Cosmetic Gynecology Surgery is becoming more popular in Thailand now, and it is important that the doctor would make the patient understand the advantages and the disadvantages of the surgery. A doctor does not only desire the benefits of the business but also considers the safety of the patient. This is the objective of Dr. Vitasna Ketglang, Head of the Cosmetic Gynecology Center and the President of the Thai Cosmetic Gynecology Society, who upholds this good doctor’s principle.
The Beginning of Interest in Cosmetic Gynecology Surgery
- “When I was a medical student, I was more interested in improving my surgical skills. I thought that Obstetrics and Gynecology is the field that I like. It is a science that does not have much difference with General Surgery combined with Internal Medicine.
- After I graduated, I paid out my scholarship by working in a hospital in the province. That was my chance to train with a General surgeon who was the Director of the Hospital in the province. I practiced doing the Caesarean Section procedures and accumulated experience. Then I worked in a private hospital for 1 year.
- During that time, Yanhee International hospital was founded and was popular for Plastic Surgery and there was only one male doctor in the Obstetrics and Gynecology Department. The hospital needed one female doctor and Dr. Supot Sumritvanitcha gave me the chance to work with Yanhee International Hospital.
Focusing on Work and Care of details
- When I started to work with Yanhee International Hospital, I worked for both the Obstetrics and Gynecology, and Cosmetic Gynecology departments. This included doing Caesarean Section surgeries, Hysterectomy, Labiaplasty, Uterine Prolapse, and Vaginal Repair.
- Three years later, there was an increase in the number of patients. There were many cases presenting to the hospital, and the results may not be completely satisfactory. However I wanted to pay attention to each case and provide the best procedures for surgery so I decided to do only Cosmetic Gynecology and did not accept Caesarean Section procedure as I did not want to hurry and pressure myself. In some cases I may be called upon to perform surgeries that include prenatal care, cancer checking, ectopic Pregnancy surgery, and tumor removal.
- Ten years later, the number of cases in Cosmetic Gynecology has increased greatly. Mostly Cosmetic Gynecologic Surgery, including both Labiaplasty and Vaginal Surgery. One of my teachers once said that, “ If one doctor has 2 Anterior-Posterior Vaginal Repair cases a month, 24 cases per year, 240 cases for ten years, that would already mean a lot. But in 6 years, I had 900 Anterior-Posterior Vaginal Repair cases for pelvic relaxation and with other cases I had a combined almost 10,000 cases. I have worked 14-15 years until now. I would like to thank the patients who honor me and the hospital. I have not been born with fame. I got the chance to work and progress here until I have had the chance to open the Cosmetic Gynecology Center to provide a service earnestly to patients.”
Certified by Laser Vaginal Rejuvenation (LVR®) Institute of America
- “We all know that Cosmetic Gynecology surgery in Thailand is ongoing for a long time. In other foreign countries, the procedure grows and new technologies are introduced. The reputation of the hospital and the specialist is not enough.
- We should bring new technology and upgrade. We should also learn new techniques to help patients and perform surgery safely. Yanhee International Hospital sent me to learn with the Master of Vaginal Repair, Dr. David Matlock. United States of America (USA) has new and better technology. I acquired many techniques especially with Laser Vaginal Rejuvenation (LVR ®) technique.”
Challenges with What Women Want
- I would say that challenges in the past years are different from now. The last 10 years, I have to try to make the patient accept to undergo the surgery without being afraid of the side effects or complications. She has to understand that after the surgery, gauze isn’t applied on the wound so she will have bleeding, and she will have difficulty in walking and urination. I have to make the patient understand very carefully. But now, the challenge is how to improve my skills to prevent postoperative complications. In my many experiences I understand that I cannot control patients to avoid the pressure on the surgical area, coughing, or sneezing after the surgery. On the other hand, I have to suture carefully and improve my suturing skills.
Dr. Vitasna as Guru of Aesthetic Gynecology
- I have heard this statement before, but I do not think that I am a Guru. I cannot be a doctor without the many teachers who taught me and I still cannot say that I am a Guru. Thank you, I am honored. I especially thank my Guru Dr. Supot Sumritvanitcha who stays in the 14th floor, the Chief Executive Officer (CEO) of Yanhee International Hospital, who believes in me and has given me the chance to be where I am today.
