Bladder Leaks, Babies, and “Ozempic Vulva”: What Can Be Improved With Non-Surgical Vaginal Rejuvenation?

Dr. G (00:00):
That's it. That's going to be our thing.

Bri (00:01):
Oh, that's so good. We've been waiting so long for something like this to retire us.

Dr. G (00:07):
Yeah. Merch incoming. All right. You're listening to another episode of All the B's with me, Dr. G and my scrub tech, Bri. Between Ozempic, childbirth, menopause, women are dealing with changes down there that nobody warned them about. Dryness, leaking when you sneeze, things not feeling the way they used to. Most women never bring it up with a doctor because it feels embarrassing or they assume the only fix is surgery. Also, sometimes you bring it up and your OBGYN or family practice person's like, "Eh, you're fine," which is the other comment I get. We see patients all the time for labiaplasty who have raised the issue with the obvious source, which would be their OB - GYN, and they're told it's fine. Today we're talking about a laser we use in our office for vaginal rejuvenation, what it can and can't do, and how it's different from a labiaplasty.

(01:02):
Also, just in general, some vaginal rejuvenation tips and tricks, because I just was recently asked to answer some questions for New Booty. No, that's Madonna. New Beauty, the magazine on Ozempic Vulva, which is just two words you don't want to hear together, but I answered their questions. Comments, questions or concerns?

Bri (01:25):
Concerns.

Dr. G (01:26):
Bri has concerns.

Bri (01:28):
But we'll get to those.

Dr. G (01:29):
Okay. But first we got to talk. So I did actually attempt to watch the VMAs. Did you watch them?

Bri (01:34):
I watched a little bit of it last night.

Dr. G (01:36):
Oh God. It was so bad. I'm sorry. It was just bad all the way around.

Bri (01:43):
Yeah. Somehow football got turned off on accident and that's what popped up. And I was like, "What is happening right now?" It was right when Sabrina Carpenter and Madonna were on stage.

Dr. G (01:56):
The craziest thing about them winning an award, which was cute, was that they're both pint size. I know Sabrina Carpenter's -

Bri (02:04):
Like 4'11", right? Yeah.

Dr. G (02:06):
Or five feet tall max. But then I didn't realize Madonna was so short.

Bri (02:11):
Oh, I didn't either.

Dr. G (02:12):
The two of them were like Polly Pockets coming on stage to get their award.

Bri (02:16):
The second they popped up on the screen, all the girls were like, "Well, at least her face has gone down from her facelift." They were like, "It was so puffy. She looked so insane."

Dr. G (02:25):
Madonna?

Bri (02:26):
Yeah.

Dr. G (02:27):
She still looks bananas.

Bri (02:28):
She does, but I was like, "Maybe she got a fat transfer and that's why it looked that way." There was a lot of conversation about her face.

Dr. G (02:35):
Her face was a mess.

Bri (02:36):
We merged from the performance.

Dr. G (02:39):
I feel like she looks shorter than Sabrina, but honestly, because Sabrina always wears heels.

Bri (02:44):
Six inch heels at least.

Dr. G (02:46):
Yeah. Also, Madonna just rambled in every one of her '90s speeches because she just kept winning awards and I didn't even know she had a song out this year.

Bri (02:58):
I didn't either.

Dr. G (02:59):
I feel like this was the VMA tribute to Madonna show with a little side tribute like, okay, also we'll acknowledge Taylor Swift and her grab for attention by releasing four more songs. So calculated. Yeah.

Bri (03:16):
I didn't know she was artist of the year. I don't know how that's possible.

Dr. G (03:21):
I couldn't figure out Madonna's face, the whole show. So when I went on social media afterwards and all they were talking about was her diaper butt, I was like, "What? I missed it." I really didn't even notice.

Bri (03:34):
I didn't notice that. Even in the performance, that never crossed my mind.

Dr. G (03:38):
I honestly did not zoom in. I just kept thinking, "What?" Her butt looks insane.

Bri (03:43):
Well, BBL.

Dr. G (03:45):
Right. She either has a BBL, which is fat transfer to the booty, or barring the fact that she doesn't have any fat, she has Alloclae in there. Or since this is for TV, somebody might've put in pads.

Bri (04:01):
I could see that.

Dr. G (04:02):
I would hope that's the case because she looks nuts.

Bri (04:05):
Because I haven't seen her in any other dresses or pictures where I'm like, "Oh my gosh, her ass is so disproportionate to her body." I feel like the shorts have to be a little padded.

Dr. G (04:14):
I would hope so.

Bri (04:15):
And you don't see that under cheek kind of, because her shorts are so short. If I wore those, you would see my cheeks hanging out. Booby. Yeah. Yeah. So maybe it was for aesthetic.

Dr. G (04:29):
I don't know. Just why even bother? Because her legs are slay. I guarantee she's on some sort of testosterone or some shit to get that ripped. But I do know she puts in the work from a dancing and working out and all that stuff. And it was kind of funny because she rolls up in no pants look with a heavy jacket to get one of her awards. And I was like, "I mean, I know your arms are also pretty ripped." But then eventually she took the jacket off and I was like, "Okay, you could have put a skirt on," is all I'm saying. I just don't understand.

