Key Factors of Cosmetic Gynecology is dependent on 2 factors.

By Dr. Vitasna Ketglang

The First factor–The Physician

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1.) The physician has to be educated about the surgical techniques and the surgical materials used.

1.1) About the surgical techniques.
  •   bullet_tickFor example– for Vaginoplasty surgery, foreign women who have to return to their countries within 5 days after the operation may need a special suture technique (s) to avoid postoperative wound disruption.
1.2) The surgical materials used.
  • bullet_tickTo avoid wound disruption–you need a special absorbable suture material–the suture materials must be absorbable to become decayed after complete healing to avoid postoperative wound disruption. This can lead to serious complications such as excessive bleeding from the surgical wound.

2) The physician has to be educated about the appropriate pre-operative antibiotics and post-operative antibiotics.

  • bullet_tick You are more likely to get infection from cosmetic gynecological wounds than the surgical wounds in other body areas. This is due to these procedures being near the urinary tract and alimentary (fecal) tract. This leaves it at risk of complications such as bacterial infection.
  • bullet_tickTo prevent the wounds infection, from all kinds of cosmetic gynecologic surgeries, a proper regimen of antibiotics for preoperative prophylaxis of infection should be followed. For prophylaxis in surgery, only antibiotics with good tolerability should be used. Cephalosporins remain the preferred drugs for preoperative prophylaxis due to their low toxicity.

 3) The physician has to educate the patient with pre & post operative care instructions, risk & complications, and a consent form.

3.1) Accurate, clear, and proper post-operative instructions.

Accurate, clear, and proper post-operative instructions will be given in order to avoid postoperative complications.

  • bullet_tickWithin 3-5 days after the surgery, take a rest (refrain from work), be still and avoid constipation. This will enable the wound to heal faster.
  • bullet_tickHave little movement as possible to avoid wound disruption for 1-2 weeks after the surgery.
  • bullet_tickYou should refrain from swimming in the pool, some types of exercise affecting pelvic muscle movement, and sexual intercourse for 6 weeks after the surgery.
3.2) Most common risks & complications for Cosmetic Gynecology Surgery. 
  • bullet_tick1) Bruising
  • bullet_tick2) Abnormal bleeding
  • bullet_tick3) Infection of the wound
  • bullet_tick4) Poor healing of  the wound
  • bullet_tick5) Unsatisfactory results of surgery such as asymmetry, the need for a revision, and a change in sensation
3.3) Preoperative agreement (patient consent form).
  • bullet_tickInformed consent is very important to protect the patient and the surgeon also. It must be signed before any surgical procedure is performed.
  • bullet_tickIt is important for patients to fully understand the procedure.

4) The physician must be open-minded, honest, and responsible with the surgical procedures.

  • bullet_tickThe physician should deal honestly and openly with patients and inform them of all the necessary facts to ensure that they understand all the processes of the procedure.
  • bullet_tickIn case of unexpected surgical results or complications, corrective surgery is an option and will be discussed between the physician and the patient.
  • bullet_tickThe surgeon has to be open minded to others’ opinions, embracing new techniques and the constant changes to modern technologies, weighing the best options to the good of the patients.

The Second factor–The Patient

1) Patient selection.

Here are some points in selecting a potential patient.
1.1) The primary vulvovaginal structures of the patient.
  • bullet_tick Cosmetic Gynecological procedures have limitations and cannot absolutely ensure results and satisfaction. For example: For Labia Minora Reduction surgery, the procedure may result to incomplete symmetrical of the Labia Minora or non-proportional Labia Minora depending on patient’s former anatomical structure of Labia Minora.
1.2) Any existing disease.
  • bullet_tickAny existing disease such as DM, Heart disease, Anemia, Renal disease etc, affecting the healing process, beyond the control by the physician.
1.3) Aging of the patient.
  • bullet_tickAging of the patient should not be too young which could affect the postoperative protocols to avoid postoperative complication.
  • bullet_tickAging of the patient should not be too old as to not affect the rate and success of the healing process.

2) Post operative manners of the patient.

One of the most important things associated with the patient, beyond the control of the physician, is ‘POST-OPERATIVE MANNERS’. As the cosmetic gynecology surgical wound is inside the vagina and around the vulvar area, it may get contaminated with vaginal secretion or vaginal fluid. This consequently leads to a longer healing process than  surgical wounds in other body areas.

2.1) Surgical wounds of the Cosmetic Gynecology Surgery.
  • bullet_tickIt is the contaminated surgical wound which is more likely to get infection, than surgical wounds in other body areas. At home, you have to completely take antibiotic to avoid postoperative infection.
2.2) For the Cosmetic Gynecology Surgery.
  • bullet_tickIn the first week after the surgery, you should try to avoid moisture around the surgical wound to let it heal faster. Cleaning the surgical wound after urinary excretion may be done with sanitary wipes, and after fecal excretion done using water and gentle toweling.
2.3) For the Labiaplasty Surgery.
  • bullet_tickThe surgical wound should be cleaned with antiseptic after a bath in the morning and before bedtime. Afterwards it should be dried with a warm dryer for 10-15 minutes or until completely dried. This should be repeated for 1-2 weeks after the surgery.
2.4) For the Cosmetic Vaginal Surgery.
  • bullet_tickAfter surgery, you should take a rest (refraining from work) and be still for at least 2-3 days after the procedure to enable the wound to heal faster.
  • bullet_tickAvoid constipation to reduce pressure on the vaginal wall. Have little movement as possible in the first 1-2 weeks after the procedure to avoid wound disruption.
  • bullet_tickRefrain from some types of exercise affecting pelvic muscle movement such as; speed running, yoga, swimming, sit-ups, weight training involving lower body parts, and sexual intercourse for 6 weeks after the procedure.

Therefore, please be informed that despite an excellent surgery by the best physician, it is of no use in case of the complications resulting from infection. You should cooperate and adhere strictly to the post operative instructions.

3) The Patient’s realistic expectations should be discussed before undergoing surgery.

  • bullet_tickAn optimal Cosmetic Gynecology Surgery candidate will understand not only what Cosmetic Gynecology Surgery can accomplish, but also the limitations of the procedure. After all these have been assessed and considered, then a decision for surgery may be made.

The key factors affecting the success of Cosmetic Gynecology Surgery include both the physician and the patient. They are equally important in the success of Cosmetic Gynecology practice and helped me get through the surgeries, avoiding complications.