Interest in Aesthetic Gynaecology Treatment in Islamabad, is on the rise among both patients and medical practitioners. This specialized field within obstetrics and gynecology has garnered increased attention. While there’s currently limited super-specialization or dedicated fellowship training in this domain, advancements in aesthetic and plastic surgery training signal the necessity of incorporating specialized education in this area.
Notably, in the US and the UK, several esteemed certification and preceptorship programs have emerged, serving as starting points for many surgeons entering this field.
Aesthetic Gynaecology Treatment in Islamabad, Pakistan
To equip physicians keen on surgical and non-surgical therapies with certification training, new programs have been globally introduced between 2016 and 2017. Our overview covers both surgical and non-surgical treatments under the umbrella of aesthetic gynecology, along with insights from prominent gynecologic associations regarding this emerging field of study.
Introduction:
Advancements in technology and fashion have shaped evolving perceptions of beauty, while social and cultural norms vary globally, contributing to diverse perspectives. Consequently, accurately representing the typical view of female external genitalia proves challenging. Hodgkinson et al. suggest that smaller labia minora and proportionately larger labia majora are considered aesthetically ideal.
Motakef’s system categorizes labial appearance based on the disparity between labia minora and majora protrusion. Similarly, Hamori et al. developed classifications based on morphological variations and shapes of labias . However, these systems lack endorsement by gynecological or plastic surgery societies, or general practitioners.
Surgical intervention in cases of labial hypertrophy or congenital adrenal hyperplasia (CAH) often necessitates labiaplasty. Yet, most patients seeking labiaplasty do so to alleviate discomfort during physical activities or clothing wear, address sagging skin, or enhance sexual experience without interruption.
Aesthetic Gynecology Surgical Art:
Aesthetic gynecology encompasses a range of procedures, such as labiaplasty, clitoral hood reduction, and vaginal rejuvenation, which includes vaginoplasty and perineoplasty.
1.Labiaplasty:
Labiaplasty, often termed labioplasty, is a popular cosmetic gynecological procedure aiming to surgically modify and often reduce the size of the labia majora or minora. Its objective is to maintain a consistent lip contour and labial edge color, reducing obstruction during sexual intercourse. Hodgkinson and Hait initially discussed this procedure. Several surgical techniques exist, including linear incision, de-epithelialized reduction, composite reduction, curvilinear resection, V-wedge resection, wedge reduction, inferior wedge resection, W-plasty excision, Z-plasty, superior pedicle flap reconstruction, and other less common methods.
However, preserving the natural contour of the corrugated free edge with these techniques presents challenges. The procedure must be personalized to suit each patient’s requirements. A study by Magon et al. in 2017 found that 97% of 550 women requested removal of dark edges, aiming for labia that were flush with or tucked beneath the labia majora, smaller, straighter, and with a pinker edge, seen as advantageous.
Gynecologists often favor the linear excision technique for its simplicity and minimal invasiveness. Some regions, like Laguna Beach, California, may use terms like “rim look,” “Barbie look,” or “hybrid look” to describe labial reductions based on the proportion of labia majora to minora.
Labioplasty can also address medical conditions like congenital lymphedema and chronic steroid-induced sagging linked to steroid use for CAH. When performed for aesthetic reasons, labia minora and labia majora plasty are typically done concurrently, though they are distinct procedures.
2.Clitoral Hood Reduction:
Clitoral Hood Reduction, also referred to as clitoral hoodectomy, involves the removal of excess tissue from the fold covering the external part of the clitoral glans, known as the clitoral head or preputium clitoridis. This procedure separates the prepuce from the clitoral tissue. It’s crucial, as Goodman noted in 2009, to differentiate this surgery from clitoridectomy.
Patients may opt for clitoral hood reduction to potentially enhance sexual satisfaction by exposing more of the clitoris. Other reasons include aesthetic, hygienic, or comfort concerns, such as reducing chafing or discomfort caused by a constricted clitoris. The surgery aims to surgically diminish the length and prominence of the clitoral prepuce. According to Kent et al.’s 2012 study of 407 patients who underwent clitoral hood reduction alongside central wedge labiaplasty, when performed by skilled surgeons, the procedure boasts a low complication rate, with only a 2.9% revision surgery rate.
3.Vaginal rejuvenation:
Vaginal rejuvenation, a surgical procedure, combines perineoplasty and vaginoplasty to address vaginal canal widening. These methods stem from established procedures like pelvic floor reconstruction and colpoperineorrhaphy.
Vaginoplasty, also known as vaginal tightening, involves altering the epithelium, deeper canal, and vaginal entrance. Contrary to popular belief, pelvic floor repair is vital within a urogynecologic evaluation. Surgery for a large or loose vagina may include excising lateral vaginal mucosa or high posterior repair, often coupled with perineoplasty and paravaginal repair, with or without anterior colporrhaphy. Clear communication between surgeon and patient is crucial to align expectations and determine the desired and feasible vaginal diameter reduction while addressing risks of over-tightening.
