Red Alinsod, MD

As the inventor of ThermiVa I have trained dozens of medical professionals who have done exceptionally well providing safe and effective treatments. Doctors, nurses, Physician Assistants can all perform ThermiVa excellently if they are well-trained and do the procedures on a daily basis. As with  any skill set, it depends on constant use and depth of experience. Ask about advanced training and volume. Ask about their comfort and skill doing vaginal exams. It is such a safe procedure with no known serious adverse events known. No blisters or burns ever in thousands of treatments. So safety wise it is okay for a licensed and trained medical practitioner to perform this very easy to do procedure once properly trained. Personally, in my practice, I do all ThermiVa treatments. My invention, my choice, My results to the best I can possibly give. 

Hope this helps.

Red Alinsod, MD

When you heal up it will probably look gorgeous and petite as the swelling goes down and scars recede. Removing "too much" is a problem that occasionally happens when underestimating the degree of tissue retraction that occurs.  There are two main ways to fix this. One is to bring down flaps from the clitoral hood region but it appears that you do not have much tissue in that area.  The other technique is to use advance radio frequency resurfacing technology to "create" the appearance of more prominent labia minora where there was none. I developed this technique over a decade ago and have found it to be useful in many but not all patients. 

Lastly, I have trained several doctors in Australia and New Zealand who may be able to help. 

Hope this helps. 

Red Alinsod, MD

Unfortunately, your particular problem is more common than we would all like to see.  Plastic surgeons typically build flaps from clitoral hood skin.  An alternative method I have developed and refined over the past decade, completely graft free and suture free, is to create labia minora from nothing using radio frequency surgical technique. It is quite remarkable.  

This is Red Alinsod, M.D. answering the question of "What is The Alinsod Technique?"  I just saw this question as I do not frequent these pages recently.  Have been very busy with the worldwide launch of ThermiVa (I have been in Cannes, Istanbul, Orlando, Vietnam, and Bangkok giving seminars recently and still here in Thailand for another teaching session tomorrow.  Have some free time now so I thought I would just set things straight.  There is no published "Alinsod Technique" in the literature. I have kept the technique quite and part of my decades old teaching program here in Laguna Beach, California, but do bring it out on my lecture circuit and meetings every year.  For those of you who do not know, perhaps plastic surgeons who have commented prior, I have been Chairing the oldest CME approved Congresses that deal strictly with Aesthetic Vulvovaginal Surgery.  In fact, it is called CAVS or the Annual Congress on Aesthetic Vulvovaginal Surgery.  We just completed our meeting a few weeks ago in Orlando.  My entire adult career has been quietly pushing for the acceptance of aesthetic gynecology along with the foresight and leadership of the Pelosis and Matlock who I consider dear friends.  Most plastic surgeons have never heard of me since I am never invited to speak at their meetings except perhaps local chapter dinners.  However, over the past decade my materials, techniques, and photos of both labia minoraplasty, labia majoraplasty, lateral and vertical clitoral hood reduction, RF resurfacing revision surgery, and now ThermiVa RF treatments (my invention) have been presented at national plastic surgery meetings by my dear friend and colleague and co-author of the upcoming textbook on the matter, Christine Hamori, M.D.  Anyway, my techniques are not published in literature and that is true, but they have been taught to my amazing colleagues over the past decades with great openess and care.  Those who valued my teaching have come from all over the world to learn extremely precise surgery that have become standards of surgical techniques worldwide without me pushing such methods.  An example is the modern medial labia majoraplasty that now the standard of how labia majoraplasty is done to hide scars and produce safe and attractive results.  I presented that technique at my meeting internationally in 2006.  If you did not attend my meetings you would not have heard of me or my techniques.  Somehow the patients found me and the plastic surgeons did not.

So here is The Alinsod Technique in a brief but detailed description:  The Alinsod Technique is my method of in-office labiaplasty done without IVs, awake, with an average of 4-7cc of local anesthetic.  This is the safest way of surgery since there is no tubes down your throat nor needles in you spine.   The Alinsod Technique can mean either labial or vaginal surgery.  If The Alinsod Technique is meant to describe my method of vaginoplasty it is the same method described above in terms of anesthesia but with a deep dissection to the ischial spines, performing the Pudendo-Levator block I developed in 2005, narrowing the vaginal vault with sutures in a layered technique and plication of muscles and fascia, excising excess vaginal mucosal tissue after careful measurements, then closing in a detailed and beautiful fashion with more layers of fine sutures.  This detail and depth of dissection is very rarely done by plastic or cosmetic surgeons and is typically done by highly skilled urogynecologist and gynecologist.  This is the "Full Length" vaginal tightening I described over ten years ago in both my meetings, teaching, and marketing.  The Alinsod Technique was not the superficial perineoplasty that  most plastic surgeons had started to perform and labelled their vaginoplasty.  I was fortunate to teach amazing plastic surgeons "my" technique of going all the way up the vaginal to the very top and doing that full length repair.  Otto Placik, Johan Brahme, Christine Hamori, Paco Canales are a few of the friends who came to Laguna to learn.  Now in terms of The Alinsod Technique of labial surgery, Dr. Goodman has it pretty correct. He knows since I trained him on my technique and we worked on a textbook together last year.  But let me add details to his description in the next paragraph.

