34 yo mother of one from Denver, Colorado referred by a Nurse Practitioner at her local OBGYN to Dr. Oscar Aguirre, a renowned Cosmetic Surgeon and Board Certified, Fellowship-Trained Urogynecologist of Parker, Colorado. She has a greater than 20 year history of undesired cosmetic appearance of her vulva. For as long as she can remember, at least since elementary school, she has been bothered by the shape and size of her labia minora. As she has gotten older she has been bothered by the discomfort she has with wearing formfitting clothing, having to rearrange herself in public. When sexually active, there is pulling, dragging and discomfort. She is very self-conscious about her vulva and will not allow men to see her “down there”. Upon further questioning she states she enjoys both vaginal and clitoral orgasms, but has noticed less sensation with sex. She also describes urinary incontinence with activity. Dr. Aguirre performed a thorough pelvic examination which revealed bilateral labial hypertrophy with hyperpigmentation, right side greater than left. There is redundant lateral prepuce bilaterally, right side greater than left with ptosis. There is also excess perineal skin. All history and finding were discussed in detail with patient along with her surgical and non-surgical options. She decided to move forward with definitive surgical therapy. Dr. Aguirre performed in-office aesthetic vaginal surgery in the form of Laser Reduction Labiaplasty of Labia Minora, Clitoral Hood Reduction, and Clitoropexy with PRP to surgical wounds, and Excision of Excess Perineal Skin. She was also found to be an excellent candidate for a Viveve (Radiofrequency Introital Tightening) to help reduce her incontinence and laxity symptoms, which she has chosen to address at a later time should those symptoms continue.