Wendy lewis investigates the incorporation of women’s health treatments into aesthetic practices
Frustrated with endless Kegel exercises, hormone creams and adult nappies, more women are turning to procedures that address both their functional problems and the changes that accompany childbirth and ageing.
Surgery to reshape the labia and other aspects of the vagina is on the rise. According to the American Society for Aesthetic Plastic Surgery (ASAPS), in 2014, the procedures that showed the largest growth in volume on a year-over-year basis included labiaplasty, which rose by 49%. A visit to RealSelf.com reveals a 94% ‘Worth It’ rating for labiaplasty from 388 posted reviews. According to Tom Seery, CEO of RealSelf, “Consumer satisfaction with labiaplasty has increased over the years, and suggests that women are very satisfied with the outcomes. Traffic to vaginal rejuvenation topics such as labiaplasty has increased 41% year-on-year. In the past three months alone, half a million consumers have conducted research on RealSelf and, in the past year, consumers have viewed 3.8 million pages of content on this topic. Labiaplasty is the most important topic, representing 68% of visits to this subject matter.” The numbers of procedures are increasing every year as vaginal rejuvenation has become accepted as mainstream. Once a procedure that was considered a dirty little secret, women are now actively searching online for practitioners, joining forums to discuss their concerns with other women, and doing research on all of the options available. While some women undergo these procedures to improve their comfort, many also want to improve their self-confidence.
Many of the clinics I work with are reporting dramatic increases in the number of women seeking labiaplasty and vaginal tightening treatments over the last few years. Some members of the medical community attribute this rise to the proliferation of pornography and the establishment of a ‘new normal’ for women’s private parts. It can also be attributed to the fact that there are more available options to women today that are safer, less invasive, less expensive and with less down-time. The increasing numbers of practitioners adding these treatments to their menu of services and honing their skills, coupled with patient referrals from practitioner colleagues, demonstrate that the desire for vaginal rejuvenation has become a topic of interest in popular culture. This newfound acceptance of procedures that enhance the beauty of an area once considered off limits can translate into growth opportunities for aesthetic clinics. Practitioners who are marketing vaginal cosmetic procedures are getting in on the ground floor of this new frontier in cosmetic medicine and surgery. As our culture continuously puts pressure on women to measure up to a certain ideal image, the popularity of this category of procedures is likely to continue to flourish.
What women want
Many practitioners I have spoken to say that while some women opt for surgery because their labia has caused them physical discomfort, there is also a growing segment of patients seeking treatments who are being encouraged by their partners. According to these practitioners, women are also requesting procedures because they feel self-conscious about their anatomy post-childbirth.
Functional female issues
While more and more women seek vaginal rejuvenation treatments for aesthetic concerns, many others simply undergo treatment for health-related issues. According to the American Urogynecologic Society (AUGS), one in three women will experience a pelvic floor disorder (PFD) in her lifetime.3 These may occur when women have weakened pelvic muscles or tears in the connective tissue, which may cause pelvic organ prolapse, bladder and bowel control problems. These symptoms are more common as women get older, and childbirth is definitely a contributing factor. Vaginal births double the rate of pelvic floor disorders compared to caesarean deliveries or women who have never given birth. Today there is a growing number of non-surgical and surgical treatment options available to address these concerns. Aside from prescription medications for incontinence, an overactive bladder (OAB) can be treated with botulinum toxin injections. Botulinum toxin is injected into the bladder muscle and used to treat OAB symptoms such as a strong need to urinate with leaking (urge urinary incontinence), a strong need to urinate (urgency), and urinating often (frequency). Many women suffer from painful intercourse due to vaginal atrophy, an uncomfortable condition that causes changes in the structure and function of the vagina. It can be caused by hormonal changes associated with menopause, or by a slowdown in oestrogen production, such as after chemotherapy or radiotherapy for cancer or removal of ovaries. This drop in hormone levels can result in a thinning and loss of elasticity of vaginal tissues. The blood supply is reduced and the vagina loses some of its natural lubrication, which can cause itching, burning, dryness, incontinence, laxity and prolapse. Not surprisingly, these symptoms can have a devastating effect on a woman’s self-esteem and relationships.
