Feminine rejuvenation has received a lot of publicity in the past couple of years, and as a result our patients at Eterna Cosmetic Surgery frequently ask if Dr. Hernandez can help improve the appearance of their external genitalia. The answer is a resounding yes!

As a result of genetics, vaginal births, aging or weight changes women can develop sagging and wrinkly skin in the labia. So, ladies of San Antonio, does this sound familiar?

  • Many patients tell us these changes make them feel embarrassed or less confident.
  • A very redundant labia minora – a condition in which one or both labia minora protrude beyond the labia majora -- can cause irritation or get in the way, causing pain during sexual intercourse.
  • Some patients avoid certain activities, like spinning classes or horseback riding, because of the discomfort they experience.
  • Some patients describe avoiding wearing thongs and yoga pants because they notice a bulge.
  • And some patients report having issues with personal hygiene because of the excess skin.

Labiaplasty can help correct these issues by removing excess skin and restoring a more compact and youthful appearance to your external genitalia. 

What is Labiaplasty?

Labiaplasty is a now-common surgical procedure that reduces excess labial skin -- typically up to 60-70% of the redundant tissue that forms the labia minora. Labiaplasty does not affect a woman's ability to delivery vaginally. The surgery also does not affect the g-spot, and Dr. Hernandez does not operate on the clitoris or its nerves directly so there is no risk of diminished sexual sensation. 

The non-surgical option

But many women don’t want surgery. For them, Non-surgical Labiaplasty is an appealing alternative that offers transformative results -- up to 40-50% reduction in excess skin and fat -- without having to undergo invasive surgery. To perform this procedure, Dr. Hernandez uses minimally-invasive AccuTite, an innovative radiofrequency technology, to perform this in-office procedure.

In fact, the skin on the labia majora typically responds so well to radiofrequency tightening, it is now very rare that reduction of the labia majora requires surgery. However, in some cases a combination procedure is best, in which surgical Labiaplasty is performed on the labia minora and non-surgical Labiaplasty is used to firm the skin on the labia majora and the mons pubis.

Who is a good candidate?

If you’re a woman in her 20's to 50's and you recognized any (or all) of the vaginal challenges we noted above, you could be a great candidate for Non-Surgical Labiaplasty. The more extensive surgical procedure can be particularly beneficial for women who have very large labia minora and for someone who has lost a massive amount of weight and now has severe excess loose skin.

It’s always best if you’re in good health overall, relatively close to your ideal weight, a non-smoker, and have realistic expectations of what can be achieved with the surgical or minimally-invasive procedure you choose.

What happens during Labiaplasty?

This is an outpatient procedure performed under local anesthesia. Because injecting the local anesthetic is uncomfortable (it stings as it takes effect), Dr. Hernandez also gives patients a combination of a pain medication, a medication to calm their nerves and an antibiotic. In addition, she offers the option of using Pro-Nox, a patient-controlled gas that can be administered briefly during the few minutes it takes for her to inject the local anesthetic and for the stinging sensation to subside. Pro-Nox is similar to a gas often offered to dental patients.

For the surgical procedure, Dr. Hernandez first marks the redundant tissue on the labia minora. She then injects the local anesthetic, as noted above, to numb the labia minora. She surgically removes the excess tissue and stitches the remaining skin back together using dissolvable sutures.

How is Non-Surgical Labiaplasty different?

For this procedure, Dr. Hernandez injects the local anesthetic in several strategic areas, then makes several tiny punctures in the skin using a needle. She inserts a filler cannula (like the cannula used for facial dermal fillers) to inject local anesthetic under the skin. This numbs the labia minora, labia majora and the mons pubis.

Using those same entry points, she then inserts the AccuTite cannula to perform radiofrequency-based tightening and fat reduction. The AccuTite wand is very small, allowing her to work both carefully and precisely. Following AccuTite, she then performs a Morpheus8 treatment on all three areas (labia minora, labia majora, and mons pubis). Finally, she applies a soothing recovery cream on the external genitalia.

As performed by Dr. Hernandez, non-surgical Labiaplasty takes about 45 minutes. 

What happens after Labiaplasty?

You should budget 2 to 3 days off work and your normal routine for recovery, for either type of procedure. You will want to rest at home for these days, and you will have to avoid strenuous exercise.

If you had a surgical labiaplasty, you will need to avoid sexual intercourse for 6 week, and you’ll need to wear loose clothing for the first 3 weeks. Most patients manage post-surgical discomfort with over-the-counter pain medication. Your stitches will go away on their own within 4-6 weeks and you will have mostly healed at that point, but it will take 4-6 months to see the final results of your surgery.

If you had a minimally-invasive non-surgical labiaplasty procedure you will have to avoid sex for 1 week afterward. You will wear compression underwear for 3 weeks. After 3 months, you will notice a significant improvement in the firmness of your skin, and you’ll see full results after 6 months.

What about the O-Shot®?

For many women, time and childbearing can take the zest out of sex as well as produce visible external changes. If that’s you, take heart. The O-Shot® is a minimally-invasive treatment that can significantly improve your sex life by regenerating new vaginal tissue. And that’s important! The O-Shot® is an in-office procedure that consists of two injections, one into the clitoris and one into the G-spot.

