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This is a new area of cosmetic surgery that combines several principles of plastic surgery and gynaecology to give a youthful rejuvenation to this area. The correct name for this would be cosmetic female genital surgery since the term vaginal surgery is restrictive. We improve the whole area. Childbirth, ageing, weight swings and other factors may result in distortion, laxity, downward descent and generalized dissatisfaction with the appearance and function of this area of the woman’s body. It is now possible to entirely correct much of this damage.

In many women, the tissues between vagina and anus [called the perineal body] got torn during childbirth [or the cut given by the obstetrician did not heal well] leading to loss of tissue or laxity in that area. In many the inner lips are over stretched or the outer lips lose fat and flatten out. The vaginal muscles may become very lax. Sometimes these changes may happen after massive weight loss as well. All these changes lead to discomfort, stress urinary incontinence, sensations of heaviness, and difficulty with hygiene or dissatisfaction with sexual relations. Sometimes there is embarrassing lack of full control over gas or urine. Now a combination of simple surgeries can restore much of what is lost or distorted.

Who is a candidate?

  1. If there is dissatisfaction with the appearance of this area especially if it has changed with time /age or childbirth
  2. Discomfort due to excessively long skin folds rubbing against the panty
  3. Awareness of being ‘loose’ down there
  4. Heaviness in the lower areas, stress incontinence or lack of perfect control over gas leak.
  5. There is sexual dis-satisfaction and a clear notion that things are not the same as it was before the childbirth.

Consultation: After reviewing relevant history of childbirth and sexual history, an examination usually reveals what the problems are. A check-up with a gynaecologist is also usually undertaken. Depending on the problems encountered in each case, a customized plan is made and all the elements of the female genitalia and vaginal cavity are addressed. I use Radiosurgery tools routinely to reduce bleeding and speed up the healing. This surgery can also be combined with other plastic operations such as abdominoplasty or breast surgery.

Surgery: For the sake of understanding we classify it as Labiaplasty or Vagina-plasty or both [Vulvo-vaginoplasty] and Perinoeoplasty. In the usual case all three components are done together.

In labiaplasty, the inner labial lips are trimmed and re-shaped. The clitoris may also be un-hooded or hooded as required or suspended if required. Fat grafting is used to restore volume and plump up the deflated outer lips. The outer lips may also be enhanced or reshaped.

In vagina-plasty or vaginal rejuvenation, the surgeon removes loose unwanted vaginal tissue and repairs the stretched muscles at the back of the vagina. This reduces excess vaginal lining and tightens the vaginal muscles. Dr. Mohan uses radiofrequency tools to minimise bleeding and to make extremely precise cuts in the vaginal mucosa. The healing is also fast since there is minimal collateral damage to the tissues. Fat may also be grafted inside the vaginal opening to improve grip, tightening and enhancing sexual stimulation.

G-shot or G-spot augmentation can also be performed by injecting a special filler to bring the extra sensitive area of vagina [called G-spot] more forward. The G-spot or Gräfenberg spot is named for Dr. Ernest Grafenberg, who first described it in a 1950′s article in the International Journal of Sexology as a highly erogenous zone inside the vagina that gets bigger when directly stimulated. Enhancing this area can bring it into better contact during sex and deepen many facets of pleasure for women. G-Spot Amplification® was invented and developed by the renowned Beverly Hills gynaecologist David Matlock, MD, MBA, FACOG. This procedure alone is also available by itself as a clinic procedure.

Perineal body reconstruction or Perineoplasty: Some women need this as well. It is also known as posterior repair. In this procedure the tissues between the vagina and anal opening are restored and strengthened. Many women develop tears in this area during childbirth. Also a cut may be made here by the obstetrician to enlarge the birth opening. Although the cut is repaired in all cases, it is not uncommon to find that in some the repair has opened or weakened. Such women benefit greatly from perineal repair.

Women who plan to have subsequent children through vaginal delivery should be aware that they may need a second procedure or might have to opt for C section.

Mons Lift: An allied procedure called mons lift is required if the entire genital complex along with pubic mound is coming down. The mons and the entire area can be lifted up by mons lift. The cut and final scar line is hidden in the hair bearing upper pubic area. Mons area can also be reduced by direct surgery or liposuction or both. This surgery adds tremendous value to both abdominoplasty and to female genital rejuvenation.

Anesthesia: This procedure can be performed under general or spinal anesthesia or under local anesthesia with sedation.

Recovery period: It can be a day-surgery or with overnight stay especially if muscle repair has been done. The patient can usually return to work 2 to 4 days after surgery or even the next day if only labiaplasty is done. Temporary pain is treated with analgesics. Swelling, tenderness, numbness of the vaginal wall may be experienced. Sequential application of cold packs for the first 6 hours after surgery helps to keep swelling down. The stitches are usually absorbable. Patients should avoid sexual intercourse for six weeks.

Outcome: Almost all patients report a high degree of satisfaction with the procedure and resulting improvements. There are no visible marks at all in these operations. The vagina should remain firm and tight for many years. Regular Kegel’s exercises will help to maintain the results. This might change if the patient undergoes vaginal childbirth after the procedure. The resulting improvement is sexual gratification makes the procedure worthwhile.

Is the use of Lasers important?
The laser has many advantages when used as a scalpel. Many plastic surgeons use lasers, but there is no magic in the use of lasers. Other instruments, such as a radio-frequency cautery, can give the same results, but it is obvious that the term “laser” adds a sense of prestige to the procedure. I do not use laser for this.