Labiaplasty, as well as other vaginal augmentation procedures, are getting a lot of attention lately. By all accounts, labia reduction appears to be the most popular form of vaginal cosmetic surgery, although that is just where the list of options begins. According to practitioners offering these treatments, vaginal rejuvenation, vaginoplasty, hymenoplasty (revirgination), clitoral hood reduction (clitoral unhooding), labial fat injections, and G-spot enhancement are becoming more commonly requested. For women who are unhappy with the appearance of their vagina, but are reluctant to undergo surgery, there are new and exciting non-surgical alternatives. There has been a recent rise in injectable fillers specifically designed for enhancing women’s anatomy. For example, Desiral by Vivacy is an antioxidant hyaluronic acid based gel formulated to preserve women’s intimate health. Cindy Barshop, founder of the Completely Bare laser hair removal clinics that were later sold and rebranded as Spruce & Bond, has jumped on this trend. She founded VSpot on New York’s Fifth Avenue as the first vaginal rejuvenation spa in the US and is carving out a new niche in the world of beauty.
“Until recently, the only option for women who suffered from incontinence, dryness, and painful sex, was invasive surgery with horrific side effects. It’s time to take control of our bodies, our sexuality and our vaginal health. VSpot is literally life changing for so many women,” she says. Although the number of procedures being performed seems to be steadily climbing, not every woman is comfortable telling her practitioner about her concerns. Such hesitation in speaking to medical professionals, however, will likely change as more women’s health clinic models such as VSpot arise, new technologies are developed and more aesthetic clinics add vaginal rejuvenation procedures to their treatment offering. The rise in the specialty of urogynecology, which focuses on the treatment of pelvic floor disorders, is also significant. According to the International Urogynecological Association (IUGA), it has more than 2,900 members from 90 countries, and is affiliated with 29 national societies including the British Society of Urogynaecology (BSUG). There are more practitioners entering the market offering some aspect of women’s health services, from gynaecologists, plastic surgeons, and dermatologists, to aesthetic practitioners.
The newest entries into this category include devices using radiofrequency or CO2 fractional energy to promote the recovery of genital mucosa by stimulating the production of collagen and restoring blood flow. Energy may be delivered externally to address tissue laxity, and internally to improve the functional aspects of the vagina. ‘Vontouring,’ short for vaginal contouring, is a new term coined by BTL Aesthetics for their Protege Intimo system (Exilis Protégé in the US). This system uses radiofrequency energy to heat the collagen and stimulate the production of new collagen fibres. The beauty of these systems from a business model perspective is that the procedures are typically performed in a clinic environment, take 15-30 minutes usually without the need for an anaesthetic, and there is minimal to no discomfort, side effects or downtime for the patient. In most cases, it also involves a course of treatment sessions, so patients will be returning to your clinic periodically and for maintenance sessions, leaving an opportunity to introduce them to other treatments on offer. These treatments can also dovetail into other non-surgical cosmetic procedures, including injectables, laser resurfacing and light-based treatments. As more companies enter this space, we can expect to see direct-to-consumer marketing campaigns that will ultimately raise awareness of treatments that address the symptoms that may already be on the minds of women of all ages. This area of practice may still be in its infancy, but everything we have seen so far points to it becoming a big growth market. According to Dr Bruce E Katz, board-certified dermatologist and director of the Juva Skin & Laser Center in New York, “Over the past few years, media attention has given rise to consumer awareness of the options available to women both from a functional standpoint as well as aesthetics. We began offering FemiLift in our practice this year because we see a need for women’s procedures that address incontinence. Most women first notice urine leakage after they have given birth, though it can happen with ageing as well. FemiLift is a 30-minute, minimally invasive therapy that uses a CO2 laser to deliver fractional laser energy that strengthens the walls of the vagina.”
