40 yo woman from Denver, Colorado was referred to renowned Cosmetic Surgeon and Board Certified, Fellowship-Trained Urogynecologist Dr. Oscar Aguirre of Parker, Colorado from a local OB-GYN. She has a 20 year history of labial hypertrophy, which has become more symptomatic over the past two years. She is very physically active, playing soccer, cycling, running, etc. and with these activities she has extreme discomfort. She is also bothered by enlarging possible hemorrhoid vs anal tag that has been present for more than three years. Pelvic examination is significant for bilateral labial hypertrophy with hyperpigmentation and asymmetry, left side greater than right. There is excess perineal skin and two anal skin tags, with one being very large. All history and finding were discussed in detail with patient along with her surgical options. She was found to be an excellent candidate for an in-office Laser Reduction Labiaplasty of Labia Minora, Excision of Excess Perineal Skin and Anal Skin Tags. She was eager to move forward with all procedures recommended and performed by Dr. Aguirre. She returned to the office for her regularly scheduled postop visits, healing nicely and very pleased with the results.