As with many simple procedures, the MonaLisa laser is relatively simple to learn. Many studies in the surgical literature have proven that high volume centers with lots of experience have better surgical outcomes. I guess you could apply that principle to this technology, however there is no specific study showing that.
I would also say that the treatment of the genital urinary symptoms of menopause goes beyond just applying the laser option. Patients should be well informed of all their treatment options and have thoroughly examined the risks and benefits of their choice of therapy. Someone with more experience with be able to share their knowledge of complications or problems that can occur and also help with other therapuetic options.
I agree with the comments of many of the other physicians who believe that experience helps decide who will be a good candidate for the procedure. Experience likely also helps counsel patients about the proper expectations from the therapy. The technique is straight forward to learn and the learning curve is likely 5 - 7 patient procedures. Although not difficult, the use of a laser is not to be taken lightly. The proper laser training is crucial as is maintaining the proper protocol. As an urologist as well as uro-gyn, I have extensive use of lasers in other areas of practice. I understand the risks of lasers, and therefore always prefer that this therapy be performed by a physician and not a nurse/nurse practitioner/physician assistant.
Through my experience with MLT, I also have found that some external treatment at the vaginal opening is helpful in almost all of my patients. I began doing this early on and consider it standard for most of my patients- at no extra cost to them.
Obtaining proficiency with the laser is not difficult. I believe that most doctors would feel totally comfortable with using the laser after 4 or 5 patients treated. The main benefit of experience is determining which patients would be good candidates and would stand to have the most benefits from the treatments.
While both Mona Lisa Touch and a similar laser therapy, FemiLift are "easy" to perform, where experience comes in is PROPER PATIENT SELECTION and utilization. You can have a "great" therapy but if applied to inappropriate patient selection it's worthless, expensive, and can be damaging. Your clinician must understand power settings, applicability, and when surgical tightening rather than "brainless," "noninvasive" laser application is appropriate.
Rule of thumb: 1. Is your clinician skilled in BOTH surgical and non-invasive techniques for vulvar and vaginal applications? 2. I would feel better about a practitioner who specializes in this field, rather than offering it as part of 20 other procedures they perform.
Thank you for your cogent question. The weblink below, in addition to other blogs and the FemiLift area of the Genital Plastics drop-down menu may be of assistance to you. Do your homework and choose your practitioner wisely; looks like you're off to a great start!
Michael P Goodman MD
Davis, CA, USA
In finding solutions for your vaginal symptoms it's always important in identifying the right specialist to help you navigate your options. Patients should have a thorough evaluation by their gynecologist to rule out any problems that would contraindicate these laser vaginal treatments. Providers should likewise be able to fully evaluate their patients and thus offer the best treatment options for each patient. Patient selection is key with these procedures, just like any other treatment. If providers perform the treatments as recommended there should be minimal to no complications.
In the beginning a year ago, I would have said NO. This is a tool with a single response. However, as the year evolved, how to deal with the vaginal opening has been THE CHALLENGE. Several people unable to use estrogen cream, in their sixties, went through their 3 treatments and said they were great. BUT, when asked about the comfort at the opening--a limiting factor to pleasure. NOW, all patients get a horseshoe treatment to the opening from the hymen out 1-2 cm. This requires BLT cream anesthetic, but has still been painless. This change allows similar results to different people and was not part of the original protocol. Experience is worthwhile if older, tighter, and esp. if no vaginal deliveries. Also, experience helps to sort out the ones who are NOT appropriate candidates for this.
As a Gynecologist who has used the Mona Lisa Touch probe over a hundred times, the technology itself is very simple, where recommended settings for each treatment is followed based on clinical studies. In my professional opinion, I have become more knowledgeable and improved on the treatment technique based on the patients feedback. I know what questions to ask and what areas to focus on based on their history and my physical exam. After the second treatment of three, patients typically have dramatic relief, and can pinpoint areas that may need addressed specifically, perhaps even with the external probe. The key is analyzing which specific areas affect you the most during intercourse or daily activities and relaying these symptoms openly to your Gynecologist. All my patients, regardless of their baseline condition, have experienced relief from their GSM (Genitourinary Syndrome of Menopause) with the clinically proven Mona Lisa Touch. I applaud you for doing your research and hope you too achieve symptom releiffrom this revolutionary treatment.
Thanks for your question, there are many new products on the market which use laser technology to improve vaginal health and issues around dryness. I think most surgeons who do these procedures will use them according to the manufacturers recommendation and few will stray from these techniques.
However, experience can be invaluable when deciding who should do these procedures. But because many of these new treatments are in fact "new" I don't think you are going to find a cluster of extremely experienced surgeons.
I would recommend that you seek out those surgeons who are performing urogynecologic procedures as well as vaginal cosmetic procedures as they will have the best understanding for treating you.
Easy to use, but equally easy to misuse. The most important aspect of any procedure is picking the right patient. Irrespective of the "package insert" that comes with laser, some patients are better suited for the procedure than others. Skill at choosing only comes with experience. The second most important element of a good result also comes with experience - this is setting the right expectation. Non-experts are most likely to overpromise the expected results of the treatment and might cause you invest something that really wasn't what you thought you were getting. Finally, customized delivery of the laser energy is something that only an expert can do because it requires experience beyond the basic cookbook protocol that beginners are given. This is to protect you from injury, but may leave you with average results when you might be able to do better.
The fractional laser technique is standardized and taught the same way to each doctor. There are subtle modifications that you make as you work more with it that can slightly improve outcomes. I think it is important to have a physician who is a pelvic expert who is able to recognize if you are a good candidate and be able to handle any potential complications (which are rare).