My "Alinsod Technique" is really a curvilinear resection of labia minora that is typically done along with a lateral clitoral hood reduction (a method I developed as well as the medial clitoral hood reduction).  Surgery is performed after Dermoelectroporation is done to numb the tissues and micro tumescent anesthesia has been completed.  I also may give some anti anxiety pills and mild narcotics and nausea reducers.  I put carefully placed marks with my blue marker on the agreed upon locations.  I can remove just the edge of dark tissue and I call that a RIM Look.  I can remove all or almost all of the labia minora to be below the level of the majora and I call that a Barbie or Smooth Look.  Then I can split the difference and remove most of the labia minora but leave a "peek-a-boo" slice of labial tissue that many want and I call that a Hybrid Look.  I always use a pinpoint radio frequency excision tip that is extremely precise and that is why it has probably evolved to become called the "Alinsod Technique."  It is because I use precision radiofrequency and not a laser, not a knife, not standard electrocautery.  Ultimate precision with the leas lateral thermal damage known.  About 20 microns with my radio frequency versus the 1 mm with standard cautery or laser based system.  With this level of precision I angle the hair tip just the precise degree and debulk the unattractive or uncomfortable labia minora, which results in the edges just falling in towards each other in the midline and pretty much disappearing due to the precise location of excisions.  In regular English, The Alinsod Technique is able to hide the scars to be invisible because of its ability to vary the length of the left over medial and later labial edges.  It is so cool and so beautiful on how that all lines up and vanishes into a gorgeous natural look.  Then The Alinsod Technique ends with clitoral hood reduction and management of the dog ears so that there is absolutely a petite and natural flow of tissues from the clitoral hood to the frenulum to the labia minora tissue.  Experienced labiaplasty experts will understand what I just wrote but lay patients and/or new labial surgeons may find it difficult to picture what I just wrote.  

It is funny that I have never once in my memory called what I do "The Alinsod Technique" except in my PowerPoint slide for the doctors who take my course.  Wonder if my slides have gotten out into the public for this discussion to even occur.  In all my lectures and academic writings for the public I have referred to my method as a generic curvilinear resection sometimes degradingly called "amputation technique" by plastic surgeons.  Perhaps I am biased but this method is the safest and most precise way of doing thins in my opinion since there is minimal risk of wound breakdown like wedge labiaplasties.  Those fall apart about 20% of the time and leave gaps and holes and that is a problem that I would rather completely avoid.  The common comment that wedge labiaplasties are done to "keep the natural edge" carries weight if the patient truly wants to keep the dark and corrugated labial edges.  However, in my practice, just about all the women who see me select me because they know I will remove those dark, irregular, corrugated labial edges to leave smooth and scar free labias.  It is good to have choices.  

Hope this helps those who were curious as how I did my labial surgeries.  Started labiaplasty surgery in 1988 when I was part of the exenteration teams for genital cancers then continued on in my military career and private practice from 1990 till today.  Thousands of cases and lots of practice.  

Lastly, I would not go to a surgeon just because they are plastic surgeons.  There are lots of poorly trained plastic surgeons and lots of poorly trained gynecologists who attempt to do labial and a vaginal surgeries.  I would personally go to the most experienced vulvovaginal surgeon that does only labial and vaginal surgery.  It is just my preference to to go to the surgeon who does the one thing over and over and has built the eye and the reputation for gorgeous results.  If I wanted a nose job I would not go to a plastic surgeon who spends the majority of their surgical time doing tummies, breasts, boobs.  I would go to the guy who concentrates on the nose whether they are in plastics or whether they are ENTs who are facial plastic surgeons.  Board certification says you can pass a test but tells you nothing about artistic eye, gentle hands, sound decision making, ability to communicate, and volume load of cases that pertain to what you want done.  Being a chairman in this, a leader in that, a moderator/organizer/planner tells you nothing about surgical skills and results.  Look at the surgeons depth of photos on the specific procedures, their testimonials, talk to their patients, go interview them.  Where did they train and who were their mentors?  Do they disparage colleagues?  Do they answer their own emails or call you back personally when you have questions or are they unavailable to you?  Must do your homework and ultimately go with your guy.

