LeRoy Yates, MD, FACOG (license suspended)

Hello, thank you for your question.  There are surgical, minimally invasive and nonsurgical options.  Surgical options are perineoplasty and vaginoplasty which involves general anesthesia often and cutting of tissue. I am fully qualified to perform pelvic reconstructive procedures but it can cost several thousand dollars once the anesthesia and hospital costs are calculated.  Minimally invasive uses laser but that have suboptimal results due to the lack of energy being able to penetrate to muscles under the vaginal mucosa. The method I currently recommend is Thermiva which uses radio frequency to achieve significant tightening without cutting or anesthesia.  The cost is $3,500 for three treatments. My patients so far report 100% satisfaction.

Lichen Sclerosis is a nutritional deficiency of the skin in the female vulvovaginal area. Estrogen and Testosterone Creams have been somewhat effective in restoring the youthfulness of this skin. In our office, we use a new technology called ThermiVa. This is a nonsurgical, noninvasive treatment that restores blood flow to the outer genital skin and rejuvenates the vaginal mucosa. Three treatments are recommended.

Superficial Botox 1-2 units under each eye is a wonderful treatment to relax the lower eye lid roll. So far, 100% of my patients like the effect and have continued it! It's a great little technique.

Botox in most of my patients lasts 8-9 months. However, I use the highest concentration allowed by FDA. Many doctors dilute Botox to the maximum lowest concentration allowed. This is especially true when you see Botox "on sale' or advertised in a "groupon".

I recently had a client come in 9 months after her previous Botox injections. She tried to bargain me down to what my competitor was offering for Botox. She admitted that my Botox lasted at least twice as long. I offered to match the competitors price if she would allow me to 'water-down' the Botox as he does or she could go back to him. She told me, "No thanks, you're worth it... you do a better job". She let me do her treatment and I'll see her in 9 months!

Some people do metabolize Botox more rapidly than others. Some people rarely develop antibodies to Botox and it does not last them very long.

I would advise a Silhouette Face Lift to restore the structure and support from elastosis. Next I recommend revolumizing your face using stem cell fat transfer (100 -130 ml if possible) or Bellafill PMMA filler. The fat transfer is permanent. Bellafill is approved by the FDA for 5 years (although it is also permanent). Finally, Profractional Erbium laser resurfacing. I use a Sciton Joule. These three treatments will give you an amazing result!