Bri (05:05):
Going to have to revisit all these pictures. All of them.

Dr. G (05:10):
It was a lot. Her speeches were so rambling and I feel like revealed her age more than anything else. She sounded like a demented old lady recounting.

Bri (05:23):
She's like, "I don't remember. I just did this speech."

Dr. G (05:26):
Recounting her heyday. I didn't think it was a good look. Anyway. And then we can talk about Taylor Swift, I think.

Bri (05:36):
So for the first time ever, I'm not a fan of Taylor Swift, but she actually looked good. Yes. Her dress was actually made her look like she had some shape.

Dr. G (05:49):
Everything looked good minus the bangs.

Bri (05:51):
Yes. I don't know. Her hairstylist, I love her whatever she calls her old money blonde, whatever. She needs to change it up. She needs some highlights. She needs some dimension. The bangs got to go.

Dr. G (06:03):
Her and Dakota Johnson and their bangs are nuts. It's like a bang club. Nobody wears bangs, bro.

Bri (06:11):
No, I just can't. But her dress actually looks good.

Dr. G (06:14):
Slayed.

Bri (06:15):
Yeah.

Dr. G (06:16):
The dress was spot on. I love that.

Bri (06:18):
I'm glad she's stepping it up.

Dr. G (06:20):
I would also like to point out that much like Taylor Swift and Madonna who are so big, I wonder if their inner circle ever feels comfortable saying, "Maybe Madonna, don't wear those shorts." Right?

Bri (06:33):
There's no way.

Dr. G (06:35):
Or, "Hey, Taylor, let's break down what patient zero actually means because your interpretation of patient zero and patient zero are two different things." And I don't understand. I know her... It's sort of like... I just don't understand why. What are you trying to reclaim the phrase patient zero?

Bri (06:59):
I have no idea.

Dr. G (07:00):
It has to do with epidemics. Originally the HIV epidemic. Why are you trying to talk about, "Oh, I was the original girlfriend." That's the patient zero she's going for, which has never been used for patient zero.

Bri (07:15):
I don't know. That wasn't the same.

Dr. G (07:16):
It's like she learned a new phrase and then was like, "Oh, I'm using this." And you're like, "Well, that's not."

Bri (07:22):
Please don't.

Dr. G (07:24):
It's getting ironic from Alanis Morissette when she actually doesn't define irony in her song. Okay. That's all.

Bri (07:32):
Maybe she's like her first boyfriend made her so crazy. She had to go into a mental hospital and she was Patient Zero.

Dr. G (07:41):
No, no, no. That's what she's using it in that context, but Patient Zero already has a context, so I don't think you can do that, but it's fine.

Bri (07:49):
Just never been a Swiftie.

Dr. G (07:52):
Yeah. I'm not a fan of the new music or any of it.

Bri (07:56):
I won't listen to it. Sorry.

Dr. G (07:59):
You do get to hit Skip in the OR.

Bri (08:02):
I do.

Dr. G (08:03):
We all get our...

Bri (08:05):
She skips Ed Sheeran and Coldplay in anything super depressing and country. I was like, actually wait, this list is kind of long.

Dr. G (08:15):
No, no, no. I will listen to Some Country. I just can't do it all the time.

Bri (08:19):
Yeah. So ever since I decided I like Country, it's now on all the time.

Dr. G (08:24):
But Ed Sheeran and Coldplay

Bri (08:26):
Yes.

Dr. G (08:26):
I feel like I skipped something else last week and I couldn't remember what it was.

Bri (08:29):
It was some girl song that was really depressing and it was so funny. It was like PTSD the second it came on. She's like, "And Skip."

Dr. G (08:37):
I know.

Bri (08:38):
It was hilarious.

Dr. G (08:38):
It's been bugging me what song it was.

Bri (08:40):
I can't even think of it.

Dr. G (08:41):
I tried to remember this weekend and I was like, all I know is I was triggered.

Bri (08:45):
You were.

Dr. G (08:45):
Oh, I remember now. It was Paramore.

Bri (08:49):
Oh yes.

Dr. G (08:50):
It was only because they sold out and whatever song that was, I was like, "No. Uh-uh."

Bri (08:55):
Yeah. It turned into a whole thing. Anyway. It was. So my skip is Taylor Swift. Dr. Abraham's skip is Bruno Mars because he thinks he's just a wedding singer.

Dr. G (09:05):
Yeah, he hates some Bruno Mars.

Bri (09:06):
He hates Bruno Mars. And I think that's it.

Dr. G (09:08):
I feel like he's also not a fan of The Weekend.

Bri (09:11):
He says that he's okay, but he doesn't. He'll skip if it's up to him.

Dr. G (09:15):
And he also stands with the Kanye is canceled.

