Radiofrequency Treatment of Labia Minora and Majora: A Minimally Invasive Approach to Vulva Restoration

Abstract

Summary: Labiaplasty has rapidly increased in popularity over the past 5 years.Traditional labiaplasty is 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 40°C–45°C. This controlled energy delivery leads to an inflammatory cascade initiating neocollagenesis, angiogenesis, and elastogenesis over the coming 3–4 months. A single surgeon series of labia minora and majora treatment by RF (InMode, Lake Forrest, Calif.) was reviewed between April 2018–October 2018. Demographic data were collected as well grade of hypertrophy (pre/posttreatment), number of vaginal deliveries, and reason for treatment. Procedural parameters were recorded, including internal/external temperatures, total energy used, and time of treatment. All adverse events were recorded. Objective and subjective data points were obtained in the form of patient surveys and photographic evaluation by lay persons as well as plastic surgeons objective to the treatment. Ten consecutive patients were treated with bipolar RF (InMode, Lake Forrest, Calif.) between April 2018–October 2018. Mean age was 44 (29–54). Average number of pregnancies was 2 (STD 1.1). Three patients were treated for aesthetic concerns, 3 for functional complaints, and 4 desired improvement in both. Overall graded improvement in labia size/contour was +50% (STD ±15.3). Patient satisfaction scale data demonstrated 9.5/10 (±1.7). All patients (10/10) stated that they would undergo treatment again. In all cases, the surgeon observed tightening of the clitoral hood, introitus, forchett, as well as improved distribution of dark pigmentation of the labia minora. There were no significant complications and no need for additional procedures. Average recovery time was 14 days (STD 2.2). Treatment of labia hyperplasia and laxity with bipolar RF may potentially fill a treatment gap of women seeking aesthetic and functional improvements without surgical labiaplasty. A powered prospective randomized double-blinded study is needed to further elucidate the role of this technology.

Peer Review

“…A frequent throwaway recommendation is that a large, multicenter, prospective randomized controlled study be undertaken to investigate once and for all whether a particular treatment (eg, a Keller funnel or radiofrequency) 13 , 18 is effective. This recommendation is naive.…”

“…After establishing relevance, the first bar for a study to meet is legality. Surprisingly, studies in plastic surgery patients are frequently published without IRB approval 11–25 . Sometimes, the authors explain that IRB review is unnecessary because they believe that their study is exempt 24 or they may be excused because they are in private practice 12,13,25 .…”

Light and energy‐based therapeutics for genitourinary applications: Consensus on protocols and best practices

“…The 40 W bipolar RF cannula is placed into the access port and moved in a radial cranio‐caudal motion until the tissues reached target temperature across the labia (Table 4). Treatment is stopped ~1.5 cm from the access port to avoid repeat heating 51 …”

“…50 Bipolar RF Bipolar RF devices on skin employ a stamping or stationary method of delivery; this approach has been modified into a probe-delivered and skin surface application of electrodes. 51 A bipolar vulvar protocol employs the insertion of a probe cannula into each labium and an opposing probe placed externally so that the RF passes through the skin 31 (Table 4). 51 This method delivers volumetric heating or microcolumns of thermal injury are generated.…”

“…51 A bipolar vulvar protocol employs the insertion of a probe cannula into each labium and an opposing probe placed externally so that the RF passes through the skin 31 (Table 4). 51 This method delivers volumetric heating or microcolumns of thermal injury are generated.…”