89 Radiofrequency-Assisted Vulvovaginal Rejuvenation

Erez Dayan

Abstract

Labiaplasty has increased in popularity over the past 10 years. Although traditional labiaplasty has a high satisfaction rate (>90%) many patients prefer minimally invasive approaches and downtime. The radiofrequency-assisted labiaplasty procedure uses thermal energy to contract labia majora and minora, avoiding traditional labiaplasty incisions and downtime.

Labiaplasty – minimally invasive labiaplasty – radiofrequency – vulovaginal rejuvenation

89 Radiofrequency-Assisted Vulvovaginal Rejuvenation

Key Points

Traditional labiaplasty has been associated with potential complications such as dehiscence, hematoma, flap necrosis, narrowed introitus, pain, and asymmetry.
Minimally invasive techniques such as radiofrequency (RF) have emerged as viable alternatives to traditional labiaplasty through a temperature controlled bipolar mechanism to heat tissues to target temperatures of 68 °C internally and 38 °C externally. This controlled energy delivery leads to an inflammatory cascade initiating neocollagenesis angiogenesis, and elastin remodeling over the subsequent 3 to 4 months.

89.1 Preoperative Steps

A detailed medical history and physical is obtained on all patients prior to treatment. Exclusion criteria include: open wounds, active infection, dermatologic conditions, bleeding disorders, immunocompromised state.

**Fig. 89.1** Bipolar radiofrequency treatment of labia majora (AVIVA, Inmode, Lake Forrest, CA).

**Fig. 89.2** Bipolar radiofrequency treatment of labia minora (AVIVA, Inmode, Lake Forrest, CA).

89.2 Operative Steps

Access points are injected at the caudal aspect of each labia (majora and minora) with 2.5 cc of local anesthesia (1% lidocaine with epinephrine). Next, an 18-gauge needle is used to create an access incision. In each treatment site 20 to 40 cc of tumescent solution is infiltrated (50 cc of 2% lidocaine, 1.5 mg epinephrine per liter of lactated Ringer’s solution).
Hydrosoluble lubricating gel is placed over the labia to improve transduction between the two ports of the RF device.
The RF settings include a controlled internal temperature cutoff at 68 °C and 38 °C externally.
The bipolar RF cannula is placed into the access port and moved in a radial cranio-caudal motion until the tissues reach target temperature (Fig. 89.1).
Fractional RF can contribute additively by producing a resurfacing and soft tissue tightening from the skin surface at adjustable depths (Fig. 89.2).