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Objectives: To present the multiple uses of HA in two different concentrations (20 and 25 mg/ml) at the level of the genital area with different application techniques applied at different layers in the genital tissues either vulval skin and vaginal mucosa.

Introduction: To demonstrate if the application of hyaluronic acid in the vulva and vagina can improve both labia majora deflation and sexual quality of life.

Materials / method: Ten patients, with labia majora deflation and sagging skin, underwent a treatment that consisted of a single application of injectable hyaluronic acid of 25 mg/ml, administered through a 25G cannula beneath the dartos and deep in the dermis with 27 G needle of both labia majora (a dual approach) Injectable lidocaine 2%, only in the skin and numbing cream was used. In the same way, 40 patients under menopause, suffering from GSM were treated with HA of 20 mg/ml in the vaginal canal.

Results: A significant objective aesthetic improvement of the sagging skin and labia majora deflation was observed in all patients, post-treatment, in all follow up. Subjectively, VAS showed that all treated patients were satisfied with the final outcome achieved. Pictures of before-and-after, as well as the evaluation of patient’s satisfaction with the Visual Analogue Scale (VAS), were done in the follow-up: immediately, and at one and at three months. VMI results indicated that 67.50% of the volunteers showed a statistically significant improvement (p=0.0459). VHI results demonstrated a statistically

Conclusion: Our results show that the use of a single injectable application of hyaluronic acid in the vulva and vagina, effectively improves both labia majora deflation and sexual quality of life, giving to the vulva a younger appearance and achieving optimal patient sexual satisfaction.

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Objectives: LA PIGMENTACION VULVAR SE HA CONVERTIDO EN LA ACTUALIDAD UNA PETICION DE LAS PACIENTES CADA VEZ MAS FRECUENTE , POR LO CUAL LOS PROFESIONALES DE LA SALUD ( MEDICOS GINECOLOGOS - DERMATOLOGOS ) NOS COMPETE DAR SOLUCION A ESTA NUEVA DISCONFORMIDAD DEL AREA INTIMA.

Introduction: CON EL ADVENIMIENTO DE LA DEPILACION CORPORAL Y EN SU CASO MAS PARTICULAR LA DEL AREA VULVAR, LA PIGMENTACION GENITAL ES MAS EVIDENTE, LO QUE A UN GRUPO DE PACIENTES LES CAUSA DISCONFORMIDAD Y PIDEN SOLUCION A ESTO, POR LO CUAL SE PROPONE UN METODO COMBINADO PARA LOGRAR MEJORAR ESTA PETICION .

Materials / method: SE PRESENTA COMO SE REALIZO UNA CLASIFICACION CUTANEO GENITAL, POST COMO SE ESCOJE EL TRATAMIENTO TOPICO PARA LA DESPIGMENTACION VULVAR CON TRATAMIENTOS EN CREMAS Y FINALMENTE COMO LOS LASERES Y EAD, NOS DAN UN EXTRA PARA LOGAR LOS MEJORES RESULTADOS POSIBLES.

Results: SE PERESENTAN LOS ANTES Y DESPUES DE LA TERAPIA TOPICA Y LASER COMBINADA , DONDE VEMOS MUCHOS CAMBIOS Y MEJORIAS OPTIMAS PARA LA DESPIGMENTACION VULVAR.

Conclusion: LA COMBINACION DE LA TERAPIA TOPICA Y LASER SON UNA MUY BUENA OPCION EN LA DESPIGMENTACION VULVAR, CON EFECTOS ADVERSOS CASI NULOS.

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Objectives: OBJECTIVES:
We recently did publish the article "PDO threads, calcium hydroxyapatite, and l-polylactic acid for vulvar flaccidity - indications, technique and results", in the indexed scientific journal Surgical and Cosmetic Dermatology. (https://doi.org/10.5935/scd1984-8773.2023150192)

Our objective is to share with medical colleagues the excellent results we have obtained with the use of collagen biostimulators in female genital aesthetics.

Introduction: INTRODUCTION:
Aging brings loss of fat and collagen from the labia majora (LM), making them flaccid. Although volumetric loss is intrinsically associated with such looseness, as it is a pending area, filling with hyaluronic acid (HA) can increasing the fall of the tissues already hanging.

We have been treating LM laxity with excessive skin sagging through the application of injectable collagen biostimulators (BT). We did use pdo threads (PDO), calcium hydroxyapatite (CaHA) and l-polylactic acid (PLLA) and we have achieved excellent results.

Materials / method: MATERIALS/METHOD
Since 2019, 20 women, between 30 and 60 years were treated. Only flaccid and pending L.M were addressed, as shown below:
- Bulky LM, which should not receive any additional volume, were treated with PDO;
- LM who needed minimal initial volumization were treated with CaHA;
- when it was desired to treat the entire genital area, involving LM and pubic mound, PLLA was chosen.
The three products were inserted into the subcutaneous tissue.

Results: METHOD
The three products were inserted into the subcutaneous tissue. CaHA and PLLA injections were performed in a fan technique, by retroinjection, with cannula 22G, 5cm.
01 syringe of 1.5ml of gel with 30% CaHA was diluted in 6ml saline, and 3,0ml was injected into the subcutaneous tissue of each LM.
01 vial with 150mg of PLLA was diluted in 16ml of distilled water and 4ml of lidocaine, with 5ml of the solution being injected into each LM and 10ml in pubic mound.
5 PDO screw threads (29G 52mm) were injected in the upper 1/3 and 5 monofilament PDO (30G 50mm) in the lower 2/3 of each LM.

Conclusion: RESULTS
Although all patients were satisfied, we observed a higher degree of satisfaction among CaHA group, probably due to its immediate volumizing effect.
There was no one complication with PLLA. We have one infection solved with oral antibiotic and 1 PDO extrusion with threads and just one small palpable non visible nodule with CaHA.

CONCLUSION
The application of BT, especially CaHA, can be an excellent method for the treatment of vulvar sagging. Patient expectations need to be adequate, since BT induce collagen production in such a way that results become noticable not before one month.

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