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What is vaginoplasty or vaginal rejuvenation?
Vaginoplasty, also known as vaginal rejuvenation, is a major modification of a traditional surgical procedure that aims to enhance your sexual experience by tightening lax muscles to increase friction during intercourse. The techniques developed result in a relatively bloodless procedure performed on an outpatient basis. In brief, the vaginal muscles and supportive tissues are tightened and excess vaginal lining is reduced. The procedure will improve vaginal muscle tone, strength, and control. This will effectively decrease the internal and outer vaginal diameters, as well as build up the perineum, the area immediately outside the vaginal entrance and above the anus. The surgery is not limited to just the entrance of the vagina, as many superficial repairs are done, but extends the length of the entire vaginal canal. Common anatomical defects or hernias known as a cystocele or a fallen bladder and rectocele or weakness in the vaginal floor are repaired at the time of reconstruction. If urinary stress incontinence coexists it can be repaired at the same time. Dr. Jacobson has been using the Biolitec optical laser for the past five years, but more recently has transitioned to the Ellman Surgitron radiosurgery system for greater precision and far less thermal trauma compared with the laser. This translates to significantly diminished swelling and post-operative inflammation, resulting in reduced discomfort and more rapid healing with a superb cosmetic result.
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What is perineoplasty?
The perineum is the muscular structure between the lower entrance to the vagina and above the anus. It acts as a sexual trigger. When firm, it tightens during intercourse, pushing your partner against the clitoris for greater sexual stimulation. Oftentimes this structure is flattened due to childbirth or previous surgery and loses its firmness and tone. Reconstruction of this area is a part of vaginoplasty, although some women only need to have a perineal repair to correct the looseness from childbirth, and this can be a stand alone procedure. Interestingly, many plastic surgeons and some gynecologists claim this surgery to be a "vaginoplasty", but it does not tighten the entire length of the vaginal canal. It is insufficient if there is significant vaginal wall relaxation. In addition, the removal of excess perineal skin will not result in sexual enhancement. The underlying muscles must be restored to their natural position to function properly.
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What is labiaplasty or labia reduction?
This surgery primarily refers to the removal of excess, uneven inner lips at the vaginal entrance which often causes irritation, chaffing and discomfort with sports, exercise, cycling and during sex. Form fitting clothing, tights, thongs, and bathing suits cannot be satisfactorily worn due to the bulk of the tissue. Many women find the size or irregularity of the smaller lips to be aesthetically unpleasant and simply desire a more ‘natural’ look. No one knows why this happens. We frequently see enlarged labia in teenagers. Once the labia have been recontoured they do not grow back. Radiosurgery is the method of choice for reduced post-operative discomfort, minimal scar formation, enhanced healing and excellent cosmetic results.
==> Read more about Labiaplasty
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What is clitoral hood reduction?
The skin adjacent to the clitoris is known as the clitoral hood or prepuce. The appearance is affected by genetics, hormonal stimulation and external alterations secondary to childbirth. The added bulk of this loose tissue can detract from the appearance of the vulva. If there is significant clitoral hood tissue and a patient undergoes labiaplasty, this area can actually appear even more prominent and unsightly. Dr. Jacobson removes this excess skin using a meticulous technique that leaves no scaring. There is never any attempt to operate on the clitoris itself, nor does one want to remove all of the skin on top of the clitoris, which can result in long term irritation. There is no evidence whatsoever to suggest there will be greater responsiveness if the clitoris is totally uncovered.
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What is labia majora reduction?
The large outer lips of the vulva, or labia majora, are often exaggerated in size and bulk, resulting in an unsightly bulge in tight fitting clothing or a bathing suit. It can be due to sagging skin or to an excess amount of tissue below the surface. This area can be safely reduced by meticulously removing the excess tissue and by hiding the suture lines in the natural skin folds. Care must be taken not to overcorrect the reduction. The labia majora are shock absorbers of the pelvis and protect the vaginal entrance from irritation due to riding, bicycling or spinning. Proper reduction will result in a more youthful appearance and better fitting clothing.
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What is hymenoplasty?
The hymen or membrane of skin at the vaginal entrance can be ruptured by sports, exercise and straddle injuries, in addition to intercourse. Many times there is no perceptible hymeneal tissue to begin with. In many cultures the presence of an intact hymen is a requirement for marriage. Bleeding and resistance are expected and in fact demanded at the consummation of the marriage. Anything less can result in cancellation of the marriage, ostracism and even physical harm. Reconstruction of the hymen will meet these requirements and can be accomplished precisely so as to appear to be unchanged from birth. Hymen repair, also referred to as hymenoplasty, is performed to make the patient appear virginal. It only works for women who have not had natural deliveries, and preferably, in those who have never been pregnant. We take advantage of radiosurgery to make extremely precise incisions in the remnants of the hymeneal ring. This is followed by using fine, dissolving sutures to bring the delicate tissues into close approximation. The final result leaves no evidence of the previous tears. Hymenoplasty takes about six weeks to heal completely, so proper scheduling of surgery is necessary. It is an outpatient surgery lasting 30-40 minutes and can be done with local or twilight anesthesia.
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High Frequency (No Scalpel) Surgery
vs. Laser Surgery
If you have visited the many vaginal rejuvenation and labia reduction websites on the Internet you have probably discovered several different techniques promoted as the best for restorative vaginal reconstruction, especially laser surgery. As someone who was personally trained by the two top two pioneers in the specialty and who has over eight years experience with restorative vaginal surgery, let me share with you my thoughts on this subject.
For the first five years working in this subspecialty I used the laser for all of my vaginal rejuvenation and labia reduction procedures. The laser was highly marketable and well known to the public, literally and figuratively the ‘cutting edge’ of medical technology, and achieved very good results. Even today, many women believe if their surgeon isn’t using a laser he is behind the times. Well, if the laser is so outstanding, what convinced me to switch to high frequency surgery to perform the same procedures?
Before we go there, let’s talk about the laser first. This is a device that focuses and concentrates light energy into a very precise cutting instrument. The type of laser used for vaginal rejuvenation uses a wavelength designed to seal small blood vessels as it cuts. The result: a precision incision with virtually no bleeding. However, there is a significant downside. The laser generates intense heat. The remaining tissue edges that need to be stitched together sustain a lot of thermal damage, resulting in swelling, peeling and inflammation that lasts for days or even weeks. A significant amount of post-operative discomfort persists and it takes a long time to heal, especially after vaginoplasty. During labiaplasty, if the inner labia are thin the residual heat damage can be very traumatic and result in distortion and prolonged discomfort, even it the best of hands.
High frequency surgery provides the best of all worlds. It generates a radiowave emitted by a fine wire. This cool tip doesn’t even touch the skin as it cuts. As a result there is virtually no thermal effect, charring, swelling or inflammation. In fact the cut edges are ‘cleaner’ compared with a scalpel or knife because the width of the incision is so fine. Patients who waddled into my office the day after laser surgery now walk in with minimal discomfort, whether they had undergone vaginoplasty or labia reduction. Where I previously ordered Percocet and Oxycontin for post operative pain with laser surgery I now only use a mild narcotic such as Vicodin, and even then only as a backup medication. Needless to say, you can be up and about and can return to normal activities faster and with greater comfort compared with the laser.
The problem with high frequency surgery is that women don’t know about it and not many surgeons are trained in its use. It’s actually been around for a long time and has been used by neurosurgeons, ENT surgeons and dermatologists. This is simply a new application of a well established instrument. It may not be sexy but it makes for a wonderful marriage of technology and restorative vaginal surgery.
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