Bri (09:20):
Yes. Kanye and Diddy are canceled.

Dr. G (09:22):
Yeah. Which is fair, But they still sneak onto the playlist sometimes anyway.

Bri (09:26):
They do.

Dr. G (09:28):
Okay. Moving on to former swan contestants. I almost died for televised plastic surgery. I do remember the swan, never watched it, but it's about to come back as Behind the Mirror premieres today, right? Or whenever you're listening to this Podcast, premieres September 29th.

Bri (09:49):
i don't even know what the show's about.

Dr. G (09:51):
Are you serious?

Bri (09:52):
Yeah.

Dr. G (09:52):
It was crazy that they did it. So it was a show where people who were ugly got free plastic surgery to go from ugly duckling to swan.

Bri (10:04):
Who's giving the free plastic surgery?

Dr. G (10:06):
I can't remember. It was... I should know.

Bri (10:09):
Ed Sheeran's on it. Just kidding.

Dr. G (10:14):
I don't think that's Ed Sheeran.

Bri (10:16):
That's definitely Ed Sheeran, right? Ed Sheeran, yep. I didn't realize that's a crazy thing.

Dr. G (10:23):
Wait, I'm going to pull it up.

Bri (10:25):
If anyone wants to give me a rhinoplasty and make me a swan reach out.

Dr. G (10:30):
I mean, it's been 20 years, so that's the...

Bri (10:33):
That's crazy.

Dr. G (10:35):
I was not a plastic surgeon at the time. And I remember thinking, whatever.

Bri (10:40):
What's it got on Rotten Tomatoes?

Dr. G (10:42):
Former contestant Kari Bravata claims she almost died for reality TV. I don't know how. She didn't wake up from the anesthesia. Her lungs filled with fluid and she had to go on oxygen.

Bri (10:55):
Go on oxygen?

Dr. G (10:57):
Everybody's on oxygen afterwards.

Bri (10:59):
I had to go on oxygen.

Dr. G (11:01):
You got free plastic surgery.

Bri (11:04):
Your lungs filled with fluid. I'm trying to think of what that could be.

Dr. G (11:09):
I was never told details of what happened. It's scary that I'll probably never know. I'm going to guess nothing happened.

Bri (11:14):
Did you swallow some spit and you got to suction it out?

Dr. G (11:18):
It was a terrible show. I mean, the premise was terrible.

Bri (11:22):
Also, if she didn't wake up, how would she... I just need more info about this.

Dr. G (11:27):
It's sort of like, what was the one where people had to lose weight?

Bri (11:31):
Biggest loser.

Dr. G (11:32):
Thank you.

Bri (11:33):
My dad watched that all the time.

Dr. G (11:35):
That also was a show that now in retrospect seems kind of cruel.

Bri (11:39):
Yeah.

Dr. G (11:39):
But again, none of these people were forced to go on the show.

Bri (11:44):
Yeah, they all voluntarily chose.

Dr. G (11:45):
They probably should have done a better job mentally screening them, but I feel like I am going to have to watch the behind the mirror though, honestly.

Bri (11:54):
This is crazy.

Dr. G (11:57):
After the show, they had no follow-up support and many of them faced ongoing medical issues. I had so many problems with my teeth, cracks, breaks, whatever they did to my gums was very detrimental because she had veneers that were done improperly.

Bri (12:11):
Well, you just got a whole new body.

Dr. G (12:14):
Oh, they had serious complications they had to pay out of pocket for, including ruptured breast implants. I think I'm going to have to watch the show.

Bri (12:21):
Yeah.

Dr. G (12:22):
Because -

Bri (12:23):
I actually might.

Dr. G (12:25):
Honestly, I don't feel that bad for these. I feel like the narrative that they were so naive and had no idea what was going on is crazy. Although 20 years ago, maybe they didn't disclose like, "Hey, implants aren't lifetime devices and you're going to need to do another surgery." But I swear, they wouldn't have listened anyway because they heard free plastic surgery. Right.

Bri (12:45):
And implant rupture is just, it can happen. And I'm sure it wasn't a consent they signed.

Dr. G (12:51):
It's sort of like when you get your house... It's basically any of these shows. You're going to pay or you're going to be on some show where they remodel your house or whatever and then, oh, there was something wrong with it that you discovered two years later something wasn't quite right. Well, that happens anytime you remodel anything, as we well know, minus the cabinets. I feel like the cabinets we did in this office slay.

Bri (13:16):
Well, that's good.

Dr. G (13:17):
Right? We've never had an issue with the new cabinets.

Bri (13:19):
I don't think so. So far so good.

Dr. G (13:21):
But every other thing I've ever done in terms of construction has always had something where maybe it's right after, maybe it's six months later, you're like, "Huh, I didn't think about that or didn't expect that to happen or we should have considered that no matter what you do." Always something. If it's for free...

Bri (13:43):
Yeah, there's always a prize. How are you mad about it? And I'm sure these consents were... There were so many of them.

