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Objectives: This study aims to assess the effectiveness and safety of combining labia minora reduction with the ice-hockey stick excision, posterior vaginoplasty through muscular plication, and autologous fat grafting to the labia majora in a single operative session. Outcomes were evaluated using FSFI and VAS scores. The study also highlights that the demand for such procedures varies among women of different ages and is not confined to the postpartum period. Introduction: Changes in genital anatomy following childbirth—such as vaginal laxity, labial volume loss, and reduced sexual satisfaction—are frequently reported concerns. These alterations can compromise both functional outcomes and psychological well-being, with significant effects on body image and intimacy. While labia minora reduction and posterior vaginoplasty are established techniques, the addition of autologous fat grafting to the labia majora offers the potential to restore volume and contour. This study evaluates the outcomes of performing all three procedures in a single surgical session, focus Materials / method: rom April 2022 to March 2024, 34 women—most of whom had a history of vaginal delivery—underwent combined genital aesthetic surgery. Labia minora reduction was performed with an ice-hockey stick excision design, posterior vaginoplasty was carried out using muscular plication without mucosal excision, and autologous fat grafting was applied bilaterally to the labia majora. Fat was harvested from the lower abdomen using gentle liposuction, processed by gravity sedimentation, and reinjected through a multilayer microdroplet technique. Patients were evaluated preoperatively and at 3- and 12-month Results: Mean FSFI scores increased from 20.4 ± 3.9 preoperatively to 26.2 ± 3.5 at 3 months and 28.0 ± 3.2 at 12 months (p < 0.01). VAS scores improved from 4.3 ± 1.1 before surgery to 8.5 ± 1.2 at 3 months and 9.1 ± 0.9 at 12 months. The most notable gains were observed in the domains of sexual satisfaction and vaginal lubrication. Complications were rare: a single patient (2.9%) developed a minor wound dehiscence at the labia minora suture line, which healed without intervention. No adverse outcomes related to fat grafting were reported. Conclusion: A combined approach incorporating labia minora reduction with the ice-hockey stick technique, posterior vaginoplasty, and labia majora fat grafting provides a safe and effective single-stage solution for women seeking both aesthetic and functional genital enhancement. In addition to anatomical restoration, fat grafting to the labia majora contributes to improved contour, body image, and sexual confidence. These encouraging results support the integration of this triple-modality strategy, though larger multicenter studies are needed to confirm its long-term benefits.