While that might sound a bit scary, you can rest assured you’re in caring, careful hands with Dr. Elizabeth Hernandez. Dr. Hernandez trained to perform this treatment from the surgeon who created it, Dr. Charles Runnels. The procedure takes just 30 minutes, most of which is allowed for skin numbing.

So what could the O-Shot® do for you? Patients report it has helped:

  • Increase libido
  • Increase clitoral stimulation
  • Reduce or eliminate pain during sex
  • “Normalize” vaginal canal feeling (either increasing or reducing feeling of tightness compared to before)
  • Increase ability to orgasm and/or number and intensity of orgasms
  • Rejuvenate external appearance
  • Reduce or eliminate overactive bladder and/or urinary incontinence

Women today are far more aware of their bodies than past generations, including their most intimate areas. One of the greatest benefits of knowing your body is understanding you do not have to simply accept frustrating vaginal changes brought on by pregnancy and childbearing, aging, or significant weight fluctuation. You can do something about it.

Labia majora augmentation is a vaginal rejuvenation treatment that can restore volume and improve skin condition to make you more comfortable and confident in your clothing and in your sexual relationship.

How Does Labia Majora Augmentation Work?

The labia majora are the outer pair of vaginal lips. You may not give them much thought, until you start to detect problems:

  • Aging, especially after menopause, and pregnancy, breast feeding, and certain breast cancer treatments all cause reduced estrogen levels that can result in vaginal atrophy. Common symptoms include dryness and external pain or irritation during intercourse.
  • Aging also causes loss of fat, and childbirth can stretch the labia majora, leaving them lax and, in some cases, wrinkly.  
  • Some women are bothered by the fact that their labia majora are not symmetrical, though this can be perfectly natural.

There are surgical techniques that can improve the appearance of the labia majora. At Eterna Cosmetic Surgery, Dr. Elizabeth Hernandez performs labia majoraplasty as an outpatient procedure using local anesthetic and oral sedation. This option can produce the desired results without the need for hospitalization and lengthy time commitment, pain, and cost that go with it.

For labia majoraplasty, Dr. Hernandez surgically removes a slender crescent of excess skin on the inside of each of the labia majora, then closes with absorbable sutures. The amount of skin removed depends on each patient’s condition, but the goal is to achieve smaller, tighter labia majora that have a more compact and youthful appearance.

Patients usually take a week off to recover. Swelling gradually subsides over several weeks, and patients can resume sexual activity after 4-6 weeks.

However, Some Women Don’t Want any Type of Surgery

At Eterna Cosmetic Surgery, we are pleased to offer three non-surgical alternatives for labia majora augmentation. Two are injectable fillers, all three are performed as outpatient procedures here in our office. These treatments are faster than surgery, with less discomfort, minimal downtime, and minimal to no scarring. Nonetheless, they can effectively restore volume and tighter skin.


This innovative dermal filler is not made from the usual hyaluronic acid but from allograft adipose matrix, a derivative of human fat. Like gel fillers, Renuva adds instant volume, but then it does more. The injected product includes growth factors, proteins, and collagen that stimulate natural enlargement of the fat cells, production of new cells and increased blood flow – renewed skin with healthier tone and texture.

Renuva treatments take only 5-10 minutes. Results will gradually improve over 3 months or so and can last for many years. This treatment can be a good choice for women who do not want to undergo fat transfer.


This is also an injectable dermal filler, but again it is different from traditional products. Bellafill® is collagen-based and incorporates microspheres of polymethyl methacrylate (PMMA) which work to provide additional support as more collagen is formed. So Bellafill® also provides both immediate and ongoing skin improvement. The bovine collagen is absorbed by the body, but the microspheres remain and the body produces collagen that attaches to these microspheres.

Most patients require just one Bellafill® treatment to achieve desired results, and results are considered semi-permanent, lasting 5 years or longer. There may be some bruising or swelling initially, so Dr. Hernandez usually suggests patients take a day or two off following treatment.

Fat Transfer

Instead of using an injectable filler to re-plump the labia majora and smooth the skin, this procedure uses your own body fat to add volume. Dr. Hernandez will use liposuction to harvest a small amount of fat from some other part of your body, then prepare the fat for injection and place it into the target area. Because it is your own fat, there is no risk of rejection or negative reaction.

Liposuction requires only very small incisions, but adding this step does make the procedure longer than simple injections, and you will need to budget a few days of downtime for recovery.

Talk to Dr. Hernandez, woman to woman

Even women who have no qualms talking to their male doctor about most health issues can feel embarrassed and reluctant to ask about feminine rejuvenation. No worries here at Eterna Cosmetic Surgery! You can feel entirely comfortable with Dr. Hernandez because she is not only a skilled and experienced cosmetic surgeon, she is a woman, too. She gets it.  

Why wait? If you schedule a private consultation now, you are taking the first step toward something you deserve – more youthful and compact looking external genitalia and greater comfort going about your daily activities.