There is a lot of talk about vaginal rejuvenation recently. It seems everyone is interested in talking about it.

So what is it and why is it so popular?

Vaginal rejuvenation encompasses many things… but broadly speaking is broken down into “functional” and “cosmetic” concerns.

Functional concerns include things like:

• Incontinence – this can come in the form of leakage with such things as laughing or coughing. This can be repaired with surgery or potentially with energy treatments such as laser or radiofrequency.
• Prolapse – this could mean many things but essentially it is internal tissue pushing into or even out of the vagina. Surgeries for this are done by gynaecologists and are covered by OHIP.

Cosmetic and/or functional concerns:

• Energy treatments may be found at your gynaecologists office but more typically it is plastic surgeons that provide this care. Plastic surgery has used energy treatment to rejuvenate tissue for a very long time including the face, neck and hands and are very accustomed to them.
• Labiaplasty
• Clitoral hood reduction (removing excess skin over the clitoris)
• Labia majora reduction
• Elevation of the mons pubis (the pubic hair region)
• Vaginal tightening
• Labia filler

Who is the typical patient for vaginal rejuvenation?

These treatments are for anyone that is uncomfortable or unhappy with their vaginal region. It is for people that are self-conscious about the way they look. For people that do not feel they can relax and enjoy intimate moments. For people that have pain with intercourse or other contact because of excessive or redundant tissue. Patients range in age from late teens with congenital asymmetry or tissue excess, to much older patients that have lost tone following pregnancy or menopause… and everyone in between.

What is a labiaplasty?

A labiaplasty is a surgical procedure that alters the appearance of the labia. There are two labia (latin for lip), the labia minora (the inner lip of tissue) and the labia majora on the outside. Either can be enhanced with surgery. The labia minora is the more common. The inner fold of tissue may extend beyond the labia majora causing a less ideal appearance or actually be large enough that it gets entrapped during intimate contact or intercourse. The most common procedure is to reduce this excess tissue so that it sits nearly flush with the labia majora. Sometimes this is required on both sides, sometimes just one.
Surgery for the labia majora typically involves reducing the overall size. This can be done by removing an ellipse of tissue thereby creating a flatter more youthful or attractive appearance.

For other patients they may have lost volume over time and want the tissue plumped up. Various fillers can be used all with the purpose of creating a fuller, plumper, more youthful contour.

Both labia minora and majora labiaplasty leave discreet scars that fade with time.

What is clitoroplasty surgery?

For some patients, they may feel that they have too much hooding of tissue over the clitoris. This may cause discomfort or the opposite, diminished sensation. Sometimes patients may feel that it is just not aesthetically pleasing. A small chevron shaped tissue resection can be done just above the clitoris to elevate the clitoral hood. The scar is hidden well with hair, even in patients that have just a small central patch.

What is mons elevation?

The mons pubis is the pubic hair region. It is fatty and provides padding and cushioning over the pubic bone. This can descend over time, after pregnancy and with significant weight loss. When the mons descends, the vaginal opening can face more downward and appear less youthful. When I perform an abdominoplasty (tummy tuck) I may also do a mons elevation for patients that need it. It is potentially possible to have just the mons elevated without having a tummy tuck. This would typically leave a small scar that is similar to a c-section scar.

What is vaginal tightening?

For patients that have had children through vaginal delivery, they may find that their opening is less tight than it once was. It may occur as a result or tissue stretching or even tearing. It can alter the sensation for patients and their partners, as well as lead to discomfort, dryness or irritation of tissue. Depending on the extent of laxity, either surgery or energy treatment such as laser or radiofrequency can be used. This may improve appearance, discomfort, sexual function, and even incontinence. For major repair, gynaecologists may be required for an OHIP repair. For energy treatment, plastic surgery offices often specialize in this treatment.

What makes a beautiful vaginal region?

As they say, “beauty is in the eye of the beholder”. There is no perfect vagina. No one has written the defining document on what amount of tissue coverage a clitoris should have. What direction should the vaginal opening face? What is the perfect amount of hair? Some may find full natural hair perfect and beautiful, while others may like none at all. No one can say what is ideal. However, for patients that are looking at having rejuvenation surgery of their vaginal region, there are a few common requests and goals as surgeons:

• Smaller labia minora that have symmetry and extend to approximately the level of the labia majora. Some people think it looks nicer if extends just beyond whereas others may prefer having the labia tucked just inside.
• Plump but not overly large labia majora. Tissue that conceals the vaginal opening is more often seen with weight-loss and post-pregnancy. Removing excess tissue so that labia minora are just visible can look more youthful.
• Direction of the vaginal opening. In a more youthful healthy physique the vagina is more anteriorly facing. With tissue laxity the tissue above the vaginal opening can hang down making the vaginal opening appear to face more towards the ground.

What is true is that every person has their own idea of what looks nice. For women that have concerns with how they appear, there are options available.

What does vaginal rejuvenation surgery entail?

Each surgery is done a little bit differently. It can be done with local anaesthetic or with general anaesthesia or sedation. Some patients may have a preference and many surgeons will as well. The surgery is done in an operating theatre under sterile technique. The area is prepped and draped, and the surgeon and team are dressed in surgical attire, including gowns, gloves, masks and hats. Regardless of whether patients are awake or asleep, local anaesthetic is injected to provide post-operative comfort. Tissue excess is removed and the contour enhanced. Sutures are then applied to close the tissue. This is nearly always done with resorbable suture material so that none will have to be removed later. Once surgery is complete, the area is cleaned, an antibiotic ointment applied and a pad or sanitary napkin held in place with underwear.

What is the post-operative recovery like after vaginal rejuvenation?

At first you will be numb from the local anaesthetic. As this wears off, you will have a little discomfort, but this should be easily managed with medication for the first couple days. You can develop swelling, so an ice pack can be applied regularly for the first few days after surgery to limit this somewhat. You can shower the next day, but should not bathe in a tub or pool for 4 weeks. You can gently irrigate the area after going to the washroom or gently dab with a wipe for the first week.

You may return to activities such as walking the next day. Running and bicycling should wait a couple of weeks. Intercourse should wait for 6 weeks to allow healing but more gentle contact can resume sooner.
Do people ever combine vaginal rejuvenation with other surgery?

Lots of surgeries can be done safely together. Women having a mommy makeover with a breast surgery and a tummy tuck may also have a small vaginal surgery done at the same time. It would not affect healing or recovery. If you are interested, speak to your doctor.

If I am interested how do I get an appointment?

If you are interested in discussing a Mommy Makeover please contact Dr. Rodger Shortt to arrange an appointment at 905-849-4282 or info(at)drshortt.com.

Dr Rodger Shortt is a plastic surgeon servicing Oakville, Mississauga, Burlington, Milton, Hamilton and Georgetown. He strives to provide his patients the best care and excellent plastic surgery results. He is one of only a few plastic surgeons in Canada with a top rating on RateMD, RealSelf and Ontario Doctor Review. Dr Rodger Shortt is a specialist plastic surgeon trained in cosmetic surgery and reconstructive surgery. He specializes in breast surgery, breast augmentation, breast fat transfer, mommy makeover, tummy tuck, body contouring, breast reconstruction and cosmetic surgery of the face. He is the Director of Cosmetic Surgery Training at McMaster University and an Assistant Clinical Professor. If you are interested in a consultation with Dr Shortt please contact as at 905-849-4282 or visit www.drshortt.com.