The range of women’s lasers
Building a women’s clinic
Establishing a centre for women’s health takes careful planning, investigation, and some marketing muscle. It requires more effort than just buying a laser and putting out some brochures in the waiting room to generate interest. Here are some pointers to help you get started:
The question on the minds of some practitioners interested in adding vaginal rejuvenation technology to their armamentarium is how to start the conversation with new and existing patients. Addressing these intensely personal concerns with women who are feeling vulnerable, especially if you are not a gynaecologist or obstetrician, can be a challenge in the beginning. Some practitioners may not have the requisite bedside manner or temperament for it. Recruiting the right staff is a critical first step. “The consultation process can be a challenge for some practitioners. My advice is to enlist a female nurse or practitioner’s assistant to talk to patients about their needs and goals. We have found that it helps to have a woman who is knowledgeable and comes from a place of credibility speak to patients about these delicate issues. It helps to put them at ease,” says Dr Katz. Plastic surgeon Dr Christine Hamori has the advantage of being one of only a handful of female surgeons performing vaginal rejuvenation procedures in her practice location of Duxbury, Massachusetts. “As a woman, I can speak to female patients from a different perspective. With men, it may sometimes be more difficult. It also helps that I have become known as a specialist in the field so women are coming to our clinic already interested in having these procedures done,” she says.
In general, Dr Hamori has found that labiaplasty is the most requested and straightforward procedure. She also performs the ‘labial puff’ with fat grafts to the labia majora for more volume or uses Juvederm Ultra Plus. “When I perform liposuction on the inner thighs, patients will often ask about where they can use the fat. They usually want the fat injected into their facial areas. In some cases, I will gently suggest that we use it to plump up the labia majora,” she says.
Practicing in the conservative market of New England, Dr Hamori sees a lot of menopausal women who are most concerned about vaginal dryness. “These women are the perfect patients for these treatments,” she says. Having used the Pelleve RF system successfully, she recently added ThermiVa to her device collection. “ThermiVa works for vaginal tightening and reduces stress incontinence. It is a series of three treatments spaced one month apart. The probe delivers controlled thermal energy externally to the labia and internally for tightening,” says Dr Hamori.
Promoting vaginal rejuvenation services requires a lighter touch than some of the tactics aesthetic clinics typically use. Whereas more women today are open to sharing their experiences with injectables and skin lasers with friends and family, this is a far more private decision that doesn’t necessarily lend itself to dinnertime conversation. Taking an aggressive approach is more likely to elicit a negative reaction on the part of many prospective patients and could turn them off. Try to put yourself in the position of a woman seeking intimate treatments and be extra sensitive to her concerns for privacy and professionalism. Having informative patient materials, a website landing page, blog content, and a selection of before and after photographs available are important to make patients feel comfortable and to educate them on what they can expect.
If you are serious about building this area of your clinic, a microsite is a good investment. A microsite is a smaller website incorporated into a main website, which aims to give specific information on a particular subject. The benefit of creating an educational microsite on women’s health issues could be, for example, that it helps position your clinic for expertise in this category of treatments. It may be beneficial to use a different domain name for the site entirely and spend some of your marketing budget on search engine optimisation (SEO). There is a lot of misinformation and widely inflated claims online about how some of these treatments work, the results that can be achieved, and if and when surgery may be indicated. A microsite offers an opportunity to inform consumers about your special expertise and approach to this sensitive area of practice, and answer their questions.
Your clinic also needs to be visible to women who are searching for these procedures online, rather than solely by personal referral. Think about the terminology they may be using to search, and invest in the most common keywords in your area. For example, common search terms include; vaginal rejuvenation, vaginal tightening, vaginoplasty, labiaplasty, labial reduction, vaginal reshaping, G-spot enhancement, laser vaginal rejuvenation, vaginal cosmetic surgery, vagina lift, and cosmetic vaginal procedures. Consider where you may be able to get referrals. For example, other medical professionals who have large populations of female patients who are of child-bearing age or peri-menopausal, and who do not already offer similar services, may be ideal targets. Aestheticians, massage therapists, yoga instructors, midwives, and personal trainers may also be worthwhile to tap into.
Like men who suffer with erectile dysfunction, women are beginning to feel more empowered to take steps to improve their confidence and their sex lives. Dr Hamori believes that Viagra-like drugs for women will go far to advance awareness of women’s health and sexual well-being treatments. At the moment, a pink pill, developed by Sprout Pharmaceuticals, is pending FDA approval to treat Hypoactive Sexual Desire Disorder (HSDD) in women. In addition, at-home devices that mimic the vaginal tissue tightening effects of clinical treatments are currently under development and may be available to consumers by early next year.