By Dr Mark X. Lowney, double board-certified in Obstetrics/Gynecology and Cosmetic Surgery
Dr Mark X Lowney aka The Real Dr Feelgood is one of the only physicians in the country double board certified in obstetrics and gynecology as well as cosmetic surgery. With over 25 years of clinical experience, he has performed over 10,000 surgical procedures including cosmetic gynecological procedures otherwise know as female genital rejuvenation surgery, designer vaginal surgery, and female genital rejuvenation surgery.
What procedures are included in Cosmetic Gynecologic Surgery?
- Vaginoplasty or “Surgical Vaginal Rejuvenation”
- Clitoral Hood Reduction or Hoodoplasty
Many women experience vaginal looseness or laxity after childbearing especially if they have multiple, large children vaginally. Other risk factors for vaginal looseness include genetic predisposition, collagen deficiency, and massive weight loss. This if often referred to as vaginal relaxation syndrome.
Common symptoms of vaginal relaxation syndrome include:
- Difficulty feeling partner’s penis during sexual intercourse
- Penis slipping out of vagina during sexual intercourse
- Inability of either partner to achieve orgasm due to decreased friction during sexual intercourse
- Trapped air being released from vagina aka quiffing or vaginal farting during sexual intercourse
- Urinary leakage during intercourse
- Gaping sensation of vagina, especially when bearing down
There are many non-invasive, non-surgical procedures available to help decrease vaginal relaxation syndrome symptoms including:
- Kegel exercises: involve voluntary contraction and relaxation of the levator muscles in attempt to strengthen the pelvic floor muscles to non-invasively tighten the vagina.
- Radiofrequency and laser devices which non-invasively stimulate collagen and elastin reformation in the superficial layers of the vaginal mucosa. Dr Mark Lowney is presently offering Viveve Radiofrequency and ThermiVa Radiofrequency non-surgical vaginal rejuvenation as a first line treatment for patients who are not candidates for surgical vaginal rejuvenation or do not want the downtime of surgery. These non-surgical, non-invasive devices are safe if performed by practitioner who has been appropriately trained. Dr Mark X. Lowney and staff at Advanced Body Sculpting of New England has performed over 1000 laser and radiofrequency procedures with no adverse side effects or complications.
- The O-Shot which involves injecting the patient’s own platelet-rich plasma containing growth factors which then attract stem cells which regenerate collagen, blood vessels and nerve supply to G-spot, anterior vagina, and the clitoris.
When non-invasive, non-surgical options fail to tighten the vagina to the patient’s satisfaction, then surgical vaginal rejuvenation or vaginoplasty is the next option. Surgery time: 1 hour. This technique involves removing a triangular wedge of posterior vaginal tissue as well as a triangular piece of perineal body (skin between vagina and anus) in order to maximally tighten vagina and build up the perineum. Prior to performing the surgery, a preoperative evaluation with Dr Lowney is required as well as surgical clearance and some lab work. This surgery usually takes about 1 hour to perform and is usually performed under local anesthesia and IV conscious sedation. It is an outpatient procedure and does not require and overnight stay. Some patients are sent home with a vaginal packing and Foley catheter which are removed the following day.
The risks of this procedure are typically very low, however can include:
- Postoperative pain
- Intraoperative bleeding
Recovery time includes:
- Back to work within 1 week
- No heavy lifting, straining, or sex for 6 weeks
- Sitz baths (soaking in Epson Salt for 30 minutes daily after 1 week)
- Stool softeners for 1 month
Labiaplasty is the term which most of the time refers to reduction of the labiaminora which are the inner, non-hair bearing lips on the female genitalia as opposed to the labia majora, which are the outer, hair bearing areas between the labia minora and inner thigh. Labiaminoraplasty is the most commonly performed cosmetic gynecological procedure for women experiencing the following conditions:
- Interference and discomfort during sexual intercourse due to the labia minora being pulled and twisted into the vagina
- Chaffing and discomfort from labia minora rubbing against panties or tight clothing
- Labia minora accidentally hanging out of bathing suit leading to embarrassment
- Labia minora causing diversion of urinary stream leading to urine not directly entering toilet but soiling buttocks and legs
- Labia minora causing unsightly bulge when wearing bathing suit
- Darkening or melanosis of edges of labia minora causing woman to be self-conscious
Labiaplasty surgery reduces the excess skin on the labia minora so that they don’t hang down below the labia majora. There are many different techniques including the “trim” technique where the outer edge is reduced to the patient’s customized liking and the edges are reapproximated with sutures that dissolve. This technique is especially popular when the outer edge of the labia minora has pigmented skin on it, i.e. melanosis. The second most common labiaplasty technique is the “wedge” technique which has many different modifications but they all essentially remove a pie-shaped wedge in the middle of labia minora and the upper and lower halves are sewn together. This technique maintains the natural border of the labia minora, however, it does not remove pigmented edges and it does have a higher dehiscence (skin separation) rate. Labiaminoraplasty surgery is usually performed under local anesthesia with a little oral or IV sedation. Prior to performing this procedure, the patient should be shown different before and after pictures in order that the correct amount of excess skin is removed. Surgery time 1 hour.
