The labia of my vagina was so big that I was embarrassed to have anyone see me. Every doctor I saw told me it was normal. Maybe it was normal but I hated the way I looked. In one afternoon it was gone. Thank you Dr Cappiello” – P.J-M.
Female Gynecological Plastic Surgery is another term for the encompassing gynecological surgical procedures performed to transform the female external genitalia to make it aesthetically more pleasing. These procedures are referred to as vaginal rejuvenation, laser vaginal rejuvenation, designer vagina, the “Mommy Makeover”, labiaplasty and vaginal tightening. These terms are used to describe operations focused on female genital enhancement.
The field of the aesthetic gynecology is the fastest growing component of cosmetic surgery. More and more women and surgeons become aware of the procedures that can correct some of the side effects of childbirth, weight fluctuations, tissue laxity and anatomic idiosyncrasies.
Dr. Gerard Cappiello is a leader and a pioneer of the Reconstructive Pelvic Surgery. He is also a member of the prestigious International Society of Cosmetogynecology.
Cosmetic vaginal surgery focuses on the external and internal female organs to restore them to a more youthful function and aesthetically pleasing appearance. Known as vaginal rejuvenation, areas that can be addressed include the mons pubis, the labia majora and the labia minora, the clitoral hood, the perineum and the G-spot.
The perineum is the muscular bridge of tissue between the anus and the vagina. This structure and the lower third of the posterior vaginal wall are the areas typically operated in vaginal tightening procedures. The perineum is by far the most vulnerable part of the vagina during a vaginal delivery. A break in this area, caused by tears, episiotomy, forceps or a large baby is responsible for the cascade of problems with urinary and fecal incontinence. The break in this area is also responsible for the loss of the vaginal axis whose integrity is essential for penis penetration and a satisfying sexual experience. Read about Perineoplasty.
The mons pubis is the structure above the pubic bone which is a fatty projection and part of the woman in the standing position. This area needs to be just the right proportional size. If it is too large, as in heavy women or those that have lost a lot of weight due to gastric banding procedures, it can cause distressing body image problems. When the mons is too small, as in women who are very thin, the female look is lost and can be disturbing to her.
Either mons pubis liposuction or mons pubis lifting will beautify the appearance of this region. Mons pubis liposuction is typically performed in the supine position 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 and sagging of the labia majora as viewed in the standing position. It is achieved by precise alignment of the central tension vectors at the time of abdominoplasty. 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 covering the clitoris. This covering over the clitoris can hinder stimulation during sexual activity. Exposing more of the clitoris (Clitoral Hood Reduction) can be very satisfying and at times essential for the sexual experience. The Mons lift is done first because it frequently produces a tightening and lifting of the clitoral hood. Reduction of the labia minora and the skin around the clitoris is also done to make the clitoris more prominent and accessible.
Reduction labiaplasty is the most common treatment for patients dissatisfied with elongated, asymmetric or hyperpigmented labial tissue. Excess of the labia minora may also cause pain during sexual activity. When examining the labia minora, it is necessary to splay them laterally onto the labia majora to determine the degrees of hypertrophy, hyperpigmentation and asymmetry which may be present. The changes to the labia minora are due to childbirth or other trauma. Reduction labiaplasty and vaginal tightening procedures are usually performed with excellent functional and cosmetic results.
Three procedures are available for cosmetic alteration of the labia majora:
The labia majora frequently loses volume with both age and weight loss producing a deflated appearance with looseness and wrinkling of the overlying skin. In most patients, these changes can be addressed effectively with autologous fat transfer. Similar to fat grafting in facial applications, a sufficient amount of fat is harvested from a suitable site, prepared according the surgeon’s preferred technique and then injected into the subcutaneous fat layer. Deep injections are avoided as they may disrupt the structures of the vestibule.
When a greater degree of skin laxity and sagging are present, an ellipsoid full thickness skin resection in the long axis of the labia majora, either alone or in conjunction with autologous fat transfer, will provide an effective cosmetic solution.
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 varicoses working from proximal to distal veins. A pelvic compression garment is worn for the first seven days. More about Labia Majora procedures.
Hymenoplasty, sometimes referred to as “revirgination”, is typically performed when a request is made for cultural or cosmetic reasons.
Commonly known as vaginal rejuvenation, procedures for tightening the vaginal dimensions originate from a class of gynecologic operations referred to as vaginoplastiescolporrhapies or initially developed for the treatment of prolapse of the bladder (cystocele) and of the posterior vaginal wall (rectocele). 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. The anterior vaginal wall plays a lesser role in vaginal tightening, but a far greater role in the surgical treatment of urinary incontinence.
Dr Gerard Cappiello is a urogynecologist with expertise in pelvic reconstruction. Experienced in the management of complex pelvic surgical conditions he is uniquely qualified in all aspects vaginal reconstructive surgery. Cosmetic vaginal tightening procedures can correct the anatomic distortion from childbirth-related damage and scarring. Vaginal reconstruction can correct vaginal relaxation, restore the normal functionality of the vagina, bladder and rectum. The degree of tightening required can be tricky to gauge, and the hands-on experience that comes from doing a lot of cases is critical.
Women who are able to achieve vaginal orgasms (referred to as “deep orgasms”) have slightly different or fuller tissue in the area known as the G spot than in women with only clitoral orgasms. The G spot is an area of the anterior (front) of the vagina, about 2 inches inside. The tissue may be a little thicker here, and is more sensitive to the touch. If you curl 2 fingers just inside your vagina and press your vaginal tissue toward your skin, and with the other hand, press down on the skin just above your pubic bone, you will likely find an area of increased sensitivity (even if it doesn’t cause arousal). This is the area of the G Spot. When stimulated, this tissue thickens further, and the nerve endings give a heightened sense of arousal, leading to a vaginal or “deep” orgasm.
The concept of the G spot enhancement, also referred to as the G shot, is to thicken the area up with a commonly used filler so that increased arousal can occur. For women who are unable to have a vaginal orgasm (so they may feel they do not have a G Spot) this procedure thickens up the tissue in that area, and increases the chances of a deep, vaginal orgasm.
Cosmetic vaginal surgery can be performed with general anesthesia, epidural anesthesia, spinal anesthesia or intravenous sedation with local infiltration and pudendal block. Dr. Cappiello performs almost all of the vaginal cosmetic procedures under local anesthesia. Prophylactic antibiotics are routinely administered. Patients are typically positioned in dorsal lithotomy with boot-type stirrups, mild knee flexion and routine intermittent pneumatic compression stockings to prevent deep venous thrombosis. Indwelling bladder catheterization and vaginal packing are employed during some operations.
Prior to any cosmetic vaginal surgery, a thorough gynecologic evaluation should be performed to evaluate pre-existing gynecologic, urogynecologic and urologic conditions, which might alter the timing of the procedure or influence the surgical plan. Failure to do so may result in patient dissatisfaction with the cosmetic procedure or, worse, aggravation of the medical problem.