57 yo mother of one from Las Vegas, Nevada with a long history of female sexual dysfunction and undesired cosmetic appearance of her vulva located the office of Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado, from a Google search on Labiaplasty. She has noticed long labia her whole life but has worsened over the past few years, creating more discomfort. She had been discussing treatment options with our patient coordinator and presented to the office for examination in anticipation of aesthetic vulvar surgery the following day, due to traveling from out of state. Thorough pelvic exam by Dr. Aguirre reveals an aging vulva consisting of bilateral labial hypertrophy with hyperpigmentation and redundant lateral and excess prepuce. There is an enlarged genital hiatus and significant tear of her perineal musculature on the right side. There are multiple anal skin tags present. All findings were discussed with patient in detail along with all surgical and nonsurgical options. She proceeded with aesthetic vulvar surgery the following morning consisting of Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction, and Clitoropexy with PRP to surgical wounds as well as Excision of Anal Skin Tags and O-Shot. Patient also discussed with Dr. Aguirre, the desire for hormonal optimization and preceded assessment prior to moving forward with Bioidentical Hormone Therapy. She returned to the office for her regularly scheduled postop appointments very happy with her surgical results and feeling great with hormone treatment.