Edward M. Zimmerman, MD

Hi Island Girl!  

Great question and while there certainly concerns about the use of the term "vaginal rejuvenation", if you are specifically interested in increased sensitivity, lubrication, decrease in incontinence and tightness that both you and your partner can perceive during relations, there are several answers.  

Either way, you need a good history and physical examination of the area before any meaningful treatment can be prescribed or surgeries suggested.  Humans are soooo complex!!

But lets look at the SCIENCE!!!  How does each modality WORK and what CAN it possibly do?

Fractional CO2 lasers (we have several) put tiny, usually bloodless, holes, penetrating less than half a millimeter into the tissue-through into the dermis, but not into the sub-dermal fat or muscle.  It's like aerating the mucosal "lawn" that lines your vagina, so that it increases nerve and blood vessel ingrowth as it heals and hence there can be some improvement in sensitivity and lubrication and often a slightly thicker skin happen.  If you make a few extra passes, in the 11 to 1 o'clock part of the vagina, the tissue may thicken a bit and help support the urethra.  That can decrease some forms of incontinence--mainly stress (SUI), and sometimes a bit of urge incontinence over several treatments and then maintenance keeps the result up.  There are several Erbium YAG lasers made for this treatment, but their penetration into the mucosa is even more shallow, so they may not be as effective unless they have a very powerful energy output and bigger spots.  Either way, laser treatments take only a few minutes compared to RF which takes 20-40 minutes, but there are more differences!

RadioFrequency (ThermiVa, that we have, and others) use monopolar radio waves that travel from one antenna (on the tip of a blunt, vaginal probe, rubbed against the mucosa), through the body, to another antenna that looks like a grounding pad on the outside skin of your back, belly or thigh.  RF likes warm, moist tissue, and the radio waves cause enough microscopic movement of water molecules in the tissue, that the tissue warms-usually about a third as deep as the electrode is wide.  Precise thermal feedback from the primary electrode allows us to know the temperature on the surface of the vaginal mucosa in real time.  We know from data on thousands of different people that the surface temperature in a human is 5-8 degrees C lower than the temperature 1 to 3mm under the skin.  This non-surgical heat, for a specific amount of time on tissue, causes ingrowth of blood vessels and nerves and actual visible tightening of the vaginal canal and can improve the appearance of redundant tissue on the outside (labia) over a number of treatments.  Then there is recommended maintenance annually.  The deeper heat and hence deeper change in tissue thickness works as well or better on SUI too.  


Other modalities.  It's like a buffet and you can mix and match as you please!  

How about the Oshot?!  We have pretty good success improving lubrication, sensitivity and incontinence with just a few drops of your own platelet rich plasma injected painlessly -hard to believe but true!-into specific areas down below.  Our RN and NP (who has a passion for women's health and 15 years experience) do those most of the time.  That's usually a once or twice treatment to start and then annual maintenance, but they don't call it the Oshot for nothing!  We offer the Pshot so your partner can keep up with you too!!

Additionally, there is the new FDA approved--for all types of incontinence--Emsella!  Yep, we have that one too!   You sit for 30 minutes, over a powerful electromagnet (think MRI magnet in a chair, powerful!) that causes the pelvic floor muscles to contract about 12,000 times (that's a whole lot of kegles girl!!) a session.  Most gals do 6 painless sessions over 2-3 weeks and then some do maintenance quarterly.  No more PEEEZING!! (when you pee when you sneeze!)

All these non surgical treatments can be used alone or together to optimize your outcome for the lease risk, expense and downtime....

Now that you understand the SCIENCE better, maybe that will help you make a decision. 

If you go to a practice where they only have one way to treat your issues, it's kinda like when you have one hammer and all the nails look the same!  But it just ain't true!  Caveat Emptor!

Hope that helps pull it all together!

Ed Zimmerman, MD  Medical Director Las Vegas Laser & Lipo, An IMQ Accredited Surgical Facility

Hi Neggy,

Here's another point of view.

The Vampire Facelift, a very conservative and rejuvenative facial filling technique is just what you are looking for.  It utilizes a single syringe of Juvederm Ultra Plus (Has numbing in it) and about 5cc of your own Platelet Rich Plasma (10-11cc tube of blood drawn before your procedure, so go to the office well hydrated!) to produce a super natural, conservative result.

Vampire Facelifts are a proprietary technique for using precise "tent poles" of filler as scaffolding and then injecting the PRP to help your body lock the filler in place and to cause skin rejuvenation in the same areas: lateral brow, cheeks, lateral chin, lower smile lines, mouth corners and even the jawline in guys! 

This procedure uses tiny volumes to precisely tent out and up, the parts of the face that need to line up in an "upwards V" to give you the most rejuvenated look, but look like you were born that way!  It is performed by an injector who has had advanced training--check out the website below to find a provider in your area who has been specially trained (or teaches this procedure to others) to evaluate and provide this service.  

It is performed quickly in the office.  After documenting your current exam with digital pictures, discussing the options and obtaining consent, you will likely be offered topical numbing cream and have your skin sanitized.  Then 1cc of Juvederm will be carefully and symmetrically injected using a tiny needle to strategically lift your cheeks and other areas to improve proportion.  There is numbing mixed with this filler, so pretty comfortable.  Next your PRP will be injected through the same insertion sites to assist the scaffolding set up by the filler with lifting and tissue rejuvenation.  You will be able to go out that night with minimal swelling or discomfort, but you will look better and even more natural in two weeks!

Once you find the contour you like, keep it for years instead of months, using a syringe or more of Bellafill, which has a 5 year FDA approved duration of action, for a subtle, but long lasting, natural rejuvenation!  It plays with PRP very well too.

Hope that helps.  Now go get ur cheek on!!  Nobody will know!!

