Monthly Archives: November 2015

The title is for those of you who receive this blog post in your inbox. I figured the nickname “Vag” was enough to get you to open it.

So here’s the scoop:

Over the past decade or so, considerably increased attention has been drawn to the cosmetic appearance of the vag (technically, in all of the papers published, it is referred to as “female genitalia” but I just can’t…)

I was personally unaware of this trend until women started coming in to see me many years ago, displaying their dissatisfactions by demonstrating: “look, this flap goes like that, and this goes like that…Can you fix it?!?”

My first thought was: “how do they even know what theirs looks like? I couldn’t pick mine out of a lineup.”

 And then:

 “Why do they care?”

 But since I need to be at the forefront of cosmetic surgery for women—I immediately did the research and read the articles. I’m talking scientific/plastic surgery industry ones, not web-based chatroom talk. Below is a screenshot of just a fraction of what a literature search for “labiaplasty” in our scientific journals brings up today:

Screen Shot 2015-11-01 at 1.13.57 PM


Clearly “labiaplasty” is no longer a “fringe” procedure. Not only is it now considered very mainstream, but culturally—at least here in Los Angeles–it has become a thing.

 It could almost be considered the new breast aug.

 Back then, as the only double board-certified female plastic surgeon in Beverly Hills (in general surgery and plastic surgery—to be fair, I hear there is a newbie board-certified in ENT and plastic surgery) I realized:

I need to offer this procedure to my patients.”

So, many years ago, I started performing my friend Dr. Gary Alter’s technique (yes, Caitlyn Jenner’s surgeon—this is public knowledge, not a HIPAA violation) for labiaplasty of the labia minora. These are the “flaps” that most patients want shaped and reduced if they are seeking cosmetic improvement. These thinner, inner “lips” that sometimes hang down below the larger, outer “labia majora,” can cause discomfort in certain clothing and, depending on your aesthetic, can be considered unattractive.

Anyway, I don’t think this is news to most of you. Points of interest that you do need to be aware of if you are considering labiaplasty of the labia minora:

  • For it to be done properly, it usually should be done in an Operating Room, with at least some IV sedation. Although it seems like a small, simple thing, it’s not just a “snip” that can be done in the office. It is a very exacting and complex procedure that the surgeon should perform meticulously under loupe magnification (microscope glasses). Not only to get you a perfect result, but to prevent complications. As you can imagine, that area could have a difficult time healing, and if it doesn’t heal well, you can wind up with something much worse than what you started with.
  • Truthfully, the recovery can be a little brutal—there can be significant swelling and discomfort for at least a few days—so you just need to be prepared and to plan for it. It’s not a go-back-to-work-the-next-day procedure. And you should have at least a week of no obligations and no sex for six weeks
  • Most patients’ significant others are not opposed to it. Except maybe for the “no sex for six weeks” part.

So labiaplasty of the labia minora is a surgery.

I just wanted to make that clear. That’s not the main reason for this blog.

I wanted to discuss this new laser, Thermiva®

In our field we often use the term “laser” loosely to keep things simple for the consumer, to describe all noninvasive skin treatments involving big machines, but Thermiva® is not actually a laser.

Thermiva® is a radiofrequency device, which means it induces skin tightening with energy that heats tissue and stimulates collagen production in order to reduce the appearance of fine lines and loose skin. The technique induces tissue remodeling and production of new collagen and elastin.

Yes, this sounds familiar because there are so many radiofrequency devices out there already for use all over the face and body, but Thermiva® is the only one that has been FDA approved for vaginal rejuvenation inside and out.

Many times, my patients will ask me off-handedly if I do that “inside tightening procedure” and I refer them to their gynecologist. But actually, this laser may take the place of that more invasive procedure.

Here are the take-home Thermiva® bullet points:

***It is done in-office, supposedly done without even any numbing cream, doesn’t hurt, and takes about half an hour.

***No downtime—you can go back to having sex the same day (yay?)

***The cost for the patient is approximately $3500 for the three recommended treatments, spaced one month apart but supposedly you see a result after just one. Each separate treatment runs approximately $1500.

***If something sounds too good to be true, it usually is, right? I need to be clear: This is not the Holy Grail for the vag. The Thermiva does not work on the labia minora, so it doesn’t replace that surgery we discussed above.

***It works well on the Labia Majora—often the cause of the camel-toe-in-LuLu Lemons®-for-no-reason. I don’t have as many women pointing this out as a problem area, but when we are discussing a tummy tuck or a lipo, they do usually ask me if the procedure will give them any kind of lift overall.

***It tightens the loose tissue on the inside. By stimulating tissue growth and rejuvenation, it has actually been shown to improve urinary incontinence (leaky bladder) after childbearing and might even replace the much more invasive and notoriously unsuccessful “bladder sling” procedure. This could actually be the most valuable application for it.

***Results supposedly last about a year.

So based on the above information and the rave five-star online reviews, this thing might really be useful.

I am always skeptical about new and expensive devices that “really work!” But I have heard a great firsthand review from a patient who says she noticed an improvement after just one treatment, and this seems to be the current theme.

So does this thing really work? And if it does, like the labiaplasty, is it something that I should be offering my patients?

I wanted to do some market research with my patients to find out what the true demand for such a procedure would be. But I found that, even with the patients that I know really well, it’s a little awkward to bridge the conversation from “Your breasts look great!” to “How’s your vag doing? Do you think it needs to be tighter?”

So instead I’m putting it out there with this blog, a chance to get anonymous feedback from my readers and anyone else out there secretly surfing the net on this subject.

Is this procedure for tightening the inside (vaginal canal) and outside (Labia Majora only) something that YOU would be interested in?

We are especially interested in those of you in the Los Angeles area, as we will be setting up a “Thermiva® demo day” where we will be doing this in the office for a very reduced price. Yes, like a focus group. I don’t like to sell something that doesn’t work.

So let us know. You know where we live.

Sorry, no before and after pics here. I just couldn’t. Besides, they would probably get taken down by WordPress anyway.