57 yo woman from Denver, Colorado located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Parker, Colorado while searching the internet on Labiaplasty. She has been bothered by her long labia minora since the age of 11. She recalls being in 6th grade and mentioning to her mother of her unhappiness with her labia. Her whole life she has had to rearrange her labia, and lately she has noticed increasing discomfort with clothing and more noticeable appearance with form-fitting clothing. She feels that her labia get in the way. She has also noticed a skin tag in front of her anus and also anal skin tags that are bothersome. With aging, she has noticed flattening of her labia majora and droopiness. Dr. Aguirre performed a thorough pelvic examination with a chaperone present, which revealed an aging vulva. There is significant ptosis of her large hood and labia minora. There is redundant lateral prepuce as well as excess prepuce as well as bilateral labial hypertrophy with hyperpigmentation. There is also labia majora deflation with laxity. Inspection of the perineum reveals a perineal skin tag as well as 3 large anal skin tags. Examination was performed with the patient observing with a handheld mirror. All findings, as well as surgical and non-surgical options, were discussed in detail with the patient. There was a discussion of a more conservative approach as in doing labia majora augmentation; however, with her standing facing forward and from behind position, there is a significant amount of excess labia majora skin, laxity and deflation. Therefore Dr. Aguirre recommended Labia Majora Reduction at the time of Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction with Clitoropexy with PRP (Platelet Rich Plasma) to surgical wounds as well as Excision of Perineal and Anal Skin Tags. She was excited to proceed with the recommended procedures. Dr. Aguirre performed the surgery in an in-office surgical setting. She returned to the office for her regularly scheduled postop visits, very pleased with her new look. She stated she was grateful and when she looks at her vulva, she has much more confidence with how beautiful it looks.