesics or anesthesia provided to patients before or during treatment. In general, the patients reported that the treatment was pleasant and felt warm but not uncomfortable. After treatment, patients were able to continue with their normal daily routines. Patients reacted positively to the procedure and the immediacy of results, and many reported that their clothes fit better when they dressed after treatment. In addition to circumferential measurement changes, patients also reported the sensation of feeling tighter in the treated area and that the treated areas had smoother skin.

The VASER Shape system presents a novel approach to achieving immediate circumferential measurement reduction noninvasively with no patient downtime.

During recent years many women have been searching for an improvement in the appearance of their vulva. We present our experience to evaluate the efficiency and safety of lifting of labia majora and evaluate the level of satisfaction with the surgical technique.

Between March 2004 and June 2011, a total of 60 patients diagnosed with flaccidity and/or hypertrophy of labia majora were selected for surgery at the Urogynecology and Vaginal Surgery Unit in Clínica Las Condes, Santiago, Chile. The patients were asked to assess the results of surgery in terms of the degree of satisfaction with the obtained results.

The primary indication for surgery was aesthetic factors (100%); 20 patients also considered functional factors (33%), and only 6 women (10%) also considered psychologic factors. For aesthetic reasons, hypertrophy and flaccidity were the primary indication, less frequent were asymmetry and previous scars. During the early postoperative period 6.7% of women had a minimal suture dehiscence with spontaneous resolution. A total of 80% of the women were very satisfied, 15% were satisfied, and 5% were unsatisfied. Four patients presented cellulitis (6.7%).

According to our experience, the lifting labioplasty of labia majora is a feasible, safe, and effective surgical procedure, with aesthetic results and high levels of satisfaction in patients.

Traditionally, surgeons have made a horizontal incision the entire length of the upper eyelid to reach the medial fat pad and remove it. Performing that incision and subsequent dissection bilaterally is a time-consuming procedure. Merely performing a 3- to 4-mm oblique stab incision to gain direct, immediate access to the medial fat pad for removal is a safe, time-efficient, minimally invasive procedure with a far smaller scar.

Under local anesthesia, a no. 11 blade is used to perform the 3- to 4-mm stab incision through skin, muscle, and septum to gain access to the medial fat pad. The fat pad is meticulously and gingerly teased out using cotton tip applications, and a hemostat to spread tissues and clamp excessive fat for excision and cauterization. The skin is closed with interrupted 6–0 nylon sutures.

The authors have performed 979 of these procedures (bilateral) with extremely high patient satisfaction rates during a 10-year period. A total of 15 patients requested more medial fat to be removed. Intralesional steroids were used in 10 patients to treat mild hypertrophic scarring where the incision site was made, which favorably resolved. The average length of time of the procedure was less than 15 minutes.

The stab incision procedure for upper medial fat pad removal is a safe, effective, and more time-efficient procedure when only removing the medial fat pad than the traditional upper blepharoplasty.