Vaginal Rejuvenation

Vaginal Rejuvenation From Scalpel To Laser
VAGINAL REJUVENATION FROM SCALPEL TO LASER
– THE EMERGING GYNAECOLOGICAL ART
Dr Lee Keen Whye
MBBS (Singapore), FRCOG (U.K.), FAMS
Consultant Obstetrician & Gynaecologist
Consultant Gynae Endoscopic Surgeon
SOG - KW Lee Clinic & Surgery For Women
6 Napier Road, #08-15, Gleneagles Medical Centre, Singapore 258499
Tel: (65) 6471 1233 Fax: (65) 6471 1233
Website: www.drkwlee.com
Email: [email protected]
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Vaginal Rejuvenation From Scalpel To Laser
Content
1. What is vaginal surgery to an obstetrician and gynaecologist? ......................... Pg 3
2. Dr Lee, how did you get started in cosmetic repairs of the labia and vagina? And
LVR? ………………………………………………………………………………… Pg 3
3. What is Pelvic Floor Repair (PFR) for Utero-Vaginal Prolapse? …….………. Pg 4
4. Who started LVR? …………………………………………........…………..…… Pg 5
5. What is the basic difference between LVR and the conventional Pelvic Floor
Repair? ………………………………………….…………………….……...…..….. Pg 6
6. What is the profile of your patients in LVR and DLV? ………………….....…. Pg 6
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Vaginal Rejuvenation From Scalpel To Laser
1. What is vaginal surgery to an obstetrician and gynaecologist?
Vaginal surgery to an O&G specialist would be operations to treat abnormalities in the
vagina or procedures that would be carried out via the vagina e.g. childbirth, sterilization,
IVF procedures etc.
Vaginal surgery for gynaecologists is a long list, examples include:
1. Vaginal tears from trauma, rape etc.
2. Congenital imperforate hymen
3. Vaginal Aplasia e.g. Sheares operation (1956, named after President B. Sheares)
4. Vaginal cysts e.g. Bartholic cyst or gardner duct cyst
5. Abnormalities of the cervix
6. Prolapses of the vagina, uterus, bladder, enterocoele and rectocoele
7. Stress incontinence surgery like Kelly stitch, IVS, TVT, TOT etc
8. Vaginal hysterectomy
2. Dr Lee, how did you get started in cosmetic repairs of the labia and vagina? And
LVR?
I got started in vaginal surgery in particular pelvic floor repair as a trainee O&G
specialist back in 1981. I am not talking about vaginal deliveries and episiotomy repairs, I
am talking about pelvic floor repairs for uterine prolapse, cystocoele (bladder), rectocoele
(rectum) and recto-vaginal fistulas. Those days we had a lot of births and multiparous
women and some vaginal repairs done by medical students and house officers were not
ideal. There will always be a list of ‘PFRs’ with or without Kelly stitch every week to be
operated on by registrars. Kelly stitch was the procedure taught as a basic surgery for the
bladder neck to correct stress incontinence of urine. Currently, the other techniques
evolved for treatment of urinary stress incontinence include Burch Colposuspension,
TVT, IVS, TOT etc. Each has its own merits and demerits.
The other unusual cases I attended to were sexually related vaginal tears and sexual
assault cases brought in by police to the A&E Dept. of the hospital. I have to be
particularly careful in examination and documentation of all police cases because of the
legal proceedings that might follow. It is from all these experiences that I am able to tell a
fresh from an old hymenal tear and learn to treat traumatic vaginal tears.
Throughout the years in government practice, there was a small group of women who
would request for vaginal tightening for loss of “feel” during sex, although on pelvic
examination, they had no prolapses. The quiet demand had always been there.
It was in 1988 when I was in private practice that I had my first request to repair a hymen
for a lady who had broken off a relationship with her boyfriend. She wanted to restore her
virginity and demanded her ex-boyfriend to foot the bill. I performed the operation, so
she could free herself from the guilt and him from her. Request for hymenal repair and
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tightening were very discreet cases and gynaecologists usually would not discuss openly.
Patients were referred by word of mouth.
In 1991, I had an attachment to the
famous Jujin Hospital of Tokyo to learn
labial vaginoplasty and honed my skills
further. Japanese and Korean ladies then
were already very particular about the
looks of their private areas. On my
return to Singapore, I had more
techniques to offer my patients. Thus my
quiet stream of patients ranged from
young ladies returning home for good to
mothers bringing daughters to me before
handing over to their future husbands.
I first heard of Dr Matlock’s LVR from a
patient in 2004 but I did not pay any
attention to it. It was in 2005 when I was
interested in a diode laser for
laparoscopic surgery that a fellow
gynaecologist recommended a laser
company to me. Fate had it that I was to
meet Dr Matlock and acquired his LVR
and DLV technology along with my
diode
laser.
The
rest
is
history.
3. What is Pelvic Floor Repair (PFR) for Utero-Vaginal Prolapse?
Pelvic Floor Repair (PFR) is gynaecological surgery to repair, mend, and reshape the
vaginal wall that has collapsed due to inherent weakness or damage to its supporting
ligaments, muscles, and connective tissues. The prolapse of the uterus drooping down the
vagina canal like inverting a sock, is known as Utero-Vaginal Prolapse (U-V Prolapse).
