Cosmetic physicians thinking about getting in on the ground floor of women’s burgeoning demand for better looking and functioning vaginas should know that while it’s a viable part of cosmetic practice, it’s serious business, according to Beverly Hills, Calif., dermatologic surgeon Jason Emer, M.D.
It’s not as simple as purchasing a technology and advertising it, and these services are not entirely cosmetic.
At Dr. Emer’s practice, vaginal rejuvenation is an umbrella of services, requiring a range of specialists, from the nurse who provides noninvasive options, to the practice plastic surgeon specializing in labiaplasty and other surgical procedures. And similar to body sculpting, vaginal rejuvenation isn’t an option lumped in with everything else. Dr. Emer’s practice has a center dedicated to vaginal rejuvenation.
The Many Faces of Vaginal Rejuvenation
A Google search on “vaginal rejuvenation” suggests the term means different things to different people.
A vaginal rejuvenation practice without the oversight of a surgeon specializing in vaginal rejuvenation surgery isn’t responsible practice, says gynecologist and female genital plastic and cosmetic surgeon Michael Goodman, M.D. Dr. Goodman, who has 40 years’ experience as a cosmetic gynecologist and two decades as a female genital plastic surgeon, and who is editor of the genital plastic textbook Female Genital Plastic and Cosmetic Surgery, says he has answered more than 1,600 questions on RealSelf on the topic of vaginal rejuvenation and has trained more than 40 surgeons to do genital plastic and aesthetic surgeries.
“The term ‘vaginal Rejuvenation,’ a proprietary term first popularized in the early 2000s by David Matlock, M.D., one of the ‘fathers’ of modern genital aesthetics, is specific in its meaning, which is a surgical procedure to re-build the pelvic floor to re-approximate muscles; remove scar tissue; rebuild the vaginal opening; and rebuild the perineal body, bulking and elevating the area between the vaginal opening and anus,” Dr. Goodman says. “Unfortunately, many non-surgically trained practitioners have co-opted the term and use it for their own marketing benefits.”
While energy-based equipment has a place in a vaginal rejuvenation practice, cosmetic practices that offer only laser or radiofrequency options provide suboptimal patient care, Dr. Goodman says.
“The best provider to honestly evaluate a patient’s needs in this area is one who can both provide trained surgical therapy and energy-based therapy, as this person will give a fair assessment and not provide second-best, so-called ‘vaginal rejuvenation’ by machine, as that is the only thing they know how to provide,” he says.
NEXT: Cosmetic… or Medical?
Cosmetic… or Medical?
There are lots of options that help to address different cosmetic vaginal concerns, but in this practice the lines become blurred between cosmetic and medical. That’s why it’s important to have providers trained in how to assess cosmetic and medical outcomes for these treatments, according to Dr. Emer.
“I don’t think it should be done by an aesthetician who does facials to bring in extra income. I think it really has to be thought out seriously for the patients because there are serious medical concerns that these women have,” Dr. Emer says.
Dr. Emer’s practice has a nurse that specializes specifically in vaginal rejuvenation. The nurse not only provides radio frequency heating, with ThermiVa (Thermi Aesthetics) and BTL Ultra Femme (BTL Aesthetics) devices, but also platelet-rich plasma injections to the vaginal area for sensitivity issues. A staff plastic surgeon does labioplasty, and Dr. Emer offers vaginal laser treatments with the Juliet erbium laser (Asclepion Laser Technologies).
Collectively, the options address external cosmetic issues, as well as internal dryness, sexual dysfunction, sensitivity and pain during intercourse, he says.
Cosmetic surgeons should look beyond the hype at what each of the modalities can and can’t do, according to Dr. Goodman.
While fractional CO2 lasers, including the FemiLift (Alma Lasers) and Mona Lisa Touch (Cynosure), and radio frequency units, such as ThermiVa and Ellman Surgitron/Pelleve (Cynosure), have excellent and specific uses in gynecology, their uses as first-line vaginal tightening modalities are substandard, according to Dr. Goodman. These devices, he says, can recondition the outside skin and inside vaginal mucosa by increasing elastin and collagen fibers, and help in the short-term with mild urinary incontinence, but the only FDA-approved use of these costly therapies is for improving atrophic vaginal changes in post-menopausal women, he says.
These noninvasive therapies will in no way significantly tighten the vagina to help with friction after childbirth, bulk up a saggy opening, or in any way improve the appearance of the vaginal opening, according to Dr. Goodman. Only surgery can do that, he says.
NEXT: Practice Guidelines
To optimally treat vaginal rejuvenation patients, practice providers need to focus on taking a medical history, to make sure patients have had their annual gynecologic exams before doing any sort of vaginal rejuvenation. Dr. Emer says it’s also important for cosmetic surgeons to be able to assess medical outcomes, like dribbling, dryness and other little things that are related to sexual activity, before patients have their procedures.
Nurses who are trained in noninvasive and minimally invasive options are a vital component of a practice’s vaginal rejuvenation center. The reason, Dr. Emer says, is vaginal rejuvenation practice can be time-consuming. Nurses can take the needed time with patients to answer questions, ask the necessary questions, make women feel comfortable and at ease, as well as educate patients about post-treatment care and need for followup.
“You want to really pick someone who is in that practice and that’s the person’s specialty. That treatment is all they do all day,” Dr. Emer says.
The practice should have a dedicated and private area for these services, and a dedicated person who does the intakes and answers questions.
“You want patients to feel very secure…. The look and feel of that part of the practice has to be different — almost like a spa. You have to have robes, a special type of bed, a treatment chair that allows a woman to be very comfortable during the treatment. I think that men could do the treatment, but I think that having women do the treatment makes women feel very comfortable,” Dr. Emer says.
There should be one room — no moving from room to room. Everything, including the physician’s internal and external assessment of the patient, subsequent treatment and recovery, should occur in that room.
Done right, there are mostly upsides to adding vaginal rejuvenation services to the cosmetic practice, Dr. Emer says.
“The biggest concern to me is that if someone has a true medical condition that needs surgery — whether it be labiaplasty or internally there are issues with the cervix or the uterus — then, I feel the uro-gynecologist or somebody that specializes in the canal area really should be addressing it,” he says.
Dr. Emer has ties with Thermi, Eclipse, Aerolase and BTL Aesthetics.
Dr. Goodman conducts training courses for surgeons through the Labiaplasty and Vaginoplasty Training Institute of America in the skills of female genital plastic and cosmetic surgery.