28 year old woman with a lifelong history of undesired cosmetic appearance of her vulva, from Denver, Colorado located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Parker, Colorado through an on-line Real Self search. She underwent a labia majora reduction last year with a local plastic surgeon and has since been unhappy with the location of her incisions and also she has noticed thick and abnormal white scarring. She has recently noticed improvement in her results but not as ideal as she had expected. She reviewed Dr. Aguirre’s website and wishes for her incisions to be more medial and looking more like the before and after pictures on his photo gallery. Dr. Aguirre performed a thorough pelvic examination which revealed abnormal appearing labia majora. There is evidence of a prior majora reduction with the incision within the mid-line rather than in the labia minora/majora verge. There persists labia majora laxity and dog ears on the posterior aspect of her majora and there is excess perineal skin continuing towards the anus. After discussing all surgical and non-surgical options Dr. Aguirre found her best option is to repeat labia majora reduction, excising the appropriate amount of labia majora with appropriate re-approximation and to leave the incision line more medial, so as to be better hidden. He also recommended excision of excess perineal skin. She scheduled the recommended surgery to be performed by Dr. Aguirre in an in-office surgery setting. She returned to the office for her regularly scheduled postop visits, healing nicely and very happy with the results.