Method, Standpoint, Slogan which you follow
- Every time I am working, I always plan. If a patient comes for consultation, I think of what to do with the case. I also review every case even after surgery. I do the surgery with refinement, I pay attention to every detail, and I do it professionally, and consider every patient as family. Now I am 50 years old, my dream is to be stable and be a good doctor, not only focusing on business.
Most frequently, tears in the support structures and muscles of the perineum, the vaginal opening and in the entire length of the vagina is caused by childbirth. Some of the most common causes include stretching of the vaginal wall, perineum tear, diminished/absence of vaginal ridges and aging. It can make the vagina feel looser, causes urinary incontinence, lack of sensation in the vagina, and pain during sexual intercourse. These can bring about psychological issues, loss of self-esteem/self-confidence, and loss of sexual pleasure.
Dr. Vitasna has been taught by Prof. Adam Ostrzenski techniques in vaginal reconstruction procedures called:
Childbirth, hormones, as well as sex, can cause the smoothing of the vaginal wall and the stretching of the vaginal rugae. These circumstances may contribute to a diminished sexual pleasure and vaginal looseness.
- 1) Site Specific Defect Reconstruction (SSDR) are procedures that aim to repair or fix specific damage in the vaginal structure, whither from the perineum, the vaginal opening, the upper (anterior) or lower (posterior) part of the vagina or on both sides – which causes “The Wide Vagina”. The procedure is done to reconstruct the vaginal muscles and the perineum muscles to improve and regain the function of the structures.
- 2) Vaginal Rugae Rejuvenation (VRR), the presence of rugae, is important in determining how much sensation a woman and her partner can feel during sexual intercourse. Vaginal Rugae Rejuvenation (VRR) can help tighten the vagina and restore the vaginal ridges/rugae. The ridges are responsible for increased friction during sexual intercourse. Thus, Vaginal Rugae Rejuvenation (VRR) results in restoration of sensation and sexual pleasure to both partners.
In conjunction with Site Specific Defect Reconstruction (SSDR), Vaginal Rugae Rejuvenation (VRR), is at times, done after Site Specific Defect Reconstruction (SSDR) procedures. Women need an adequately trained surgeon who can do excellent vaginal reconstruction techniques. Dr. Vitasna offers these minimally invasive procedures to help resolve the “wide vagina” for the enhancement of sexual pleasure for both partners. The overall result will be that women will be happier about themselves again.
Prof. Adam Ostrzenski, M.D., Ph.D., Dr. Hab; is an internationally known gynecologic surgeon, speaker, professor and researcher from Florida, USA. He has received national and international awards and accolades for his contribution in the advancement of women’s health and developing new cosmetic/ reconstructive surgeries for the female genitalia.
Excerpted from Dr. Ostrzenski’s Advanced Gynecology Workshop, January 26 -29, 2012, St. Petersburg, Florida, USA.
A pose after receiving our certificates from Prof. Adam Ostrzenski
at the Bay Medical Center, St. Peterburg, Florida, United States of America
Through the centuries, many attempts have been made to establish the anatomic existence, location, and size of the G spot. It became one of the most intellectually-stimulating topics on the female sexual expression field. There is indirect scientific data, which strongly support the physical presence of the G-spot. A very thoughtful scientific contribution to the challenging dilemma of the G-spot existence was the fact that the stimulation of the G-spot resulted in an approximately 50% swelling of the anterior distal vaginal wall and provided high levels of sexual arousal with a powerful orgasm.
- The G spot gene has been identified and has been already incorporated into the Affymetrix GeneChip (microarrays of probes to match specified genes). The vaginal electric activities (the electrovaginogram) documented that a pacemaker was positioned to exist at the upper vagina evoking electric waves, which could be recorded.
- This finding suggested that the vaginal pacemaker seemed to represent the G-spot, which women reported as a small area of erotic sensitivity in the vagina. The ultrasonographic study postulated that clitoral bodies have a descending movement and come close to the distal (upper) anterior vaginal wall. This happens during a voluntary contraction and relaxation of the pelvic floor muscles, and the anterior vaginal area demonstrates the particular sensitivity to stimulation corresponding to the G-spot location.
- Professor Ostrzenski concluded that the anterior vaginal wall, up to the pubocervical fascia, most likely would not contain the G-spot and hypothesized that the G-spot maybe located deeper. Since it has been documented that stimulation of the anterior vaginal causes the vaginal wall to swell, Dr. Ostrzenski determined that this structure must consist of erectile tissues, which causes the anterior vaginal wall to swell.
