56 yo mother of one from Santa Fe, New Mexico located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado through an on-line Real Self search. She is a woman with a long history of undesired cosmetic appearance of her vulva as well as difficulties with achieving orgasm. She is interested in vaginal rejuvenation options to improve the appearance of her vulva. She states she is looking to reduce her hood and make her vagina overall tighter. She is also looking to improve sex. A virtual consultation was arranged and photos she had submitted to Dr. Aguirre, where reviewed with her. During this initial consultation with Dr. Aguirre she relayed wanting to improve her sexual relations and make orgasms easier to achieve. She has noticed improved lubrication and orgasms with testosterone, but still struggles. She is also interested in a much more youthful appearance. Review of photos revealed clitoromegaly due to testosterone. The patient was aware of this being the cause. She was noted to have a large hood, large irregular labia and lax and deflated labia majora. Dr. Aguirre discussed in detail with the patient, all history and findings along with his recommendations for in-office aesthetic vulvar surgery. She decided to move forward with definitive surgical therapy and arrived in Colorado the day before surgery for a preoperative surgical consultation and confirming examination. She proceeded with the surgical procedure recommended. Dr. Aguirre performed Laser Reduction Labiaplasty of the Labia Minora, Labia Majora Reduction and Excision of Excess Perineal Skin Dr. Aguirre also felt she would benefit greatly from laser vaginal resurfacing of the vagina with FemiLift CO2 Laser, an O-Shot, and introital radio-frequency tightening with Viveve. At the time of her postop appointment she opted to have the O-Shot only. She will follow-up in the future for the FemiLift and Viveve treatments. She was pleased with her results.