One vaginoplasty technique entails removing excess vaginal mucosa from the fornices, while another option includes excising lateral vaginal mucosa or anterior/posterior colporrhaphy, or a combination. Perineoplasty, or perineorrhaphy, reconstructs the vaginal introitus by reducing the vaginal opening size and tightening perineal muscles. Typically performed alongside posterior colporrhaphy, it repairs weakened or damaged vaginal walls in pelvic organ prolapse cases.
Perineoplasty aims to enhance the perineal area’s appearance, improve sexual satisfaction by elevating the perineum and enhancing friction during penetration, and potentially refine defecation mechanics. However, when used alone to address sexual dysfunction, perineoplasty might not yield effective results.
Reverse perineoplasty is another variation targeting scar tissue from prior surgeries or lichen sclerosus, a vulva-affecting skin condition. This procedure involves removing visible bands and scars while constructing an advancement flap to enhance the introital caliber.
4.Labia majora augmentation:
Labia majora augmentation, a non-surgical procedure, focuses on enhancing the aesthetic appearance of underdeveloped or lax labia majora. Common methods include hyaluronic acid (HA) fillers and autologous fat grafting. The fat used in grafting is usually sourced from various fatty areas, predominantly the thigh or inner knee, prepared through techniques like the Coleman method. However, the possibility of graft re-absorption is a consideration for achieving desired results. HA fillers are more prevalent in Europe due to cost efficiency, while fat grafting finds more usage in the United States.
In Europe, HA fillers enhance labia majora, whereas in the US, procedures like labia majora-plasty or radiofrequency shrinkage are preferred for a streamlined appearance. Surgeons’ expertise and anatomical understanding are crucial for successful outcomes. Nonetheless, caution is necessary when using HA in this region to prevent complications such as granuloma formation.
5.Hymenoplasty:
Hymenoplasty, often termed revirgination in Western societies, raises numerous ethical considerations. This least-researched female genital surgery is predominantly sociocultural. Ethical committees often don’t classify hymenoplasty as cosmetic genital surgery, viewing it more as a reconstructive procedure rather than an aesthetic one. While this surgery can carry significant cultural and social implications, for some women, it might also be a matter of personal safety. To respect patients’ privacy, practitioners might refer to the procedure as a “vaginal repair,” emphasizing its relatively straightforward nature.
Aesthetic Gynecology Non-Surgical Treatment:
1.Fractional lasers non-surgical vaginal laxity:
Fractional lasers offer a surgery-free remedy for vaginal laxity. Among these, the fractional carbon dioxide (CO2) laser, with a 10.600 nm wavelength, stands out. Its unique ability to absorb tissue water rejuvenates the vaginal mucosa, triggering collagen fiber regeneration and restoring suppleness. Conversely, the fractional erbium laser, operating at 2,940 nm, addresses conditions like stress incontinence, vaginal tightness, and postmenopausal vulvar-vaginal atrophy. Influencing collagen fiber contraction, the erbium laser, with a water absorption capability 10-15 times greater than the fractional CO2 laser, aids in tissue tightening.
Additionally, it minimizes heat-related damage to surrounding tissue, decreasing postoperative discomfort and edema. However, the term “laser vaginal rejuvenation,” originally coined by Matlock using a 980-nm diode laser, has evolved. Several laser companies now employ newer, minimally invasive fractional laser techniques to shrink vaginal walls, often termed vaginal laser therapy or laser vaginal resurfacing. Notably, debates persist among medical professionals concerning the safety and effectiveness of laser vaginal rejuvenation.
2.RF(Vaginal Rejuvenation):
Energy-based skin rejuvenation techniques have effectively addressed vulvovaginal laxity resulting from aging or childbirth, employing radiofrequency (RF). Research demonstrates that RF treatment enhances collagen and elastin production in vaginal tissue . RF surpasses laser therapies in naturally moist tissue and offers a more universal approach, irrespective of skin type. Temperature-controlled RF, regulated by thermistors to maintain tissue temperatures between 40-45 degrees Celsius, exhibits promising safety measures.
This method fosters healthy tissue development by inducing collagen denaturation and healing, ultimately leading to tightening effects. The immediate post-procedure tightening is attributed to the formation of thicker, shorter collagen fibers under tissue heating.
RF technology’s unique capability to stimulate elastin production, uncommon in alternative methods, offers potential benefits in addressing vaginal laxity. Improved local blood flow from RF treatments also aids in enhancing sexual function and satisfaction by reducing dryness associated with vulvovaginal atrophy. Furthermore, studies indicate RF’s ability to tighten the pubocervical fascia and alleviate stress urinary incontinence.
3.Volver Lightning:
Chemical agents or the fractional carbon dioxide laser approach can aid in reducing the hyperpigmentation of the vulva. However, it’s crucial to prioritize preventing any subsequent hypopigmentation. Techniques involving energy-based tools like CO2 lasers may trigger either hyper- or hypo-pigmentation issues. While ablative radiofrequency (RF) treatments can also cause pigmentation concerns, the non-ablative RF approach proves beneficial in circumventing these issues.
