Mommy Makeover Vaginal Rejuvenation | "The Inside" | Orange County Plastic Surgeon

Let's talk about vaginas, or more specifically, let's talk about leaking pee, leaking urine, when you're coughing, exercising, picking up your kid, pretty much doing anything where you're straining. There's really not too much to say about that except that, yeah, it stinks. Nobody wants it, everyone's embarrassed about it, but nobody talks about it. So we're going to talk about it. It is something that affects half of women who've had children, and by the age of 80 it's like 80% of people, and yet most people think they just have to live with it, that this is part and parcel of what it means to grow older, to have children, to go through menopause, but it's not. We have options now, and it doesn't necessarily mean you have to go in and have a big procedure with a piece of mesh stuck in.

What I'm talking about is treating stress urinary incontinence, or leaking when you're straining, with lasers. So why should a laser work down there, and does it hurt? I'm kind of scared. What does it mean? Let me break it down for you this way. The vagina is skin, kind of like on the face, so things that help to tighten and stimulate collagen in the face also work in the vagina. The reason that you leak urine is because when you have children or when you go through menopause, a lot of that musculature where the vagina and the uterus lay up against the bladder tends to get very distended, stretched, and then after children, it becomes very weak. It never really rebounds the same way as it was when you were in your twenties.

Let's talk a little bit about the anatomy of the vagina. So I have a diagram here. All right. Everyone should be familiar with this. When you look at a belly, this is the front of the belly and this is your buttock. So you have the opening to the vagina here, and in front of it you have your urethra, which is where the urine comes out. You can see that the uterus shares a wall with the bladder. That's the two pink organs that you see side by side.

So you can imagine when you have a baby in there and this uterus gets enormous, it's putting an enormous amount of pressure on the bladder, and that changes the dynamics around the urethra, which normally has good support so that when you squeeze, or even involuntarily, it will tighten so that you don't leak urine. But once you have a big, giant baby and their head that passes through, even afterwards, nothing tightens and shrinks back to what it was before, and in a lot of women, you just don't have that support in this area to allow you to not leak urine. So you may go from little squirts to a more steady stream, and there's a grading for the amount of incontinence.

The laser that we have in this office that I'm pretty happy with is called the Bella V. It's by a Korean company called Lutronic. It's an Erbium YAG laser, which we actually have a lot of research on for the face, and now we're turning the applications down to the vagina for very similar reasons, to stimulate collagen, to tighten, lubricate, and strengthen. And by doing this, we're able to return the support to the bladder and the urethra that you used to have before you had kids.

The Bella V laser is one treatment which consists of three visits to the office, where we will do the procedure. We recommend a three part visit based on data that we have done with the company and also with other laser devices. What we found is that the time it takes to build that collagen continues to improve and grow over a three to six month period, but with each visit, you boost that result. So you may, and most people do, get improvement with the first one. You're almost perfect with the second, but we always recommend that you complete your treatment with a third to get the optimal result.

The way this procedure works is you come in, it's kind of a lunchtime thing. It takes about 15 minutes. There's no numbing, very minimal discomfort, no downtime. I usually say don't have sex for about three to seven days, especially if you're spotting a little bit, which can happen, but most of my patients notice that maybe there's a little discharge right after, and then by the time they're home it's not really an issue.

This I wanted to show because everyone's curious about what actually goes on during this laser, and what am I going to feel? So my patients say that it's much, much, much less invasive than having a normal pelvic exam. So if you can imagine the speculum, this is nothing like it, and yes, it's a little bit symbolic looking, but hey, we work with what we've got. So this is the only thing that really goes into your body that you feel. The rest of the laser fits within this, and it delivers its light through this cage.

I also like that you get a pelvic exam and a pap smear within the last year from your OB/GYN just to make sure that the tissues are healthy. I know I'm not a gynecology person, but I do know skin and I do know anatomy, which is why I think this is a great device that I can offer to patients.

The Bella V Laser, as I mentioned, is an Erbium YAG laser. That means that it is attracted to water in the tissue. So when the light goes in there, we target the layer of the vagina called the propria lamina, which is just deep to the actual skin of the vagina. What this does is it causes almost like a shrinkage effect because it's taking all that water in there and it's vaporizing it, so everything gets tighter. And with that tightness effect, with those micro channels that you create with that laser, comes a response from the body to heal, heal, heal. When that happens, collagen is stimulated, much like in the face, in the body, anywhere. You get that tightening, bulking, thickening effect, and in the vagina that's especially excellent when we're talking about leaking urine, dryness, painful sex, or lack of sensitivity because all of these things are improved by this process.

So what does this mean for you in particular? If you are someone who loves to work out, if this is meaningful to your life and it's important to you but you can't get through a workout without wearing a tampon or expecting to wet yourself a little bit, this can completely change your quality of life. Imagine what it'd be like to go and do your Pilates or go and do your trampoline cardio and not have to worry about this, not have to keep checking, or not having to clamp down afraid or embarrassed because there's urine coming out. This is something that is really great for someone like you.

If you are someone who doesn't really enjoy intercourse, doesn't have fun having sex anymore, and you say, "I used to love sex. I used to be so juicy when I was in my twenties, but now I'm kind of dry. Now it hurts. Now it's just not the same," and some women, it gets to the point where just the idea of penetration is so awful because it hurts. There are also options for treating the outside if having loose skin or creepiness or discoloration is a concern to you.

This laser, I can't say enough good things about it. I've had women come who said, "Oh, my gosh, I can't believe it. I had sex. I was lubricated. The sensation was great. My partner noticed the difference, and I wasn't afraid, and I wasn't embarrassed." Most of our patients who have done this has been very happy, even after the first treatment, but we always say come back, complete the whole series, because we want you to get a result that's going to last.