- Therefore, to test this hypothesis, the objective was established to dissect the anterior vaginal wall layer-by-layer. This was done to potentially identify the existence of the anatomic G-spot by exploring the space between the inferior surface of the pubocervical fascia and superior surface of the dorsal perineal membrane.
- Recently, Professor Ostrzenski’s anatomic study documented that the G-spot creates a 350 angle between the urethra with the lower pole being positioned 3 mm from the urethra, and the upper pole being situated 15 mm from the urethra with the length of 8.1 mm. The G-spot is located much more deeply than it was previously postulated. It is a well-defined and uniform structure within a sack and the G-spot appeared to be erectile tissue.
Excerpted from Prof. Adam Ostrzenski, Advanced Gynecology Workshop, January 26 – 29, 2012, St. Petersburg, Florida, USA. For Further Reading: G Spot Augmentation
Prof. Ostrzenski doing the traditional Thailand greetings, Sawadee “the wai” .
A pose after receiving our certificates from Prof. Adam Ostrzenski, M.D., Ph.d., DrHab
at the Bay Medical Center, St. Peterburg, Florida, United States of America.
Professor Ostrzenski defines clitoral hoodoplasty, or better known as Clitoral Hood Reduction, as a surgical intervention which transforms the Clitoral Prepuce to more pleasing appearance with preservation of function. For more information on this procedure (including post-operative care information), please visit the Clitoral Hood Reduction page of this website.
The Clitoral Prepuce is the visible skin fold over the clitoris, which is known as the Clitoral Hood. There are two distinct types of Clitoral Hoodoplasty:
1) Reductive Clitoral Hoodoplasty
2) Restorative Clitoral Hoodoplasty
The Reductive Hoodoplasty is a surgical intervention aimed to decrease the excessive length of the Clitoral Prepuce tissue or to reduce the uneven thickness of the Clitoral Hood.
- Ostrzenski’s modification of hydrodissection with reverse V-plasty is used to reduce the excessive and overlapping Clitoral Hood.
- The hydrodissection with reverse V-plasty is used to split the adhesions between the inner surface of the Clitoral Prepuce and Clitoris.
- The extra Prepuce tissues removed during the reverse V-plasty hide the suture lines. This procedure can liberate the Clitoris so you can have a better sexual experience for you and your partner.
The Restorative Hoodoplasty procedure is performed to restore the damaged opening of the Clitoral Hood, which usually is due to skin conditions etc., and repair the lost Prepuce without causing permanent nerve injuries.
- By using sterile saline, the Hood can be separated from the Clitoral adhesions.
- Opening the partially or completely closed Clitoral Hood is done to expose the tip of the Clitoral Hood.
- This technique prevents complications of Clitoral numbness. The direct use of metallic instruments on the Clitoris is associated with Clitoral numbness.
Professor Ostrzenski conducted the clinical study between 2006 and 2010, which assisted him to develop a new Clitoral Hoodoplasty classification and new surgical procedures. This classification is very useful for women and doctors to select the appropriate procedure.
Clitoral Hood characteristics were used to establish a new classification:
- 1) Occluded Clitoral Hood (the Clitoral Hood opening is partially or completely closed with the Clitoris buried under the skin)
- 2) Hypertrophic-Gaping Clitoral Hood (the Clitoris foreskin can be elongated, too thick, or both)
- 3) Asymmetrical Subdermal Hypertrophy (uneven thickness of the Clitoral Hood)
Each category of clitoral characteristics will require a different surgical intervention. Dr. Ostrzenski emphasized that a “one-fit-all” procedure could not be offered to all women who requested Clitoral Hoodoplasty.
Dr. Ostrzenski based upon this classification has developed the following surgical interventions for Clitoral Hoodoplasty:
- Hydrodissection was applicable for the occluded Clitoral Prepuce
- Modified Hydrodissection with Reverse V-plasty was applicable for Hypertrophic-Gaping Clitoral Hood.
- Clitoral Subepithelial Hoodoplasty was applicable for Asymmetrical Subdermal Hypertrophy (uneven thickness).
Excerpted from Dr. Ostrzenski’s Advanced Gynecology Workshop, January 26 -29, 2012, St. Petersburg, Florida, USA.