Best, Z

Hi Ms PinkFlamingo!  Great questions.  Ain't no replacement for youth and that under 25, never been pregnant, eating right and working out, body!!

We don't know from your question,  what your initial weight/BMI/measurements were, your natural elasticity (ancestry), if there are stretch marks and if your torso was ever larger around previously due to weight or babies?  All those factors can make a difference on the route and manner we suggest to enhance your figure.

Let's assume you were average weight, average exercise, minimal stretch marks, no babies and you were never heavier.  The one liter (about a quart US) of fat that was removed from your mid-section left a deflated space that was initially filled by swelling and inflamed tissue that takes several months to resolve.  Collagen and elastin from any invasive procedure generally take 90-120 days to show visible smoothing and tightening.  At 4 months out, honestly, you are not likely to see a lot more tightening-some, perhaps, but not a lot and the swelling that was masking the deflation has resolved.  Bummer!!

In your ideal world, you might have been offered Laser (SmartLipo and others), Mono-polar Radio Frequency (ThermiRF or BTL) or Helium Plasma (Renuvion) to "shrink wrap" the skin and tissue an additional 10-20% after the fat was sucked/scraped/washed/ from the inside.  If there is a lot of extra skin expected, you might have considered surgically moving the belly button upwards to release the redundant skin and trim the extra-sometimes 3-10 inches tall by 20+ inches across!) from the inferior  abdomen.  That's called a skin excision with umbilical relocation.  If the underlying muscle is tightened at the same time, then we call it an abdominoplasty.  It generally leaves a scar somewhere in the underwear area.

What to do now?  If there is just a bit of extra skin, then external RadioFrequency micro-needling (Profound, Vivace, and others) may be enough to fulfill you skin tightening needs for at least a few years.  If you regain the weight around your middle, that will re-inflate the skin, but if you get thinner as you age, the appearance of extra skin when you sit, may return.

Surgery trades removal of extra skin and stretch marks for a while, but torso skin stretches, the spine looses height over years and abdominal muscles relax and lose volume.  The scar is now part of your wardrobe....so think long term happiness if that is a good trade.

A new technology called EmSculpt causes your abdominal muscles to enlarge without actually doing the exercise yourself.  What would your belly look like if you did 20,000 (yes, 20,000!!) crunches in 30 minutes twice a week for a few weeks?

Hope that gives you something to ponder constructively.  Either way, the fat is probably better gone for your long term health, so something to rejoice about!  Enjoy the journey!

Best, Z

Hi Prudie!

Thanks for your great question.  Bellafill has been FDA approved in the USA since 2006.  I was one of the early adopters, so I have happy patients with over a decade of experience and over five years of my own experience to state that this filler is awesome.  It is the MOST STUDIED filler on the planet and has a very low risk and adverse event profile.  

So, your concern about enhancing aesthetics over time is perhaps more a question of are you working with an injector with lots of Bella experience and knowledge? (the company calls us BellaDiamonds on their physician finder).  Is your injector someone who intentionally "sculpts" the face into a timeless contour based on the pictures of your younger face that you like?  Do they follow the subtle changes with good digital photos? etc.

Also recognize that while Bellafill is long lasting, Mother Nature ( the Queen "B") is sucking 1/2 to 1 teaspoon of volume out of your facial balloon every year, so volumizing is not a one and done for life kinda thing...you gotta keep it up: proportion, volume, symmetry and texture, ... but at least with Bellafill, you don't start from scratch with every filler visit.  You always build on what you've got!

Hope that helps!

Best, Z

Dear Flat...Thanks for your quandary on this frequent issue and posting the pictures.  You appear to have several things going on, leading to your butt's droopy condition: fat loss, skin laxity, and muscle volume loss are the easiest items to overcome to get you back into your favorite clothes or keep you happier in your birthday suit.  Let's advance to the rear as Pogo so eloquently stated and get this behind us!

J-plasma (now called Renuvion) is currently my favorite subdermal skin tightening tool with or without lipo sculpting or fat shifting.  The new Thermi Avanti RF may be a close second once they have a longer disposable electrode to use, but I don't know when that might happen.  I don't usually shift fat to the same area where we want to shrink-wrap the tissue, as the two technologies are not complementary (Renuvion may locally decrease grafted fat viability).  But Renuvion to the sub dermal and supra-facial tissue everywhere you don't graft fat (you might put some fat on the lateral aspects of the butt to round it out without becoming J-Lo) works well.  You usually keep more than half the fat you move in healthy, non-smoking folks.

Other thoughts include combining Renuvion with a couple of 4 pack treatments of the new EmSculpt.  You do sets of 4 sessions, a couple each week, and then consider maintenance if you don't work out much on your own.  Each painless, no-sweat, half hour session is like doing 20,000 squats!  What would your butt look like after 80,000 squats in two weeks to rebuild the muscle over a couple of months after you shrink wrap the skin with Renuvion??

We can also add volume to the butt without using your own fat.  We use large amounts of tissue builders and activators (Sculptra, Radiesse and Bellafill), to strategically enlarge the butt where you can visibly benefit the most.  There is essentially no downtime and the results can last years.  The downside is a BellaButt costs big bucks!

Finally, there are butt implants which are probably more of a pain in the backside than they are worth-google all the risks and issues, and skin excision surgeries which work well in the right patient.  Butt skin reduction from the top, placing the scar in the thong area and/or anchoring the top of the back of the thigh back up to the bone and removing a 1 to 3 inch high crescent of skin with the scar in the horizontal gluteal crease, can be fair to good long term solutions.   

All the solutions turn the clock back, but don't stop it entirely, 

Hope that gives you something to reflect over and that you will find a solution(s) that make you nothing butt happy!

Best, Z