49 yo mother of two from Morrison, Colorado with a 23 year history of undesired cosmetic appearance of her vulva located the office of renowned Cosmetic Surgeon and Board Certified, Fellowship-Trained Urogynecologist Dr. Oscar Aguirre of Denver, Colorado from an internet search on Labiaplasty. Since her second vaginal delivery she has noticed changes to her vulva that have progressed. She has been bothered by decreased vaginal sensation, which has worsened and worsening labia minor asymmetry, darkness and laxity, contributing to her being very self-conscious and inability to relax during sex. This has affected her ability to enjoy intercourse and have orgasms which she reports faking her orgasms twenty percent of the time. This has become very bothersome to her since she never used to have these issues. Dr. Aguirre performed a thorough pelvic examination which revealed changes consistent with an aging vulva. There is labia majora laxity and deflation as well as labia minora asymmetry, hypertrophy and hyperpigmentation. There is redundant lateral prepuce on the left with ptosis, excess perineal skin and three anal tags. Internal vaginal exam revealed slightly enlarged introitus and poor lubrication present. Following examination she and Dr. Aguirre discussed, in detail, all surgical and non-surgical options. She was found to be an excellent candidate for an in-office aesthetic vulvar surgery. Dr. Aguirre discussed a labia majora puff versus labia majora reduction, which she chose to proceed with the more conservative route with regards to her majora. She decided to proceed with surgery and scheduled a Laser Reduction Labiaplasty of Labia Minora, Clitoral Hood Reduction with PRP to surgical wounds, and Excision of Excess Perineal Skin and Anal Skin Tags. She was also treated with non-surgical Labia Majora Puff, Laser Vaginal Resurfacing with FemiLift and Radiofrequency Introital Tightening with Viveve. She returned to the office for her regularly scheduled postop visits, healing nicely and very pleased with the results.