48 yo mother of two from Aurora, Colorado with a 10 year history of undesired cosmetic appearance of her vulva located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Parker, Colorado through an on-line search. She has a history of morbid obesity and after a significant weight loss she has noticed labia majora laxity, deflation and persistent enlarged labia minora. She presents for aesthetic vulvar surgery consultation. Upon further questioning, she is also bothered by a 5-year history of urinary incontinence which started as stress incontinence but developed into urinary urgency. She is also bothered by vaginal dryness and has required lubricant for the past 3 years. Pelvic examination performed with a chaperone present and patient observing with a handheld mirror revealed bilateral labial hypertrophy with hyperpigmentation and redundant lateral prepuce. There is also labia majora deflation and laxity with 3 anal skin tags present. After discussing all surgical and non-surgical options with Dr. Aguirre, she was eager to move forward with in-office aesthetic vulvar surgery. Dr. Aguirre performed Labia Majora Reduction, Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction, and Excision of Anal Skin Tags. In addressing her vaginal dryness and incontinence issues, Dr. Aguirre recommended the FemiLift and O-Shot which she decided to address in the future. She did return for her regularly scheduled postop appointments, very happy with her surgical results.