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  • The popularity of vaginal rejuvenation has increased dramatically over the past decade.

  • Several trends are responsible for this surge in interest, including the Internet and significant changes in grooming habits, as well as improvement in surgical techniques.

  • There is a bimodal age distribution of women seeking vaginal rejuvenation with peaks in both the fourth and sixth decades.

image Beginner Tips

  • A thorough and comprehensive understanding of vulvar anatomy is a prerequisite for considering female genital rejuvenation.

  • A full perineal evaluation should be performed when labia minora reduction is requested.

  • Baseline photography, both standing and in lithotomy, is very helpful.

  • Noninvasive treatments, such as ablative and nonablative fractional laser treatments, are increasing in popularity.

image Expert Tips

  • Labiaplasty may be combined with fat grafting and laser resurfacing to provide an optimal outcome in the appropriate patient.

  • Treatment of the labia majora should be done with caution, as scars tend to be significantly more visible than those associated with labia minora reduction.

  • Thin labia minora are less amenable to wedge resection.

  • Patients with large clitoral hoods are better treated with an extended wedge technique, rather than an edge trim.

image Don’t Forget!

  • Atrophic labia majora may contribute significantly to the appearance of labia minora redundancy.

  • While still controversial, the net effect of labiaplasty in the absence of complications is an improvement in sensation.

image Pitfalls and Cautions

  • A common complication of inadequate closure of the wedge defect is a window, or mid incisional partial dehiscence.

  • Repair of the defect is difficult, as the temptation exists to re-excise the wedge, which frequently results in a secondary dehiscence.

image Patient Education Points

  • Controlling patient expectations is critical.

  • Review the patient’s anatomy with a mirror in the standing and lithotomy positions to make sure that their expectations are realistic.

  • Recovery is often extensive, and patients should understand that they will need a lengthy period of pelvic rest.


Vaginal rejuvenation, or aesthetic female genital surgery, includes myriad cosmetic procedures designed to improve the appearance of the female external genitalia, including the mons pubis, labia majora, labia minora, and the clitoral hood. Historically, such procedures date back to ancient Egypt, where enhancement of the vulva with adornments, bleaching and reductive techniques were described.1 It is a distinct and separate entity from female genital mutilation, or the complete removal of the labia minora, clitoral complex, and labia majora, which is practised in some Islamic and Arabic countries.


Modern surgical techniques for reduction of the labia minora were first described in the 1970s and 1980s,2,3 and most techniques represented variations of trimming the distal edge of the labia minora. It was not until 1998 that Gary Alter, a plastic surgeon and urologist, described a modified wedge procedure for labia ...

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