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For the labia minora you would benefit from a labiaplasty with hood reduction which involves trimming of the redundant tissues of those areas. But this will not 100% completely resolve the dark pigmentation. For the labia majora you could benefit from fat transfer to the outer labia to "plump" the outer labia and further hide the inner labia in the outer folds. Fillers are an option as well but you stated you wanted something more long lasting. In regards to your laxity issue the surgical route would be a vaginoplasty and the non surgical route would be some type of radio frequency tightening procedure or laser. In my practice we offer a radio frequency procedure called ThermiVA which can address all three of your issues but does not offer the same surgical results. It would be a great pre-treatment, however, before deciding to opt for something definitive such as surgery. The ThermiVa can offer tightening of the inner and outer labia, as well as the vaginal canal. At the same time it helps smooth the texture of the skin, improves sexual satisfaction for some. ThermiVa would require three in office treatments spread out a month each with maintenance at every 6 months or a year. Without a proper examination it’s hard to say if you are a vaginoplasty candidate for your laxity concern but based on the photos provided you would be a candidate for a Labiaplasty with clitoral hood reduction and some fat grafting.
Unless you would be satisfied with still possibly having loose skin the microinvasive procedures with liposuction could be an option. I cannot tell from you photos, but unless you have a scar around the belly button, you might not of had a full abdominoplasty. I general without an examination, I would lean to the TT.
Thank you for the question. Imaging is used to help guide one to a look and size that would be close to the appearance after surgery. Remember that the images are computer generated based on a series of possibilities to come up with a close approximation. That is not the same as now one's own body is going to look in the end. 10% is not very much. That is only 40 cc of a 400 cc implant or just over 2 Tablespoons in volume. I recommend you express your concerns to your surgeon.
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