By William Payton

The rising popularity of vaginal rejuvenation procedures, or “vontouring,” has transformed the appearances and improved the self-esteem of countless women. And this is a trend that shows no sign of dying out. In 2014, the number of labiaplasty procedures performed jumped close to 50% compared to 2013, according to statistics from the American Society for Aesthetic Plastic Surgery

Duxbury, Massachusetts-based plastic surgeon and vaginal rejuvenation specialist Christine Hamori, MD, is on the front lines of the cosmetic gynecology boom.

She spoke with PSP about many of the factors that are driving this trend.

1) How big a part of your practice is aesthetic vaginal surgery?

Aesthetic vaginal surgery makes up about 20% of my practice. The whole field has been growing exponentially over the past few years. I used to have just a few labiaplasty consultations a month, and now I have about five to eight per week.

2) Why is this such a “hot” area, in your opinion?

I believe the rise in cosmetic genital procedures is multifactorial. Primarily, the grooming habits of women (and men) has changed in regard to pubic hair. Most women in their teens to late 50s have very little pubic hair. The genitalia with all its anatomical variation is now visible for full view and comparison to images on the Internet. Women want to feel confident and sexy, and realize that improvements in the appearance of their genitalia can help.

3) What are the most exciting advances in this area?

There has been little change in the basic surgical procedures to trim the labia minora (labiaplasty), the most commonly requested procedure of the vaginal area. However, now there are nonsurgical treatments to enhance the area, such as fillers to plump deflated labia majora and lasers and radiofrequency energy to smooth out wrinkles of the vulvar area and even tighten the vagina itself.

4) What is the new cosmetic ideal?

The new cosmetic ideal is no different from the cosmetic ideal of pretty breasts. Women want to be attractive and sexy. If they perceive that their genitalia could be improved in order to make themselves feel more confident and pretty, why not? The majority of women who seek labiaplasty in my practice have significant excess of tissue that affects their everyday life, whether it be physically or emotionally. The impact of surgery on these women’s lives is significant.

5) Please tell us about the “labial puff” procedure.

Labia majora are naturally fatty and plump in most patients. As women age, there is fat atrophy and skin laxity similar to what happens with the face. The labial puff is a procedure where fat or filler is injected into the labia majora to plump them up to a more youthful state.

6) Is there an advantage to being a female plastic surgeon who specializes in aesthetic vaginal surgery?

Yes, absolutely. Men go to male urologists, right? The topic is difficult to discuss with anyone, but patients feel that a woman may understand the problem perhaps with less judgment than a male.

7) Do you think that Addyi, the newly approved “female Viagra,” will cause a further uptick in desire/demand for these procedures?

It is not clear at this time whether Addyi will increase the demand for cosmetic vaginal procedures. It will, just as the uptick in aesthetic vaginal procedures, further validate the sexual revolution for women. High self-genital perception has been shown to correlate directly with sexual satisfaction in women. Aesthetic procedures of the vaginal area help women in this aspect of sexual health.

8) How did you decide which of the available energy-based technologies is best for your patients?

I have good results with radiofrequency tightening of the labial tissues and vaginal canal. Laser-based treatments produce laser plume, which may produce airborne viral particles. This is worrisome, considering the high incidence of HPV in the population. There have been no good clinical trials comparing the two modalities to date, so, in my mind, the jury is still out.

9) Does fat grafting play much of a role in vaginal rejuvenation?

Fat grafting is a powerful tool for improving the appearance of the labia major and mons. There are some physicians using the fat to narrow the vaginal canal, but no clear benefits have been demonstrated to date.

10) Any advice for surgeons who are interested in performing more vaginal rejuvenation?

My advice for surgeons would be to learn labiaplasty techniques from a colleague or teaching course, and be honest with your patients regarding your experience in the area.

William Payton is a contributing writer for Plastic Surgery Practice magazine. He can be reached via [email protected].