The patient may notice a lump or protrusion at the vagina opening. Patient may complain
of pain, backache or pelvic discomfort. When the bladder wall droops into the vagina, it
is called a cystocoele. She may notice a “ping-pong” ball at the vaginal opening or
complain of urinary symptoms like dysuria or urgency in urination.
If the rectum or bowel is involved in protruding into the vagina, then it is called
rectocoele or enterocoele. The complaints will be discomfort or difficulty in emptying the
bowel. Hence the complaints will depend on the severity of the prolapsing vagina and the
number of neighbouring organs involved, like the bladder and rectum.
In management, a thorough history taking on the possible causes like, obstetric history
(childbirth, parity, episiotomy), medical history (asthma, smoking, obesity) and surgical
history (vaginal operations, hysterectomy) are important.
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Examination should look out for pelvic trauma, scarring, and integrity of the perineum,
the various protrusions from the vaginal opening and general proportion of the uterovaginal anatomy. It helps a great deal if the patient is seated up on the examination chair
with a mirror or TV monitor for the patient to understand her anatomy and defects during
the clinical examination. Patients should be informed what could be repaired and the
expectations after recovery.
Surgery aims at strengthening the supporting connective tissues, ligaments, and muscles
in and around the vagina. A hysterectomy may or may not be required depending on the
clinical situation. The repair of the anterior vaginal wall weakness is called anterior
colporraphy and the repair of the posterior wall weakness is called posterior colpoperineorraphy. Restoring the vagina back up or hauling it up, is called colposuspension or
vaginal vault reconstruction. Repair of herniation of rectum or intestine is called
rectocoele repair or enterocoele repair.
Hence, surgery involves not just incising into vaginal walls and suturing them tighter, but
looking for ligaments, tissues, and muscles to tighten before closing vaginal wall in
layers again. It is even more important to avoid damage to the urethra, bladder, bowel and
rectum. This skill is acquired through years of training and surgery within the female
pelvis. This area is pure gynaecology and solely a gynaecologist’s domain.
Occasionally, I do get request to tighten the vaginal canal for a better feel during sex. The
degree of tightening is a judgement call and the skill comes from years of experience
doing vaginal work. It is true to joke that an O&G looks at the vagina more than looking
at the mirror.
4. Who started LVR?
Dr David Matlock, an American
gynaecologist, was trained in basic
pelvic floor repair for prolapse of the
uterus and vaginal wall like most
gynaecologist. It was in 1996 when a
woman after giving birth to 4 children
complained to him about stress
incontinence of urine and laxity of her
vaginal tone. It affected her sex life. He
operated on her gynaecologically to
regain function and aesthetically to be
more sexually appealing. After this his popularity grew by word of mouth and he became
a household name in L.A. This enterprising, talented gynaecologist then conceptualized a
system for cosmetic vaginal reconstruction surgery. The system comprises the surgical
procedure, the technique to ensure a bloodless field, precision of incision with a laser and
a detailed protocol for triage and counseling of patients. The consent form for patients is
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the typical American style of at least a page long. In USA, intellectual property is a
legally protected right hence he owns the right to Laser Vaginal Rejuvenation (LVR) and
Designer Laser Vaginoplasty (DLV).
I am glad it is a fellow gynaecologist who made these designs which becomes very easy
for me as a gynaecologist to follow.
5. What is the basic difference between LVR and the conventional Pelvic Floor
Repair?
Conventional gynaecological pelvic floor repair (PFR) deals with restoring normal
anatomical relationship of the vagina, bladder, rectum and uterus to its normal position.
Laser Vaginal Rejuvenation (LVR) combines a philosophy of function, aesthetic design
and sexual enhancement with a youthful appeal. Similarly, any art class will teach you
how to draw, but, if you want to be a good artist, you will have to learn from the likes of
Picasso, Leonardo or Michaelangelo.
Familiarity with the use of the laser is a basic requirement. In Singapore, a laser license
from the Ministry of Health is required. Next is a keen eye for artistry, symmetry and
knowing what the woman wants. It is not what the surgeon desires. In LVR and
especially DLV, the woman is a partner in the design.
LVR and DLV have another aspect of surgery which I will regard as aesthetic
gynaecology or social gynaecology. Hymenoplasty or simply hymen repair is done on
request for cultural or psycho-social reasons where the hymenal ring is reconstructed. In
LVR/DLV concept, a laser is used as well in the process. Labiaplasty or plastic repair to
labial minora is done for sexual, social, and image problems. This surgical art is very
demanding because tailoring stretchable, gathered flaps of skin symmetrically is very
tricky. In this aspect, the Matlock technique is superior to the Jujin technique. Finally to
bring the reshaped labia to be proportionate to the rest of the vulva, the clitoral flaps or
hood may need to be aesthetically sculptured.
6. What is the profile of your patients in LVR and DLV?
The ages of my patients range from teenagers to mid-fifties. They make appointments to
see me asking for LVR and DLV after reading about it or are referred by friends.
Their basic requests are a) hymenoplasty, b) labiaplasty, c) vaginal tightening and repair,
d) combination of labiaplasty and vaginal reconstruction.
Most of these procedures are done as day surgery in my clinic or the hospital. Duration of
surgery varies from half an hour to 2 hours, depending on the complexity. Most patients
return to normal activity in one to two days. Sexual activity is not advised for a duration
of 6 weeks in patients who have undergone LVR.
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