Dr. G (13:48):
Yeah. I would hope that legally they had their consent came together. But this 20 years ago was the era of the swan, the biggest loser, extreme makeover. Even America's Top Model was kind of like demeaning and take people. It was our transition from that.

Bri (14:10):
But then these people watch these shows and like, "Oh, I'm going to go on this." You know what you're signing up for.

Dr. G (14:17):
Fear factor.

Bri (14:18):
Oh my God. That's terrible. I could never.

Dr. G (14:23):
All right. Moving on. We can talk a little bit about Dakota Johnson. Okay. So I did see this thing, this woman analyzes celebrities faces and she thinks that Taylor Swift's bangs are in play because she has had to stop doing Botox because she's pregnant, which is a good whatever. But the thought about Dakota Johnson and her bangs is did she have an upper bleph? And she's about to do a press tour for Verity. Did you ever read that book?

Bri (14:57):
Actually, my sister bought it for me when we went to Panama, so I've been reading it and I know it comes out Friday.

Dr. G (15:04):
Nice. I read it so long ago, I've already forgotten it. It was not memorable. I mean, it was at the time, but then it's...

Bri (15:10):
I watched the trailer and I was like, "I don't know if I need to finish the book." That's my problem.

Dr. G (15:17):
I mean, good for her. I will say on the VMAs, she looked great, Dakota Johnson. And her skin, whatever she's doing for her skin is keep doing it. It's so perfect and glassy. Yeah, she's great skin. Her skin is... I don't care whether she got anything done with her eyes, honestly, because her skin, that's all. I was like, "Damn. She looks amazing."

Bri (15:46):
And if she did get an upper bleph it looks really good because I couldn't even tell.

Dr. G (15:50):
Yeah. I guess I'm sort of aghast that people dive deep into some of this stuff. Unless it's botched, why do you care?

Bri (15:59):
Yeah, she looks so good.

Dr. G (16:01):
I feel like a lot of these celebrities too, instead of doing upper bluff, you could do threads to raise the eyebrows, which aren't permanent. You could change your makeup. There's a lot. I mean, if you spent any time down the rabbit hole of TikTok makeup stuff, they make people look totally different with the right amount of contouring.

Bri (16:22):
I watched this thing that Anne Hathaway does and she does two little braids and I go under and it pulls it up and it totally lifts all this up. And I was like, "Damn."

Dr. G (16:33):
They have the tricks.

Bri (16:34):
Yeah, they do.

Dr. G (16:35):
Little tapes.

Bri (16:36):
They do the tapes. Yeah. I just can't imagine at an event, yeah, but if you were to do this on a date and imagine all of a sudden you start taking all your-

Dr. G (16:45):
Face comes down.

Bri (16:46):
You're a whole different person.

Dr. G (16:48):
I keep forgetting about the braid trick. I need to try it.

Bri (16:50):
Yeah, the two braids and then pull it up really tight.

Dr. G (16:53):
I need to do that.

Bri (16:54):
I feel like that's how she always says such a slay face guard.

Dr. G (16:57):
Yeah. Okay. And then on the Vogues, the run through, Dakota reacted to donor fat filler with horror, then decided it's just creepy enough. What? She's also compared it to Recycling.

Bri (17:15):
I'm sort of into it.

Dr. G (17:17):
Again, I guess I don't really... I feel like we're too deep in the industry to be alarmed.

Bri (17:24):
Yeah.

Dr. G (17:25):
Oh, but we can do a big reveal on the show. This will be exciting for Bri.

Bri (17:30):
Oh.

Dr. G (17:30):
So I did talk to Rob, our rep from Alloclae.

Bri (17:35):
Do we get free Alloclae?

Dr. G (17:37):
And you're going to get...

Bri (17:39):
"Bleep" Oh, sorry. I don't know if you can put that on there, but wait, that's so exciting. Stop.

Dr. G (17:44):
Yep. 50 ccs.

Bri (17:44):
Stop. Oh my God, this made my whole day. How did you get that?

Dr. G (17:51):
I mean, I had to buy a lot of Alloclae. But for you, it's worth it.

Bri (17:56):
That was such a good answer. Wow. It's the best present ever.

Dr. G (17:59):
Maybe we'll just record you getting an Alloclae.

Bri (18:02):
I'm so excited.

Dr. G (18:04):
Wow. Because although I could probably use some, I don't really care that much. No one cares.

Bri (18:08):
You're perfect. My tits are fine. They're Okay.

Dr. G (18:12):
Oh my God, I'm so excited. Yeah. Wow, this is so cool.

(18:16):
Yeah. So

Bri (18:18):
Man, really excited. You guys can all see.

Dr. G (18:21):
Yeah. So we'll do some... Because to be honest, out of all the hundreds of ccs of Alloclae, I pump into people, no one either... If they do come back, their answer for photos is no, or they are happy and they don't even come back for the post-op photos. And I'm like...

Bri (18:38):
Or they come back and they're like, "This is amazing. I need more, more, more."

