W. John Bullis, MD

That's a great question and one I hear nearly on a daily basis. While I routinely tell my patients massage is totally optional, I also have colleagues who are much stronger proponents. Many patients can also perform a gentle self-massage one or two times per day, which may be better than weekly professional massages. In theory, massage helps to bring more blood to the local region by causing a mild vasodilation of the capillaries in the skin - this is why some people's skin gets that pink glow after a massage. Increased blood flow through the post-operative subcutaneous fat brings increased oxygen to the damaged and inflamed tissues and it also washes out some of the inflammatory markers released by the injured tissue, returning them to the normal circulation where they will be metabolized by the liver and/or kidneys. Our bodies have an amazing capacity to heal and whatever one can do to give one's body everything it needs to do its job of healing, the better, in my opinion. Good nutrition, avoiding smoking and alcohol, low sodium, certain vitamins and supplements - even IV, hyperbaric oxygen, and more - all of these, along with massage, I would lump into the category of "not going to hurt and will probably help." Unfortunately, many of these adjunctive therapies and treatments, although logically, they make sense, they have perhaps not been subjected to the rigors of randomized, placebo-controlled clinical trials, which we consider the highest standard of proof in medicine. I hope that answered your question.

Thank you for your question and photos. My preference would be for augmentation, given your anatomy, aesthetic concerns, and age. Labial augmentation, in my practice, is most commonly performed in women in their thirties or beyond, who have had at least one pregnancy and complain that their labia majora look "deflated" after childbirth or that their labia minora protrude out more than they used to. In your question, you expressed a similar complaint and clearly, one does not have to be in her thirties to have this appearance and the procedure is the same regardless. I usually use one's own fat ("autologous fat grafting") from a place where they may have a little extra (often the lower abdomen or inner thighs). In cases where the patient is quite thin and may not have an adequate donor site, I will often use Sculptra, a "collagen stimulator" commonly used for adding volume to the face. This would also help to correct the asymmetry you describe, as I can add a little more to the side that needs more. If childbearing is in your future, then I would advise against having surgical skin excision at this stage of life, as things will change after vaginal delivery. I hope this answer was helpful.

Thank you for your question - it brings into focus some confusion people seem to be having with terminology.  The term, vaginal rejuvenation, refers to a surgical procedure, whereby the caliber of the vaginal opening and canal are reduced in order to correct the problem of laxity, or looseness.  Vaginal laxity is generally considered to be a complication of vaginal childbirth and can result in decreased sensation and difficulty achieving climax during sexual intercourse.  This surgery alone will not do anything to improve vaginal dryness, however.  The term Laser Vaginal Rejuvenation is a trademarked term, which refers to the same surgical procedure as above, only instead of using a scalpel or other cutting device, a laser is used to make all surgical incisions.  Again, this will not treat dryness.  Hormone therapy, as you mention, is one way to treat vaginal dryness and may also be helpful for many other reasons.  As an adjunct to hormonal therapy, I would also recommend ThermiVa, if you were a patient of mine (and I would probably have you add progesterone to the mix, if you're not already on that).  ThermiVa is a radio frequency energy device, which uses gentle heating of the tissue to get results.  It is extremely gentle and comfortable and addresses many concerns, most notably, vaginal dryness.  I did not choose to purchase one of the many laser devices for my practice, because I simply do not like the idea of burning thousands holes into the vaginal tissue.  ThermiVa works remarkably well to treat vaginal dryness, particularly.  It takes three treatment sessions spaced about one month apart and requires periodic "touch up" procedures to maintain results.  Those maintenance procedures may be done every 6 to 18 months, depending upon individual variations.

Thank you for your question and photos.  Unfortunately, most, if not all, health insurance plans fail to recognize this as a "medical" problem, but treat it solely as a "cosmetic" procedure, so almost never cover any of these surgical costs.  With that said, you have many excellent surgeons in SoCal to choose from.  Find either a Gyn with cosmetic expertise or a plastic surgeon with Gyn expertise - do not choose a "run of the mill" Gyn or plastic surgeon without that additional training and experience, or you could be sorry.  Regarding sensation - that's a great question and one that deserves some consideration.  When performed properly, labiaplasty, with or without clitoral hood reduction, should not result in a decrease in or loss of sensation.  "Never say never," though - any surgery, no matter how "simple" can have unexpected complications.  One of my mentors used to say, "There is no such thing as a 'simple' surgery," stressing that a complication can occur with any surgery and that, as surgeons, we should never become complacent or cocky and always respect the fact that we are doing SURGERY - our job is to know the anatomy backwards and forwards and do a meticulous job and never treat any surgery as a "simple" surgery.  If you are committed to having this procedure done, seek out the right doctor first and get an in-person consultation.  Expect to pay in the neighborhood of $5000-$7000 - most cosmetic surgeons will have financing options available.  If you don't click with the first surgeon you meet, get a second opinion.  You should feel confident in your surgeon and trust his or her recommendations - if you don't, then find another one.  I hope this was helpful and best of luck!

Thank you for your question and photos.  The most important thing is to find the right surgeon and go in for an in-person consultation.  An appropriately trained and experienced surgeon should be able to offer you more than one surgical approach, but may recommend one over the other based on your aesthetic desires.  I encourage my patients to bring in photos or illustrations that show their desired result, as that may influence my surgical choices and allow me to better counsel my patient and manage her expectations.  Based on the photos you submitted, I would recommend a labiaplasty (either linear or wedge type, depending upon your goals) and also a clitoral hood reduction, as you do have excess skin around the clitoris.  Doing only the labiaplasty will result in a "top-heavy" result that does not match the reduced labia minora.  In Southern California, you have many excellent surgeons locally.  You do NOT want a generic gynecologist or plastic surgeon.  Whether the surgeon has a primary specialty of gynecology or plastic surgery is really immaterial, in my opinion.  If you choose a Gyn, make sure that he or she has had the appropriate training in aesthetic or cosmetic surgery of the female genitalia - not something that is learned in a standard Ob-Gyn residency.  On the other hand, board certification in plastic surgery also does not necessarily require any training in cosmetic procedures of the female anatomy.  Only choose a plastic surgeon who has had additional training and experience in these procedures.  If you find the right doctor, you should have no problem and get a result that will make you feel more confident and comfortable in intimate situations.