50 yo woman from Bailey, Colorado with a greater than 10-year history of undesired cosmetic appearance of her vulva, located the office of Master Cosmetic Surgeon and Board Certified, Fellowship-Trained Urogynecologist Dr. Oscar A. Aguirre of Parker, Colorado through an internet search. She states she has always had large labia, but her excess skin on her perineum has increased in size over the years. This now will pull and drag during sex and cause significant pain. Over the past 3-5 years, she has noticed an increase in the size of her labia and is interested in aesthetic vulvar surgery. Dr. Aguirre performed a thorough pelvic examination with a chaperone present, which revealed excess vulvar skin. There is excess perineal skin, right side greater than left. These is also bilateral labial hypertrophy with hyperpigmentation. There is a bump on her anterior right labia and mid left labia. There is a large ptotic prepuce and anal skin tag, Inspection of the general vulva also reveals a very large mons and labia majora laxity and deflation. All history and findings were discussed in detail with the patient, along with her surgical and nonsurgical options. She was found to be an excellent candidate for in-office aesthetic vulvar surgery and had a strong desire for a full intimate makeover. Dr. Aguirre recommended dividing her procedures into two. The first procedure consisting of Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction with Clitoropexy, Excision of Excess Perineal Skin, and Excision of Anal Skin Tag. The second procedure in the future would be Liposculpture of the Mons with Labia Majora Reduction. She was eager to get the initial recommended procedure scheduled and with Dr. Aguirre. She returned for her regularly scheduled postop appointments, very happy with her results. She will return in the coming months to proceed with scheduling the second phase.