Dr. G (18:41):
Right. Those are the only people we get photos for.

Bri (18:44):
Yeah, that's true.

Dr. G (18:46):
Anyway.

Bri (18:46):
I'm so excited.

Dr. G (18:48):
Sure. I guess it's creepy if you think about it, but everything we... It's like the stigma of Botox when it first came out. It's a Toxin.

Bri (18:57):
You have so many things that shouldn't be in your body between men, injectables, surgery, implants. Let's be so for real.

Dr. G (19:07):
Yeah. We're going to draw the line now?

Bri (19:10):
Nope.

Dr. G (19:10):
At Alloclae? No.

Bri (19:11):
No.

Dr. G (19:13):
Calm down. You take your own blood and rub it in your face, inject it. Come on.

Bri (19:21):
I don't think it's creepy.

Dr. G (19:23):
No. Okay. Since we were talking about Dakota Johnson and fat and GLP, this is the question I got from New Beauty, not to be confused with new booty, which I bet is some sort of platform somewhere.

Bri (19:39):
Don't Google it.

Dr. G (19:40):
I'm not going to. GLP patients are running out of fat, and it's not just your face that deflates, as we know. Honestly, the new ASPS statistics show that filling and lifting are the new trends. So 2025 was a year of lifting, and then we're also filling. And then they put out something called, for better or for worse, Ozempic Vulva, which I would like to say, my daughter blew up my phone yesterday. The tie-in is to Ozempic, not vulva. Blew up my phone yesterday at the end of my workout and she was like, "We have no eggs. We're out of eggs." She's like, "Bro, we have an Ozempic fridge. There's no food in the fridge."

Bri (20:24):
That's hilarious.

Dr. G (20:25):
And I was like, "Okay, can we stop using Ozempic for everything?

Bri (20:27):
We have an Ozempic fridge. Solid.

Dr. G (20:30):
Okay. So ASPS jumped on that old bandwagon and they call it Ozempic vulva. What is it? What do you need to know? Well, your labia majora, your outer lips can deflate with weight loss. And it's usually rapid weight loss will deflate things faster, right? So if you're letting the air out of a balloon, you end up with that extra skin and it looks deflated and wrinkly, and that could happen anywhere. Most people come in complaining about either their neck, their boobs, their belly, their arms, their thighs, and then -

Bri (21:06):
And their face.

Dr. G (21:07):
Vulva. Yeah, face. So it's just that area, honestly. So it really depends on how fast you lose the weight, what your weight is, where you're starting and where you're ending. If you're like 140 pounds and you get down to 125, probably not going to be a problem. If you lost 60 pounds on a GLP-1 really quickly, then maybe that's going to be an issue. So it just depends. And it also depends on where you're holding the fat to start with. But your options are either to remove the excess skin or re-inflate the space. And so oftentimes it's removing the excess skin is the right move, especially if you lost that weight fast or you can address the sagging. And so that can be done non-surgically or surgically for both options. So let's talk about the Rejuvenate laser actually has to do... It's a CO2 laser is for vaginal tightening, and it's not aggressive, aggressive tightening, which would be surgical, which we don't perform in my office.

Bri (22:24):
Which I think is also... I feel like recently we've had a lot of people come in saying they want a labiaplasty and then it is the majora and they're like, "This is the saggy part." So it's not the same thing.

Dr. G (22:35):
No, they're both considered labiaplasties because it's both the labia, but the outer majora is also treated by excision just like the inner lips can be treated by excision. The incision actually heals really well and is on the junction between the majora and the menorah. So it's hidden and it's about the same recovery time as just a standard labiaplasty. And it can be done at the same time as a labiaplasty, although you're really gearing up for some swelling with that. But yeah, so that's one option is skin excision. You can do skin tightening with the majora. You can't do that with the inner labia. And rejuvenate can be used for that as a CO2 tightening, but I feel like the better option is radiofrequency microneedling, which we can offer. If you're doing rejuvenate laser, usually that is for vaginal rejuvenation, which is a word that is, again, essentially means nothing, but it's just stimulating the collagen elastin in the vaginal canal, which increases lubrication, tightens up a little bit, increases cell turnover.

(23:45):
It's usually done once a month for a series of three, and the effect is positive. It can help with dryness. It can help with, like I said, lubrication. It can help a little bit with that stress urinary incontinence. So it's pretty popular for that. It can be done in conjunction with a regular labiaplasty, either one. We'll usually do the first treatment at the time of your surgery, and then you come back for the second and third later. So it's a popular option, and I feel like CO2 is probably the best option for the vaginal canal. I do prefer radiofrequency microneedling for external because the CO2 is a little rough on the skin down there, and I feel like the amount of tightening on the surface level isn't the same as with a radiofrequency microneedling device where the needles are going in, tightening a little bit under the surface and then coming back out.

