Laser Vaginal Rejuvenation, and female genital enhancement are fastest growing in cosmetic surgery as women and surgeons become more aware that the nonmedical genital effects of childbirth, weight fluctuations, tissue laxity and anatomic idiosyncrasies can be addressed by a variety of procedures. The pioneers in this type of surgery are all members of the International Society of Gynecology Aesthetic Medicine and Surgery.

The perineum which forms the muscular bridge of tissue between the anus and the vagina, and the lower third of the posterior vaginal wall are the areas typically operated in vaginal tightening procedures. The anterior vaginal wall plays a lesser role in vaginal tightening, but a far greater role in the surgical treatment of urinary incontinence. Hymenoplasty, sometimes referred to as  “revirgination” is typically performed when a request is made for cultural reasons.

A gynecologic evaluation should be performed to screen for pre-existing  gynecologic, urogynecologic or urologic conditions which might alter the timing of the procedure or influence the surgical plan. Another issue which must always be kept in mind is the potential effects of future vaginal childbirth on the cosmetic procedure and that a cesarean delivery by patient request may not always be available.

Mons pubis liposuction is typically performed at the time of general abdominal liposuction.
The mons pubis lift is an effective aesthetic option for women with significant laxity in the mons pubis region. The pubic lift integrates well with mons pubis liposuction and yields a more complete and balanced aesthetic solution for the abdominal wall.

Cosmetic alterations in this region are focused on the excision of loose, redundant folds of skin from the prepuce. When planning surgery of this type in combination with a mons pubis lift, the lift is done first because it frequently produces a tightening of the prepuce in the vertical axis when the mons pubis is placed on cephalad traction.

Reduction labiaplasty is the most common treatment for patients dissatisfied with elongated, asymmetric or hyperpigmented labial tissue.  When combined reduction labialplasty and vaginal tightening procedures are performed, vaginal tightening is performed first because it involves the resection of the fourchette with subsequent reconstruction in a more anterior position.

Three procedures are available for cosmetic alteration of the labia majora: augmentation by autologous fat transfer, skin tightening by resection of loose skin, and sclerotherapy. The labia majora frequently lose volume with both age and weight loss producing a deflated appearance with looseness and wrinkling of the overlying skin.

Varicose veins of the vulvar region respond to sclerotherapy in much the same manner as those of the lower extremity. Not infrequently, these varicosities are a source of pelvic pain. The veins are targeted in the standing position and injected in the supine position. The technique is identical to sclerotherapy of the leg varicosities working from proximal to distal veins. A pelvic compression garment is worn for the first seven days.

Commonly known as vaginal rejuvenation, procedures for tightening the vaginal dimensions originate from a class of gynecologic operations referred to as vaginoplasties or colporrhapies initially developed for the treatment of prolapse of the bladder  and of the posterior vaginal wall. Mild to moderate degrees of vaginal laxity can be corrected quite adequately by targeting the lower third of the posterior vaginal wall and the perineal body for this type of surgery.

Experience with the management of complex pelvic surgical conditions is mandatory for surgeons embarking upon vaginal tightening procedures.