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Surgical Procedures

Vaginal Rejuvenation

Vaginoplasty is a plastic surgery reconstructive procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvogainal structures that might be absent or damaged because of congenital disease (e.g. vaginal atresia) or because of an acquired cause (e.g. physical trauma, cancer). As such, the term vaginoplasty generally describes any such vaginal surgery, and the term neovaginoplasty specifically describes the procedures of either partial or total construction or reconstruction of the vulvovaginal complex. The post-operative outcome of vaginoplasty is variable; it usually allows coitus (sexual intercourse), although sensation might not always be present. In biological women, menstruation and fertilization are assured when the uterus and the ovaries have preserved their normal functions; in a few cases, vaginal childbirth is possible. In male-to-female sex reassignment surgery, some trans women patients undergo vaginoplasty as part of their physical (sex) transition. The physical factors that limit vaginal dimensions are the rectoprostatic Denonvilliers' Fascia (depth) and the Levator ani muscle (diameter); thus, in trans women patients, the narrowness of the male pelvis can reduce the available area to use for vaginoplasty.

Vaginal Rejuvenation Information

Vaginoplasty utilizes autologous (patient-derived) tissue from the patient's person, to construct areas of vagina and areas of the vulvovaginal complex. The tissues available for surgical correction include the oral mucosa, skin flaps, skin grafts, the vaginal labia, penile skin, penile tissue, scrotal skin, and intestinal mucosa. In surgical praxis, it is important to electrolytically remove the follicles from a hair-bearing skin graft, unless the surgeon directs otherwise; usually, the skin graft is depilated intra-operatively, either manually (scraped) or by electrocauterization. Besides the vaginoplastic surgery techniques herein discussed, earlier plastic surgery procedures do exist, but have been superseded by the more effective results (outcome) of contemporary vaginoplasty.

Balloon vaginoplasty In the balloon vaginoplasty technique, a foley catheter is laparoscopically inserted to the recto-vesical space (recto-pubic space), whereupon gradual traction and distension are applied to create a neovagina.[1] [2] Moreover, balloon vaginoplasty also is a new technique for treating vaginal aplasia, which also is applied as a technically simple, physically safe, and medically effective alternative vaginoplasty for creating a neovagina, especially when conventional laparoscopic surgery is either infeasible or unsafe

Buccal (oral) mucosa A relatively novel surgical approach to treating vaginal agenesis is utilizing the buccal mucosa as the tissue for lining the vagina (ca. 8.0 cm. deep). The medical advantages of this vaginoplasty technique include the biological and healing qualities of the buccal mucosa tissue, minimal scarring, and a short, post-operative recovery for the patient. The disadvantages include limited vaginal dimensions (depth and width), and the possibility of either intraoral damage, when tissue-harvesting, or of complications.[3] In surgery, the tissue donor site in the cheek (ca. 2.5 x 8.0 cm.) is marked to avoid damage to the Stensen's duct (parotid duct) and to the parotid gland. To create the vaginal lining, the buccal mucosa tissue graft is micro-perforated to allow shaping it to a larger size of greater area (surface); it then is formed upon a stent, and afterwards affixed to the vaginal space (created earlier in the operation), with its edge sutured to the minor labia and to the perineal skin. The vaginal mold of buccal mucosa is then (temporarily) secured to the perineal skin, to allow the patient's recovery.

Colovaginoplasty The colovaginoplasty (colon section) technique creates a vagina by cutting away a section of the sigmoid colon and using it to form a vaginal lining. This surgery is performed on women with androgen insensitivity syndrome, congenital adrenal hyperplasia, vaginal agenesis, müllerian agenesis, and other intersexual conditions wherein non-invasive forms of deepening the vagina cannot be performed (mostly on trans women patients) as an alternative to penile inversion, with or without an accompanying skin graft (usually from the thigh or the abdomen). Because of the potential complications (e.g. diversion colitis) most surgeons will recommend a colovaginoplasty procedure only when there is no alternative procedure.

Don Flap (labia minora flap) The Don Flap correction of vaginal agenesis, uses a technique similar to that of penile inversion, that sutures the labia minora together to create a neovagina. A refinement of this vaginoplsatic technique is its utilization of the prepucial skin (hood) of the clitoris as a horse-shoe-shaped, one-piece flap. Yet, although the Don Flap technique is a relatively simple surgical procedure, the most obvious disadvantages of the labia minora flap surgery include the need for restorative labiaplasty and cervical dilation to produce a vagina of adequate dimensions (depth and width).

McIndoe technique The McIndoe vaginoplasty technique utilizes split-thickness skin grafts that cover a mold, which then is inserted to a surgically created space, between the bladder and the rectum. The principal, technical difference between the McIndoe vaginoplasty and the Vecchietti vaginoplasty, is which tissue to utilize to line the created neovagina. Each surgical procedure has positive and negative factors, especially regarding upon whom such a plastic surgical technique can be applied, because the post-operative outcome varies with the patient's indications.

Penile inversion In genital reassignment, penile inversion is the most common plastic surgical technique for creating a neovagina for trans women patients; it also is used for the genital corrections for people born intersex. Along with the colovaginoplasty procedure, penile inversion is one of the two, principal vaginoplasty procedures used for creating a neovagina. Applying a flap technique (first used by Sir Harold Gillies in 1951), the spongiform erectile tissue of the penis is removed, and the skin, with its nerves and vacsular system (blood supply) still attached, is used to create a vestibule area and labia minora, which then are inverted into the neovaginal cavity created in the pelvic tissue. Part of the glans penis tip, with its nerve and vascular systems still connected, becomes the clitoris; and the urethra is shortened to end at a place appropriate to the female genital anatomy. Another common technique for creating a neoclitoris utilizes the urethral spongiform tissue. This was the most common penile inversion technique, and was so used by Dr. Burou and Dr. Stanley Biber; however, some surgeons do not create a neoclitoris as part of a penile inversion.

Vecchietti procedure In treating müllerian agenesis, the Vecchietti procedure is a laparoscopic surgical technique that produces a vagina of dimensions (depth and width) comparable to those of a normal vagina (ca. 8.0 cm. deep).[5] [6] A small, plastic sphere ("olive") is threaded (sutured) against the vaginal area; the threads are drawn though the vaginal skin, up through the abdomen, and through the navel. There, the threads are attached to a traction device, and then daily are drawn tight so that the "olive" is pulled inwards and stretches the vagina, by approximately 1.0 cm. per day, thereby creating a vagina, approximately 7.0 cm. deep by 7.0 cm. wide, in 7 days. The mean operating room (OR) time for the Vecchietti vaginoplasty is approximately 45 minutes; yet, depending upon the patient and her indications, the procedure might require more time

Wilson Method The penile-inversion technique of the Wilson Method is different from the traditional penile-inversion technique in that it is a three-stage surgery, comprising a two-stage initial vaginoplasty.[8] The Wilson Method surgery is initially performed like a traditional penile inversion, until the vaginal-vault creation step, in which the vault of the vagina is left unfinished, as a raw surface, and is packed with a sterile stent, which, after 5–7 days, then is lined with a skin graft harvested from the buttocks. The penile skin is used to create the labia minora, clitoral hooding, and the anterior fourchette (frenulum); the glans penis is used to create the clitoris, and the scrotum is used to create the labia majora.

Procedures Plastic Surgery...


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