CHAPTER 13

Auxiliary Procedures

Clara Santos, Red Alinsod

VULVAR LIGHTENING TECHNIQUES

Today’s selfie-sensitive patients are more than ever seeking physical perfection rather than only improvement. As women become more comfortable with the idea of elective procedures designed to enhance their appearance and self-confidence, it is not surprising that they may wish to alter, “rejuvenate,” or reconstruct even more intimate areas of their bodies.1

Causes of Vulvar Hyperpigmentation

Skin color is formed by a combination of the pigments carotene, hemoglobin, and melanin. The main cause of vulvar hyperpigmentation is the production of melanin. Everyone has the same number of melanin-producing cells (melanocytes), regardless of ethnicity; however, the amount of melanin produced and how it is distributed will differ from person to person.

Benign pigmented hyperpigmentation of the vulva can occur in patients with dermatologic conditions such as lentigines, melanosis, postinflammatory hyperpigmentation, seborrheic keratoses, acanthosis nigricans, lentigo simplex, warts, lichen planus, discoid lupus erythematosus, and psoriasis. Systemic conditions such as Cushing disease and Addison disease can contribute to vulvar hyperpigmentation.2

Malignant pigmented lesions include some cases of vulvar intraepithelial neoplasia and melanoma.³ A biopsy is always recommended when a diagnosis cannot be made with certainty after clinical examination and dermatoscopy.

Less commonly, drugs such as psoralens, bergamot, arsenic, and cytostatics can cause hyperpigmentation. Endocrine pathologic states such as kwashiorkor and adrenocorticotropic hormone excess, as well as endocrine physiologic states like pregnancy, can stimulate darkening of the genital area. In these conditions, patients’ skin color response is mostly associated with pigments from hemoglobin and carotenes.

Most common causes of vulvar hyperpigmentation are physical in origin: waxing treatments for hair removal and the wearing of G-string undergarments and tight clothing or swimsuits. These practices result in excessive rubbing against the skin, which causes irritation and darkness of the vulvar-inguinal and perianal areas. This darkened skin may embarrass patients and affect their self-esteem.

Ideal Vulvar Aesthetics

Pigmented lesions of the genital mucosa are more frequent in women than in men.⁴ Some women may seek vulvar or vaginal treatments either for purely cosmetic enhancements or for functional improvements. One of the most common reasons for a cosmetic consultation is vulvar hyperpigmentation. Even in the absence of functional concerns, vulvar hyperpigmentation causes many women to have poor self-confidence, which may lead to sexual impairment.

Chemical Agents Used for Vulvar Lightening

Lactic Acid

Lactic acid belongs to the alpha-hydroxy acid group and is a gentle acid commonly used in many skin care products. It is naturally occurring and present in sour or fermented milk. Lactic acid improves skin hydration, coloration, and quality. This chemical agent has moisturizing, exfoliating, and skin-lightening properties. As a moisturizer, lactic acid improves the skin hydration level by creating a barrier to hold moisture inside skin cells. The exfoliation property of lactic acid gently removes dead skin cells. After the skin scales, the new, younger skin looks softer and smoother. For skin lightening, the use of low concentrations of lactic acid for multiple cell cycles evens the skin tone.

Azelaic Acid

The G-Peel is a compound formulation mainly used for genital lightening. The agents’ combination works by reducing the hyperpigmentation without creating skin damage. G-Peel treatments involve eight office visits. Patients should undergo trichotomy the day before each visit. Right before the peel, the affected area should be cleansed with the use of a pH neutral soap. Protecting the mucosa with gauze afterward is important. The solution is applied to the darkened areas of the vulva and the labia majora using a disposable brush, and it is left on for 15 to 20 minutes. The peel solution is removed with water. The skin usually appears to be calm, and patients should have no discomfort. If a patient reports any irritation during the procedure, the peel solution should be removed immediately. For patients with no concerns, the peel is repeated every 15 days for 2 months until the desired results are achieved.

Fractional lasers have been used for many dermatologic, gynecologic, and cosmetic procedures (see Chapter 17). A fractional CO₂ laser treats only a specific column of skin and thus leaves the surrounding tissue intact. This type of laser can be used for the treatment of vulvar pigmentation in selected patients with Fitzpatrick skin types I to III, because darker skin is prone to rebound hyperpigmentation.

Safety Precautions

To treat the genital skin, the use of peel agents and lasers requires care to prevent burning the skin and postinflammatory hyperpigmentation or hypopigmentation.

Treatment should be discontinued if patients develop any of the following:

• Redness

• Scaling

• Itching

• Burning

The session should be postponed until the skin is normal again if any such sensitivity develops.

Results

Patient examples of auxiliary procedures are shown in Figs. 13-1 and 13-2.

Fig. 13-1 A, This 32-year-old patient is shown before treatment. She had hyperpigmentation and lack of volume of her labia majora. B, After treatment. Hyaluronic acid filler was injected in her labia majora (5 cc on each side), and a G-Peel bleaching treatment was performed on the hyperpigmented areas.

Related posts:

Fractional Erbium Laser for Vaginal Rejuvenation Labia Majora Reduction Surgery: Majoraplasty Anatomy and Classification of the Female Genitalia: Implications for Surgical Management Psychological Issues and Social Mores in Female Genital Aesthetic Surgery: What Is Normal? Augmentation of the Labia Majora With Fat Grafting Anatomy and Classification of the Female Genitalia: Implications for Surgical Management

Stay updated, free articles. Join our Telegram channel

Join