Warm regards,

Red Alinsod, MD

• 1.Costs: ThermiVa is significantly cheaper for the doctor to use and probably about the same for the patient. The single use hand piece is cheap and disposable. The system warrantee costs are a fraction of what laser companies charge.
• 2.Availability: ThermiVa is rapidly growing in availability worldwide because it is more affordable and fits the practice of gynecologists better than laser systems. Even plastic surgeons are opting out for ThermiVa over lasers since they own so many already.
• 3.Safety: No known adverse reactions or complications with ThermiVa. No blisters or burns. No need for a special laser room with signage, no need to use laser glasses or smoke evacuators or masks for the venereal wart viruses that may get in the air with laser systems when they smoke tissues.
• 4.Simplicity: ThermiVa is a simple lightweight box that can be carried or pushed from room to room or office to office quite easily. About the size of a small gym bag. No reticulating arms or smoke evacuator or mirrors to align and worry about. You press button to start it, raise or lower the temperature, use a simple disposable wand. Super simple controls without having to worry about watts, spot size, depth of penetration, patterns.
• 5.Convenience: ThermiVa has a single use wand. No cleaning of wand. No cross contamination. No sharing of vaginal hand pieces. You know it is a brand new and clean wand when you open the package yourself. Plus, with not having to switch hand pieces, there is no downtime when you go from external to internal treatments and no need to disconnect and reconnect anything. It is a totally seamless procedure.
• 6.Anesthesia: ThermiVa does not need any type of anesthesia. Laser systems typically do not need anesthesia for internal vaginal treatments but will most likely need anesthetic cream for treatment of the vaginal opening and labia majora. ThermiVa treatments feel like a warm stone massage while laser treatments are known to give prickly and pokey sensations during treatment.
• 7.Downtime: Zero downtime for ThermiVa. You can have sex, go to the gym, do anything you want to immediately after treatments. There is no abnormal discharge after treatment. Laser systems claim no downtime also but there is a discharge from the ablative or resurfacing effects for 5-7 days. It is not appropriate to claim that there is no downtime or discharge with the use of FemiLift or MonaLisa or IntimaLase.
• 8.Versatility: Excellent for
• a.Labia Majora Laxity: Non-surgical treatment
• b.Vaginal Laxity: Non-surgical treatment
• c.Atrophic Vulvovaginitis: Non-hormonal treatment
• d.Stress Incontinence: Non-mesh treatment for mild to moderate incontinence
• e.Overactive Bladder: Non-drug treatment
• f.Pelvic Prolapse: Can reduce a fallen bladder or fallen rectum about one stage so that surgery may be avoided
• g.Orgasmic Dysfunction: Average reduction in time to achieve orgasm is 50% in those with a problem achieving orgasms
• h.Repetitive Vaginitis: Normalizes vaginal pH
• i.Repetitive UTI: Normalizes vaginal tissues and vaginal pH
• j.Lichen Sclerosis and Hyperplastic Dystrophy: Adjunct to steroid and PRP
• 9.Results: Patient satisfaction is very high with ThermiVa and the stories told are simply amazing. It is more than just tightening of the feminine structures! ThermiVa addresses the complete spectrum of feminine rejuvenation. Pelvic pain and discomfort from atrophy or dryness improves. Everyone who is dry and atrophic gets moister (even irradiated pelvis). Results for incontinence are similar to surgery and drugs. Improvement in orgasmic response is consistent for those who suffer with orgasmic dysfunction.
• 10.Doctor Training: No laser training needed with ThermiVa. Simple procedure. If you can do a Dilation and Curettage you can do ThermiVa.
• 11.Doctor Support: ThermiVa support is rapid and immediate and the reps are always available. They provide on-site training by their nurse instructors and also offer free webinars and live training at established centers such as mine.

It is certainly very possible to do vaginoplasty under conscious sedation.  In fact, we do just about all our vaginoplasty/perineoplasty/labiaplasty surgeries without conscious sedation and without IVs placed!  For the past decade or so we have done these surgeries in our office extremely safely and comfortably with you listening to music, taking a nap, or watching TV.  Many patients spend the time texting and emailing friends and I have even had patients take photos of their surgeries and update their families in real time.  Your doctor has to know how to do the local blocks and how to give you the right mix of pills and creams to avoid having to have an IV or tube or needle placed.  With special creams and a device that pushes the local anesthetic deep under the skin and with strategic blocks deep in the pelvis you can safely have these surgeries.  There is no safer way to have surgery than to be awake, speaking with  your surgeon, giving live feedback, without worries of aspiration, fevers, and not waking up. My teaching program has taught surgeons all over the world on how to do these procedures in the office.  