(24:42):
I think that's a better option for the labia majora or the Ozempic vulva. That being said, the gold standard is always excision, always, always excision. But if you're not willing to do that, then I think doing a non-surgical option for the majora is the right move. Rejuvenate laser, there really is nothing else besides a CO2 or radiofrequency device for the vaginal canal that is effective. You can do the so-called husband stitch that people talk about.

Bri (25:18):
In the last office I worked for, they did an internal... It was brutal to watch. I tried to Google it again and I couldn't find it, at least who the doctor was. But entire, they just... I don't even know how to explain it and I forgot what they call it.

Dr. G (25:35):
It's just a perineoplasty, but they're taking the inner -

Bri (25:39):
They swept the entire inside and it was very aggressive.

Dr. G (25:43):
It is. You have to be under anesthesia. You have to have usually a speculum in lithotomy and they're bringing -

Bri (25:51):
12 Alice clamps just doing things.

Dr. G (25:55):
The vaginal canal is imbricated. It's sort of like a diastasis repair, but for the vagina, and that just seems not worth it to me.

Bri (26:06):
Seems miserable. That was hard to watch.

Dr. G (26:10):
Yeah. I feel like if you really need that, it's probably related to some sort of birth trauma, and then it probably needs somebody who is adept in that, which I would defer to the OB-GYNs. Unfortunately, they're generally not excited about that type of procedure anyway, and so don't offer it. Although the other office you worked at, that's who came in and did it, was an OB - GYN.

Bri (26:31):
Yeah.

Dr. G (26:32):
But even amongst OB-GYNs, not very many do it. But I feel like that was a whole Brooke Shields controversy, how she said she had a labiaplasty and that someone threw in the extra husband's stitch for her without her consent. And I was like - Crazy. What? Because that isn't just a... It really literally isn't... It shouldn't just be a stitch. You really do have to dissect all those tissues out, pull it together, and then put it back together. It's not

Bri (26:57):
One stitch seems like it wouldn't do much.

Dr. G (26:59):
No, that's usually referred to as when you're delivered your child and you had an episiotomy or a tear and they're putting it together and they decide to make you extra tight, which is -

Bri (27:12):
Just a little extra stitch here.

Dr. G (27:14):
Yeah. No.

Bri (27:15):
Men doing work for other men.

Dr. G (27:18):
I think since most OB-GYNs are women at this point, it's probably less prevalent. Okay. The right patient for the rejuvenate laser is somebody who's perimenopause or menopause, to be honest. It can be used in just a postpartum patient, but unlike our labiaplasty population, it's not women who haven't had kids yet.

Bri (27:41):
Yeah.

Dr. G (27:41):
It's generally older women who are either motivated by the issues of a small amount of stress urinary incontinence or vaginal dryness, and they just want a little bit of tightening along with that.

Bri (27:55):
And how does it help the dryness?

Dr. G (27:57):
Because it's improving the quality of the tissues, that's where it's helping. So the injuries by the fractionated CO2 laser is stimulating collagen elastin and the vaginal mucosa to grow because it has to repair the injury. So just like everything we do on the face, you're creating an injury to stimulate your tissues to do their job. And then by doing that, you restore the balance of the vagina, which is to provide lubrication. It's not the end all be all. So if you're menopausal, it's not going to solve all your problems. It's usually helpful to be on hormone therapy, which has been a recent change in how we as physicians treat menopause. So 20 plus years ago, everyone was on Premarin, which was a hormone replacement, and then a study came out suggesting that the increased risk for cancer, breast cancer wasn't worth being on the hormones.

(28:58):
So everybody came off hormone therapy, and now we're realizing that that study was a little overblown and we're swinging back the other way. So I strongly suggest seeing somebody if you're a perimenopausal or menopausal who is well versed in hormone replacement therapy and all of those areas. And I know in San Diego, Dr. Jennifer Davis, who we've met, has a great San Diego menopause practice. I've thought about offering it to my patients, but after speaking with her, I'm like, "Oh no, I just -

Bri (29:37):
I'll just be sending over to you.

Dr. G (29:39):
Just send it to her. She is so well versed. This is what she does. Everything she does, she knows every nuance about... Just as you know how we have labiaplasty locked in, that's her with all of the hormone stuff. And so I don't need to dabble in it. You need to find some They qualified. Now, that field is just like GLP-1s and bio-identical hormones and all this other stuff. There's tons of people in there for the money grab. And so there are unqualified RNs and nurse practitioners and other providers who have not put the work in, just want the easy money. So you really do have to do your research and make sure that you're speaking with someone who's qualified and well versed in that.

Bri (30:27):
Kind of off topic, but did you ever watch The Neighbors?

Dr. G (30:32):
The movie?

Bri (30:33):
No, the show. Let me show you the guy and tell me. They made a whole season was about the girl all of a sudden goes to have sex. She got divorced, goes to have sex with this guy.

Dr. G (30:48):
Oh, Friends and Neighbors?

Bri (30:49):
Friends and Neighbors.

Dr. G (30:51):
Oh Yeah.

