41 yo mother of three from Arvada, Colorado self-referred to renowned Cosmetic Surgeon and Board Certified, Fellowship-Trained Urogynecologist Dr. Oscar Aguirre of Denver, Colorado through an internet search for Labiaplasty. She presents with a 25-year history of undesired cosmetic appearance of her vulva and has also noticed progressive vaginal looseness and occasional stress urinary incontinence. Her primary concern is with regard to her long dark labia minora and loose labia majora. Dr. Aguirre performed a thorough pelvic examination which revealed urethral hypermobility and a distal stage I rectocele. As this was not her main concern attention was then focused on inspection of the vulva with the patient observing with a handheld mirror. She was found to have bilateral labial hypertrophy with hyperpigmentation as well as redundant lateral prepuce with ptosis. There is labia majora laxity and deflation. The above history and findings were discussed in detail along with all surgical and nonsurgical options. She proceeded to schedule in-office aesthetic vulvar surgery with Dr. Aguirre performing Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction and Clitoropexy with PRP (Platelet Rich Plasma) to surgical site, as well as Labia Majora Reduction. She was also found to be an excellent candidate for an O-Shot which will be performed in the future. Upon returning for her regularly scheduled postop appointments, she was found to have healed great.