The risks of labiaminoraplasty are rare but include:
- Overcorrection (too much skin removed)
- Dehiscence (skin separation)
Recovery time includes:
- 1 week from work. To decrease pain and swelling for 1st 72 hours, an icepack placed over a sterile gauze should be placed on labiaplasty site 30 minutes on, 30 minutes off while awake
- Showering can be resumed within 24 hours; however, tub bathing should be avoided for 1 week. After showering and urinating, the area should be gently patted dry or dried with blow dryer set on cool.
- Running and weight training exercises should be avoided for 2 weeks. Walking at least 30 minutes, 3 times a day is encouraged after any surgery to prevent DVT/PE.
- Sexual activity and tampon use should be avoided for at least 6 weeks after labiaplasty surgery
3. Clitoral Hood Reduction or Hoodoplasty
There is a layer of skin which covers the clitoris called the prepuce or clitoral hood which is very similar to the foreskin which surrounds the glans (tip) of the penis. Often times when there is redundant labia minora skin, concomitantly there are also excess folds of skin on the clitoral hood. A hoodoplasty removes this excess skin thus giving this area a more esthetically pleasing appearance. Sometimes, the hood skin can prevent the glans of the clitoris from being stimulated during sexual intercourse leading to difficulty in the woman achieving a clitoral orgasm. Hoodoplasties are usually performed at the time of labiaplasties utilizing local anesthesia with either oral or IV sedation. Risks, recovery and postop care are exactly the same as for a labiaplasty mentioned above. The satisfaction rate for both labiaminoraplasty and hoodoplasty is over 90%!! Surgery time: 20 minutes.
The labia majora is the hair-bearing outer part of the female genitalia which frames the labia minora, vestibule, and vagina. The labia majora frequently loses volume with both age and weight loss producing a deflated appearance with looseness and wrinkling of overlying skin. This can lead to discomfort during intercourse secondary to loss of the fatty layer of protection.
In most patients, these changes can be addressed effectively with autologous fat transfer. A small amount of fat is harvested from a suitable area like the abdomen, hips or inner thighs, purified of blood and tumescent solution, and injected into the subcutaneous fat layer in the labia majora. Sometimes, 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 is resected, thus removing the saggy skin. Skin resection and fat transfer can be performed at the same time if fat transfer alone does not bring about desired cosmetic result. Non-invasive radiofrequency heating and/or laser resurfacing can be performed after autologous fat transfer to tighten labia majora skin Surgery time: 1 hour
Risks of Labia Majoraplasty are rare but include:
- Fat necrosis
- Fatty cyst formation
Recovery for Labia Majoraplasty
- 1 week from work, 6 weeks for sexual activity
- Intermittent icepack like labiaminoraplasty
- Scar creams starting 1 week postop
The mons pubis is area is the area located below the lower abdomen and above the vulvar commissure of the genitalia. This is the area where the majority of female pubic hair is located and has the propensity to collect unwanted fat as well as saggy skin, especially after massive weight loss surgery. This area often times remains fatty and bulges forward even after achieving ideal body weight after dieting and exercising.
Monsplasty surgery usually consists of liposuction alone, but occasionally involves removal of loose skin which can be performed as a stand-alone procedure or at the same time as an abdominoplasty (tummy tuck). When severe pytosis or drooping of the mons area is present, it is critical that the scarpa’s fascia of the mons area is plicated with delayed absorbable or permanent suture or recurrent drooping will occur.
Risk of Monsplasty
- Overresection/Underresection as well as unevenness from liposuction
Recovery from Monsplasty
- 1 week from work or light physical activity
- 6 weeks for sexual intercourse
- If drain placed, removal when output less than 25cc’s in 24 hours, usually 1 week.
- Postop lymphatic massage or endermologie encouraged starting within 2 weeks as this area prone to prolonged edema (swelling).