49 yo mother of three from Westminster, Colorado located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar A. Aguirre through an internet search on Vaginal Looseness and Labiaplasty. She has a greater than 10 year history of vaginal looseness that she noticed following her third vaginal delivery. This has progressed significantly overtime for which she did try a Viveve treatment which she states did not help with her looseness but did reduce her mild stress incontinence. She performs Kegel exercises which have also helped with her stress incontinence, but not with her sexual dysfunction. She is also bothered by her large, dark, and drooping labia minora, which makes her very self-conscious with intimacy. Dr. Aguirre performed a thorough pelvic examination with a chaperone present, which was significant for a parous-appearing perineum with an enlarged genital hiatus and decreased size perineal body. Exam also revealed she performs an excellent pelvic floor contraction proximally; however, distally there are torn pelvic floor muscles. There is bilateral labial hypertrophy with hyperpigmentation, a large ptotic prepuce, excess perineal skin, and multiple anal skin tags. Her history and findings, along with all surgical and non-surgical options, were all discussed in detail with the patient and her husband, whom was present at the appointment. She decided to proceed with definitive surgical therapy to address both her vaginal laxity and labial hypertrophy. Patient was scheduled for outpatient surgery at Milestone Surgery Center. Dr. Aguirre performed a Vaginoplasty to address the vaginal looseness as well as Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction, Clitoropexy with PRP and Excision of Anal Skin Tags to address her aesthetic concerns. She returned to the office for her regularly scheduled postop appointments very pleased with her excellent results.