4.Platelet Rich Plasma (PRP):
Since its inception in 1987 for open-heart surgery, autologous Platelet-Rich Plasma (PRP) has been extensively researched across diverse fields like orthopedics, dentistry, wound care, and cosmetic surgeries. PRP comprises robust growth factors, including platelet-derived growth factor, transforming growth factor beta, and epidermal growth factor (as illustrated in Figure 3 demonstrating PRP injection in the vagina). Being autologous, PRP is generally nonantigenic and commonly devoid of adverse effects.
Beyond its surgical applications, PRP injections show promise as potential non-surgical remedies for female sexual dysfunction, inadequate lubrication, and stress urinary incontinence. Combining PRP with RF has emerged as a promising avenue for long-term relief in lichen sclerosis, with ongoing studies exploring this treatment.
The identification of an erotic zone along the anterior vaginal wall, linked to vaginally activated orgasms, was first noted by Grafenberg in 1950, later coined as the G-spot by Addiego et al. While its precise anatomy remains under investigation, it’s believed to be a neurovascular complex associated with vaginally triggered orgasms . Augmenting the G-spot region with fillers like collagen or autologous fat transfer has been reported to potentially enhance sexual activity by increasing the bulk of the vaginal lumen.
5.HA Filler:
Ostrzenski established a clinical diagnostic criterion for secondary dysfunction of the G-spot, including indicators like challenges in achieving orgasm through vaginal stimulation, reduced vaginal engorgement, decreased sensation in the anterior-distal vaginal wall during sexual arousal, history of complicated vaginal birth or surgery, and previous noninvasive medical treatment.
G-spot amplification, also known as G-spot augmentation or the G-shot, represents a minimally invasive cosmetic surgical procedure designed to temporarily enhance the G-spot’s size. Positioned roughly halfway between the pubic bone and the cervix, the G-spot is targeted during the amplification process, often employing HA fillers or, in some cases, autologous fat transplants injected into the bladder-vaginal septum. This technique’s concept revolves around the expansion of the G-spot to potentially heighten sensory input and friction, aiming to elevate sexual pleasure. Additionally, HA fillers have been utilized to enhance both the major and minor labia, addressing issues of deflation or atrophy.
6.Lipofilling:
Adipose-derived stem cells (ADCs) are a plentiful source of widely distributed stem cells. Autologous fat transfer bears a very low risk of rejection. ADCs constitute part of a complex blend termed the stromal vascular fraction (SVF), encompassing endothelial cells, extracellular matrix, and various immune cells.
Lipofilling, a technique involving fat transfer, aims to augment the thickness of vaginal walls, revitalize vulvar skin, and restore genital volume. This procedure involves grafting fat into the labial folds, effectively thickening them and consequently reducing the vaginal diameter.
Applications Of Vulvovaginal Cosmetic Procedures In Adolescents:
Women may opt for cosmetic treatments for various reasons, including enhancing appearance, addressing functional concerns, or dealing with psychological aspects. Young girls and teenagers deciding on labioplasty may have differing motivations. Girls aged nine to 13 might seek surgery to alleviate problems like rubbing, chafing, or sports-related disruptions. Sometimes, a concerned mother may notice her daughter’s issue and reach out to a doctor. On the other hand, young adults aged 14 to 17 may primarily consider labioplasty due to appearance concerns and worries about acceptance by sexual partners.
When contemplating labioplasty for teenagers, additional considerations are crucial beyond the usual preoperative planning and counseling. These encompass the purpose behind the procedure, specific anatomical concerns, the patient’s physical maturity, societal impacts, parent-child decision-making dynamics, and the patient’s post-operation outlook. It’s essential to factor in typical physiological and developmental changes in young females, especially in the vulva, and postpone treatments until the patient reaches a stage of mature genital development.
Marketing Cosmetic Procedures:
Marketing cosmetic procedures like labioplasty and vaginal rejuvenation can pose ethical dilemmas. Advertisements might not accurately convey the risks and potential side effects, leading to unrealistic patient expectations. Moreover, the financial incentives for medical professionals conducting these procedures could influence decision-making and lead to unnecessary operations.
Gynecologists must prioritize patients’ health and well-being over financial gain. Patients should receive comprehensive education about the benefits and risks of each surgery. While discussing procedures and their potential advantages is acceptable, misleading or promoting unnecessary surgery is unethical. Gynecologists should exercise professional discretion, adhere to ethical standards, disclose any conflicts of interest, and always prioritize patient safety and welfare when considering advertising aesthetic procedures.
Popularity Of Cosmetic Surgeries:
The surge in popularity of cosmetic surgeries for female genitalia, despite lacking substantial evidence, raises significant concerns. Educating and counseling women about their anatomy, embracing natural variations and changes, is vital. Counseling should precede informed consent, ensuring women grasp the potential risks and unintended consequences.
Technological advancements have introduced tools to reverse aging effects and restore tissue function, particularly in vaginal rejuvenation. Despite overdue acceptance and the need for regulatory oversight, cosmetic gynecology exhibits promise in enhancing patients’ lives. However, it addresses issues often considered taboo, hindering open discussions and awareness among women.
As this field rapidly advances, establishing standardized practices becomes imperative for safety. Long-term studies are crucial to understand outcomes and validate the efficacy of novel approaches. This evolving field requires cautious development to ensure both safety and effectiveness in improving women’s well-being.
