61 yo mother of three from Boulder, Colorado located the office of Urogynecologist and cosmetic surgeon, Dr. Oscar Aguirre through an ad in a magazine. Three years ago she noticed severe labial looseness and has since been interested in plastic surgery to tighten the labia. Upon consultation she reports being bothered by pelvic pressure and a palpable vaginal bulge as well as obstructive defecation symptoms of which she felt was normal. She is very self-conscious about the appearance of her vulva as well as the openness of her vagina. She feels that she could be made smaller. Dr. Aguirre performed a thorough pelvic exam which revealed severe deflation and laxity of her Labia Majora as well as uterine and vaginal prolapse and the presence of bothersome anal tags. After discussing all surgical and non-surgical options and the primary concern of the appearance of her vulva and gaping introitus, she decided to proceed with definitive surgical therapy. Dr. Aguirre performed Labia Majora reduction and Vaginoplasty to improve the aesthetic appearance of her vulva and vaginal introitus as well as reconstructive pelvic surgery in the form of Total Vaginal Hysterectomy, Anterior and Posterior Repair and Anal Tag Excision. She returned to the office for regularly scheduled postop exams with excellent results and very pleased with her vaginal function and appearance.