36 yo mother of one from Cheyenne, Wyoming with a greater than 20-year history of undesired cosmetic appearance of her vulva located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar A. Aguirre through a RealSelf search on Labial Hypertrophy. Since going through puberty she has been bothered by her large dark labia minora, which have become progressively larger, darker, and longer. She is married and has experienced difficulties with sex due to labia dragging and pulling. Wearing form-fitted clothing is also bothersome to her. Since her delivery she has noticed some micro tearing at her perineum to which her gynecologist prescribed a steroid ointment that has not been helpful. Dr. Aguirre reviewed photos she sent in electronically and discussed, via Virtual Consultation, findings of bilateral labial hypertrophy with hyperpigmentation, as well as redundant lateral prepuce with ptosis and multiple anal skin tags. All surgical and non-surgical options were discussed in detail. Dr. Aguirre recommended in-office aesthetic vulvar surgery consisting of Laser Reduction Labiaplasty of Labia Minora, Clitoral Hood Reduction with Clitoropexy, and Excision of Multiple Anal Skin Tags. Patient arrived at the office where Dr. Aguirre completed an in-person pelvic examination to confirm all findings prior to taking patient to the procedure room where all recommended procedures were performed. She returned to the office for her regularly scheduled postop appointments, very happy with nice symmetry and overall excellent results.