Bri (30:51):
And then she's just stopped all of a sudden because she didn't get wet. She was too dry. And then the whole rest of the season was about her going through menopause and her life was ending and all these things.

Dr. G (31:02):
Yes. Who's the actress that does that? Who plays her? Oh my God.

Bri (31:06):
Amanda Peet.

Dr. G (31:07):
Amanda Peet. I was like, neighbors, friends and neighbors. Friends and neighbors.

Bri (31:10):
Friends and Neighbors.

Dr. G (31:12):
Yes. Amanda Pete.

Bri (31:13):
And then she runs over the dog.

Dr. G (31:14):
Because her friends are like, no, we just... Yeah, she does run over the dog.

Bri (31:18):
Everything was just downhill.

Dr. G (31:20):
She's a hot mess in that show, like everyone is on that show. But yeah, her friend is like, "Yeah, just carry a lube with you everywhere." And she was like, "What?" But yeah, she does ask her husband for money for the CO2 laser, which is -

Bri (31:37):
I had a girlfriend one time that would just carry a dildo with her everywhere or a vibrator because she just wasn't sure. And I was like, "That's the craziest thing I've ever heard." She's like, "I just don't know where the night's going." I'm like, "That's crazy. That is insane." Well, in a nightclub and she's like, "Hey, check it out." I'm like, "Okay." Drops it out of her purses like, "You're getting a UTI for sure."

Dr. G (31:58):
It's all fun and games until -

Bri (32:00):
It's disgusting.

Dr. G (32:01):
Your purse falls and the contents go spilling out on the dance floor or some shit.

Bri (32:06):
100%. Yes, her. She was so great.

Dr. G (32:09):
Amanda Peet. Yeah. She was an absolute train wreck in that movie or in that show.

Bri (32:14):
That's so funny.

Dr. G (32:15):
I feel like there's another season coming.

Bri (32:16):
They do. I hope so. That's a good one that can just keep going.

Dr. G (32:22):
It was like a boost for my life just to watch it because you're like, God, how do these people continue to have these big choices and then make the wrong choice every time?

Bri (32:31):
Every time.

Dr. G (32:32):
Okay. So let's talk about the Rejuvenate laser in our office. Do you know anything about how the appointment goes? I feel like you kind of stay out of this. It's not like labiaplasty. I do kind of stay out of it, but I can give you my two cents.

(32:45):
Okay.

Bri (32:45):
So

Dr. G (32:46):
Please do.

Bri (32:47):
Do you want to consult first?

Dr. G (32:48):
Yeah.

Bri (32:49):
Yeah. Okay. So you want to consult first because you basically want to make sure that this is the best option. The procedure itself, you don't even need to take a sedative or anything. I always thought we threw on a bunch of numbing cream, but I don't think we do.

Dr. G (33:02):
No, we do.

Bri (33:03):
We do? Okay. So I was right. And then basically the laser just goes in and out and you just click it over a couple times as you're coming out. And it's super painless. I've seen it. I've seen actually our old nurse do it on herself. I feel like I may have helped her before she quit. And it was actually really cool. She just sat there. It was literally her last day and we're just all sitting there staring at her vagina, but it was totally painless, super easy, took maybe, I don't know, 20, 15 minutes, 20 minutes. Probably takes longer when you're doing it yourself and your legs up like this.

Dr. G (33:38):
That's so funny.

Bri (33:39):
She's like, "Press the pedal." It's like, okay.

Dr. G (33:41):
Right, because how are you activating it?

Bri (33:43):
I press the pedal.

Dr. G (33:44):
When we first got it, I thought about doing it. And then I was like, "Well, first of all, my partner was a man and that was not going to happen." And then I'm like, I never even wanted one of the nurses to do it. I just feel like it's -

Bri (33:56):
Or put the pedal up by your arm and press the pedal.

Dr. G (33:58):
Yeah, you could do that. Yeah. Anyway, yes, we do put numbing cream on the vaginal area prior to doing it, but it provides a little lubrication. And then just the act of doing that, I feel like mentally prepares people for what's not going to hurt. It's not going to hurt.

Bri (34:19):
Probably don't even need it at all.

Dr. G (34:20):
We don't need it. But I feel like it also doesn't hurt for us to put it on there.

(34:25):
So we put that on, your legs are up in a lithotomy. We have a special chair that allows for lithotomy legs, so you're up a little bit, but you don't need to. You could frog leg your position.

Bri (34:37):
You just look like you're giving birth essentially.

Dr. G (34:39):
Yeah. And then the laser is on a probe and it has a little, the part that delivers the laser energy is at the end. And so you go into the vaginal canal and then you deliver the beam and then you rotate it on a clock, one through six, hit it again. So that way you're going all the way around clockwise or counterclockwise, then come out a centimeter, you go the other direction, come out a centimeter, go the other direction. And I usually do two or three passes. And so it's like eight centimeters, whatever the length of the vaginal canal is. And then you repeat. I usually do a little bit of lasering at the urethral opening as well. You can have a little bit of spotting, but no one's ever complained about it for three days. And you're supposed to have what we call vaginal rest for three days, so nothing in the vagina. And then that's it. And then -

Bri (35:35):
Easy peasy.