Hope this helps.

Warm regards,

Red Alinsod, MD

ThermiVa is a wonderful procedure that is more than a tightening surgery.  I invented ThermiVa to be a more complete solution for feminine rejuvenation than just a tightening procedure.  Sure it will tighten the labia majora and make it look youthful.  It will also tighten the vaginal opening and deep into the vagina all the way to the very top.  But the feminine rejuvenation effects also are for increased vaginal lubrication, reduction in bladder leakage and urgency, and improved local blood flow of the the clitoral and G-Spot areas.  These effects are durable and last about a year before touchups are recommended.  On the other hand, a vaginoplasty with a perineoplasty is more long lasting in terms of tightening the vagina and opening.  It is the gold standard for tightening surgery.  The vaginoplasty will not help with vaginal moisture, leaky bladder, or increased local blood flow to the clitoris or G-Spot.  So although both ThermiVa and Vaginoplasty tighten the vagina they are distinct and separate procedures.  You have to gauge what it is your goals are and choose the right procedure that will best help achieve your needs.  In my practice, which is 100% aesthetic gynecology (I do not do breasts, tummies, noses, etc) I am finding that the patient is often combining the two complementary procedures to get the best results possible.  

Hope this helps,

Warm regards,

Red Alinsod, MD

As the developer and originator of radio frequency treatments for gyn use, I have used radio frequency for vulvar and vaginal dryness for over 6 years and have found it to be the safest, most painless, and least obtrusive of all treatments available for this condition.  It is totally hormone free and laser burn free.  It works in 100% of patients who complete a course of ThermiVa radio frequency treatments.  There is absolutely no downtime and it feels comfortable and like a warm stone massage both externally and internally.  The lasers available to treat vaginal dryness only do so internally so external tissues are not helped.  The lasers that can help externally need special handpicks and local anesthesia.  With ThermiVa, the entire vulvovaginal areas are treated and relieved of dryness without the need for anesthesia of any kind.  No stinging, burning, or discharge.  New collagen and new skin are made so there is improved moisture, softness, and sensitivity also.  The skin gets tighter and you get a true "feminine rejuvenation" effect.  Most plastic surgeons and cosmetic surgeons do not work in this area of concern so may not be exposed to these "new" therapies, specifically ThermiVa.  You can Google the term ThermiVa and see all the websites dedicated to ThermiVa and the YouTube videos that help explain and explore the full spectrum of use that ThermiVa has.  For example, its use for leaky bladders, overactive bladders, orgasmic dysfunction, fallen bladders and rectums, as well as the dry vagina.  ThermiVa is a disruptive technology that will transform gynecology.  Just my 2 cents worth :-)  For the gynecologic surgeon or plastic surgeon, the cost for ThermiVa is one third of the laser systems.  

ThermiVa is an excellent option for non-surgical vaginal tightening. As the inventor of ThermiVa I am certainly biased that it is the best option out there if you want to avoid surgery and achieve significant and consistant vulvar AND vaginal tightening effects. Lasers such as MonaLisa, FemiLift, IntimaLase, Juliet  just cannot get the level of tightening that radiofrequency ThermiVa can achieve.  Radiofrequency is superior to fractional lasers for tightening. Period. To achieve the same level of vaginal or vulvar tightening a laser must be ablative and non-fractional which results in a very long downtime of months with resultant shrinkage of vaginal mucosal tissue that can cause painful sex. 

The current vaginal lasers out in the market are fractional so do not cause those problems but then they cannot achieve the same tightness as radiofrequency. ThermiVa is the only one that can tighten the labia majora without anesthesia and without having to purchase additional laser hand pieces. Both technologies work for dry vagina but only ThermiVa works on the labial dryness without additional anesthesia and laser handpieces. ThermiVa is wonderful for stress incontinence and overactive bladder. Some of the lasers can help with stress incontinence but not overactive bladder like ThermiVa can. ThermiVa is the only device shown to improve orgasmic dysfunction and reduce the time it takes to achieve an orgasm. 

Lastly, ThermiVa is the only device known with muscle and fascial healing effects to both heal and improve muscle function inside the vagina. So when I logically look at the pros and cons of the systems available for non-surgical vulvovaginal tightening I must ask myself which technology has the most value.  When I get past the marketing hype it is a rather easy decision in my eyes. 

The huge majority of these wound separations fill in from the bottom up and are undetectable at 6-8 weeks Post Op. Just keep clean and dry. Use of estrogen or collagen cream can aid in healing but I doubt it is absolutely necessary. Even entire labiaplasty surgeries that breakdown can heal beautifully on its own without need for resuturing. It just takes time and patience. 

Hope this helps. 

Red Alinsod, MD