Q: Will vaginal reconstruction (vaginoplasty) correct cystocele? A: "Vaginoplasty" is a term commonly used in cosmetic gynecology, but it is medically defined as the creation of a vagina de-novo when it is absent. This is a complex issue that requires further explanation. The urinary bladder is supported not only by the anterior-distal vaginal wall but also by its own suspensory and supportive structures; therefore, vaginal reconstruction (vaginoplasty) alone will not resolve bladder prolapse. Clinical assessment and imaging must confirm the site-specific defects within these supportive structures before surgery. These defects can be corrected using native tissue to reposition the urinary bladder. Surgical mesh is unnecessary as native tissue can be effectively utilized. Several anatomical regions need the restoration of the bladder's supportive and suspending structures. Vaginal Reconstruction This procedure must follow the principles of site-specific defects reconstruction instead of using a generic repair for the vaginal wall. Under no circumstances should vaginal tightening be offered, as it involves resecting the posterior vaginal wall and partially removing the posterior perineum (crotch). Such procedures can result in urinary and fecal incontinence due to unintentional damage to the perianal body. All the best, Prof. Dr. Adam Ostrzenski Florida, USA
Q: Will corrective surgery improve the external genitalia look? A: Yes, it will significantly improve the external genitalia's look. The revision surgery must address the following structures: 1. Reduction of the clitoral hood (the clitoral prepuce) and clitoral prepuce orifice, 2. Clitoral frenulopasty, 3. Labia minora reconstruction (not repeating labium minus amputation) with neurovascular bundle preservation (a new surgical technique developed by Ostrzenski), 4. Restoration of the labia minora frenulum. 5. It isn't easy to decide on pictures, and clinical evaluation will be very helpful. Labia majora restoration: 1. Identify clinically site-specific defect (most likely, the surgeon opened an adipose sac, creating herniation since it is getting larger in standing position). (This technique was also developed and published in medical literature by Ostrzenski), 2. Restoration of the adipose sac will eliminate the appearance of "third labium minus appearance) All my research and new surgical techniques can be found on the PubMed website using my name (ostrzenski a). Kind regards, Prof. Dr. Adam Ostrzenski Florida, USA
Q: Can cosmetic surgery treat dyspareunia and acquired healing skin deformities? In dual conditions, the functional disorder of dyspareunia (pain during vaginal intercourse) must be treated first and not a cosmetic anomaly. An esthetic surgery that was suggested by a doctor, even by a skin smoothing around the Fourchette (the midline posterior fusion of both labium minus, it is not a vaginal opening) and fossa navicularis (natural depression between the hymen and fourchette). It is not an acceptable medical approach. Therefore, you need an experienced medical practitioner in the diagnosis and therapy of dysmenorrhea. Reviewing the submitted two pictures, there is no vaginal gapping present, and why the surgeon presented a video of how he executes this procedure is unclear to me since the vaginal gapping is not related to this case; the presented technique is also called into question due to not addressing all the anatomical structures responsible for vaginal closing mechanism. However, the picture from December 2024 indicates that there is gapping anal orifice with the corrugator cutis ani (the anal orifice gapping) defects. In summary: 1. Find a doctor who specializes in the diagnosis and treatment of dyspareunia, 2. Rospond cosmetic surgical therapy until such time that your functional problem (dyspareunia) will be under control, 3. Select carefully a doctor to care for dyspareunia and an eventual cosmetic surgeon if you decide to go ahead with your cosmetic surgery, With regards, Prof. Dr. Adam Ostrzenski Gynecologic Surgeon USA 2.
Q: What could be done to make it look better? A: Yes, revision of this batched cosmetic surgery is possible. Pictures show the following postoperative functional and cosmetic anomalies: 1. The clitoral hood is tightened, the clitoral gland is hidden, and the clitoral frenula are not completely visible, 2. Surgery left a lot of redundant tissue, 3. The labia minora are asymmetrical, the right labium minus is inverted, and both present with deep wrinkles. The red arrow on picture # 1 indicates an over-resection of the left infralabial crease and the fragment of the labia majora. Both labia are fused with the skin of labia majora and crease. This post-operative fusion can cause functional problems (pain at the beginning of penetration, dryness, and loss of labial protection). It requires surgical treatment by applying a labiolysis technique I developed and published. Black and wrinkled tissues are depicted in both pictures in the lower part. If you are having symptoms, the surgery can help. Your esthetic problems can be also corrected. An experienced surgeon would be the best choice for your subsequent surgery, and you should ask a prospective surgeon questions like the ones I have created above. Please feel free to contact me through the RealSelf company.” Adam Ostrzenski, M.D., Ph.D. Professor of Gynecology
Hello Doctor! Q: Am I a candidate for consideration for examination and revision of vaginal reconstruction (marketing vaginoplasty) and iatrogenic stress urinary incontinence? A: Yes, both conditions are curable; however, iatrogenic stress urinary incontinence depends on the prior surgical-related injuries. The surgery failure for a sensation of the wide/smooth vagina requires a very meticulous clinical pelvic evaluation that includes the paravaginal, lateral, anterior-posterior vaginal walls, and posterior perineum. Also, dynamic MRI is beneficial in establishing site-specific defects. The sensation of a wide vagina is a complex surgical treatment in multiple anatomical regions. You will find my research on this topic by consulting the PubMed database and using the password Ostrzenski a. I will give you a few of my scientific-clinical articles that will help you familiarize yourself with your condition: 1. Ostrzenski A. An acquired sensation of wide/smooth vagina: a new classification. Eur J Obstet Gynecol Reprod Biol. 2011 Sep;158(1):97-100. doi: 10.1016/j.ejogrb.2011.04.019. Epub 2011 May 26. PMID: 21620554. 2. Ostrzenski A. Anterior vaginal introitoplasty for an acquired sensation of wide vagina: a case report and new surgical intervention. J Reprod Med. 2014 May-Jun;59(5-6):327-9. PMID: 24937977. 3. Ostrzenski A. Modified posterior perineoplasty in women. J Reprod Med. 2015 Mar-Apr;60(3-4):109-16. PMID: 25898473. 4. Ostrzenski A. Vaginal rugation rejuvenation (restoration): a new surgical technique for an acquired sensation of wide/smooth vagina. Gynecol Obstet Invest. 2012;73(1):48-52. doi: 10.1159/000329338. Surgical iatrogenic stress urinary incontinence can be caused by: 1. Surgically released the “kinked urethra” due to bulging urinary bladder. This condition requires reconstructive surgery with native tissues. 2. Inadvertently resection of the perineal body. This structure is located under the posterior-distal-middle vaginal wall. If the perineal body has a site-specific defect(s), this condition is surgically treatable. Ostrzenski A. Anatomy of the bulbus vestibuli: A cadaveric study. Ann Anat. 2021 Jan; 233:151588. Doi: 10.1016/j.aanat.2020.151588. If, during your prior surgery, inadvertently, the perineal body was partially resected, then therapy is possible but difficult. A diagnosis and corrective surgery must be done by a very experienced with a well-documented track record of reconstructive surgery with native tissue. I do not use the RealSelf company for my practice marketing, so I cannot offer you a telehealth consultation through these sources. Kind regards, Prof. Dr. Adam Ostrzenski USA