Dr. G (35:36):
Usually people get a result after one treatment, but it's a buildable thing because the CO2 is causing your tissues to regenerate and you want that to build. It's going to continue to rebuild over three to six months. And so you really want to stack the treatments. And so probably one of the hardest things we had was people not coming back for the second and third treatment because they already got results. And I was like, I know, but

Bri (35:58):
The good feedback I got is people were like, "Oh yeah, I actually told a difference." And I feel like they had already purchased three at a time and then they just don't come back.

Dr. G (36:05):
I know. And I was like, "No, no, no, just come back."

Bri (36:07):
And

Dr. G (36:08):
Maintenance would be ideally once a year or every other year.

Bri (36:12):
It can't hurt and it's so easy.

Dr. G (36:14):
Yeah. I would say the most common question is, is it going to hurt? Because even if you tell people it's not going to hurt, they stress out. And the results are almost like within weeks you notice a difference.

Bri (36:29):
Is there anyone that's not a candidate for it?

Dr. G (36:31):
Somebody who hasn't seen a gynecologist in a while, you probably need to have your annual exam. So I'm not doing a speculum exam, so I need to know that everything's okay in there. If you have some condition like lichen sclerosis or something like that, that's not cleared by your gynecologist. If you have an acute infection, if you have active genital herpes, those are all things that would be a no-go. But yeah, the FDA did put out a warning in 2018 about energy-based devices for vaginal rejuvenation. I think because the claims being... It was more of a marketing problem. So what are these claims being made? There's no official testing on this. The studies weren't strong. And then it's off-label 90% of what I do. And it's safe. The settings are safe. I mean, again, yes, if you want to go to some med spa where nobody knows what they're doing, then sure.

Bri (37:28):
Right. Is there an age that you can and can't do it?

Dr. G (37:32):
But it's really not indicated for, like I said, people who are pre-childbearing. What are you gaining there? There should be no reason why you need it. Okay. I feel like we could do myth or reality.

Bri (37:48):
All right, let's do it. Myth or reality. Vaginal rejuvenation is only for women who've had babies.

Dr. G (37:55):
Well, the rejuvenate laser is generally yes.

Bri (37:59):
The laser can fix labia that looks deflated after weight loss.

Dr. G (38:05):
It can, but it's not as good as either radiofrequency microneedling or just excision.

Bri (38:13):
You need hormones for this to work.

Dr. G (38:15):
No, but it generally helps.

Bri (38:17):
This can help with leaking when you laugh or sneeze.

Dr. G (38:20):
Correct.

Bri (38:21):
Your partner will be able to tell.

Dr. G (38:23):
Absolutely not.

Bri (38:25):
You should carry lube everywhere.

Dr. G (38:27):
Sure. You never know.

Bri (38:30):
You never know where the day's going

Dr. G (38:34):
Or the night.

Bri (38:37):
There's going to be a huge influx of carrying pocket sized lube with you.

Dr. G (38:40):
Oh my God. It could be like, maybe that's what we need to do. I feel like our producer's about to fall out of her chair, but you know how the lip gloss is, like the little ones, the little minis, and you can attach it?

Bri (38:53):
Yes.

Dr. G (38:53):
And it's really just lube.

Bri (38:55):
And just lube. Like a key chain. It looks like lip gloss, but it will.

Dr. G (38:58):
Yes.

Bri (38:58):
If anyone steals this invention, don't even think about it. Genius.

Dr. G (39:04):
Lube for you. We just need a better name.

Bri (39:06):
Lube to go

Dr. G (39:07):
Or wherever the day goes.

Bri (39:09):
Wherever the day goes. God, this is so good.

Dr. G (39:12):
Brilliant. You heard it here first. Lube. That's it. That's going to be our thing.

Bri (39:19):
Oh, that's so good. We've been waiting so long for something like this to retire us.

Dr. G (39:24):
Yeah. Merch incoming. All right. So if you have actual questions about vaginal rejuvenation, i.e. The rejuvenate laser, labiaplasty. We didn't even talk about how you could fat graft the labia majora if you needed to, to restore a volume. We do that occasionally, or you could use our go-to favorite cadaver Alloclae.

Bri (39:46):
Alloclae.

Dr. G (39:47):
Another place you could put Alloclae. Those are all options. So if you have questions, if you're more confused after listening to this, please reach out for a consultation. And yeah, like and subscribe.

Bri (40:00):
Like and subscribe.

Dr. G (40:01):
So we're going to scrub in.

Bri (40:02):
Scrub out.

Dr. G (40:06):
Peace. If you're listening today and have questions, need info about scheduling, financing, reviews or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. Learn more about us, go to restorestplasticsurgery.com or follow us on Instagram @restoresdplasticsurgery. If you enjoyed this episode, please share it and subscribe to all the bees on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.