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    Derms take on female rejuvenation

    Three dermatologists with different perspectives weigh in on this controversial topic

    Female rejuvenation includes a range of functional and aesthetic procedures for the female genital region. Therapies are aimed at correcting and restoring the vagina’s structural form and surrounding tissues, and improving the vaginal mucosa’s hydration and elasticity, according to Bruce Katz, M.D., a proponent of these procedures, and director of JUVA Skin and Laser Center, New York, where the procedures are offered.

    It’s estimated that more than 50% of the female population over age 50 has some degree of uterine prolapse or pelvic organ prolapse.1 Almost all post-menopausal women have vaginal atrophy, dryness, and dyspareunia and other symptoms associated with menopause. An estimated 15 million women suffer from stress urinary incontinence.2 Almost all women have some degree of vaginal laxity after bearing children.

    “All of these women could potentially benefit from non-invasive vaginal rejuvenation procedures,” says Min-Wei Christine Lee, M.D., M.P.H., dermatologic surgeon and director of The Skin and Laser Treatment Institute, Walnut Creek, Calif.           

    Dr. KatzAccording to an unpublished pilot study at Dr. Katz’s institution, of the women who are getting female rejuvenation procedures, 56% are aged 50 to 59, 22% are aged 40 to 49, 11% are aged 30 to 39, and 11% are aged 20 to 29. Pointing out that 22% of the women getting the procedure are under age 40, Dr. Katz notes that it’s not just a treatment for pre- and post- menopausal women.

    “It’s often used after childbirth when tissues become stretched,” Dr. Katz says. “This can result in loss of self-confidence, reduced participation in exercise, loss of sexual interest or desire, and disturbed interpersonal relationships.”

    Dr. Katz’s laser center is equipped with 45 lasers, so adding female rejuvenation procedures to its menu was a logical decision.

    “We already used laser technology for other areas of the body, such as eliminating wrinkles and rejuvenating the face, neck, chest, and hands and are very comfortable using it,” Dr. Katz says. “We mostly treat women in our practice, performing cosmetic dermatology and cosmetic laser surgery, and this was another facet to help women make improvements functionally and aesthetically.”

    The scope of the procedures performed at JUVA Skin and Laser Center include using the Femilift™ (Alma) laser to treat tissues internally to improve atrophy, tighten vaginal skin, improve vaginal lubrication, and treat stress urinary incontinence. The ThermiVa™(Thermi) radio frequency device is used to treat tissues internally as well, and also externally for vulva laxity, tightening of vaginal tissue for aesthetic purposes, and increased hydration in the vaginal mucosa. 

    Dr. Katz says the procedure improves lubrication because it improves blood supply to the tissues. Combined with improving the elasticity of the vaginal muscles, women who have had the procedure report having intensified orgasms.

    Dr. Katz is a proponent of female rejuvenation procedures because they are minimally invasive, safe and have no downtime.

    “We can help women with these issues that in the past could only be addressed with surgery, Kegel exercises, or electric stimulation, with the latter two not helping much,” Dr. Katz says. Regarding malpractice, he doesn’t see any potential risks as there have been no significant side effects from the procedures.

    “Learning to use the Femilift™ laser is fairly easy,” Dr. Katz says. In fact, he doesn’t actually perform the procedures; rather a nurse practitioner trained in gynecology does them.

    A good fit for some dermatologists

    Dr. LeeAs a physician who had education in obstetrics and gynecology (OB/GYN) prior to switching to the dermatology specialty, Dr. Lee believes she is in an ideal position to perform female rejuvenation procedures.

    “Since the mid-2000s, there has been a noticeable need for non-invasive procedures to help with vaginal laxity,” Dr. Lee says. “The first device for tightening of the vagina canal - the Fontona Intimalase® (Clarion) became available internationally several years ago. I was the first U.S. doctor to start performing procedures with it in 2014.” She also uses Fontona Incontilase® (Clarion) which helps with stress urinary incontinence

    Prior to these laser procedures, Dr. Lee believes the surgical solutions for these problems have been unacceptable.

    “They are extremely painful, have long recovery times, and have a high risk of complications,” Dr. Lee says. “There was a great need for non-invasive and safer options for women. Even if they only had modest improvement, women suffering from these gynecologic conditions are very grateful for any improvement. I have treated hundreds of women who all experienced improvement in their gynecologic conditions with no side effects or complications.

    Another reason why Dr. Lee believes dermatologists are ideal for performing female rejuvenation procedures is because OB/GYN physicians are not comfortable with lasers and have not embraced this new area of research.

    “Many feel the use of the new lasers for gynecologic applications is outside their comfort level,” Dr. Lee says.

    In addition, dermatologists treat all parts of the skin and have traditionally been the pioneers and experts in all laser procedures applied to the skin.

    “The vaginal mucosa is a continuation of the skin — dermatologists are very experienced and adept at treating the mucocutaneous juncture, which includes oral mucosa, vaginal mucosa, and rectal mucosa,” Dr. Lee says. “Because dermatologist thought leaders also are the leading experts at dealing with lasers and complications from lasers, it was natural for laser companies to seek their advice in terms of how to assess and evaluate tissue interaction and clinical application of laser wavelengths as it applies to any skin surface, including vaginal mucosa.”

    Dr. Lee’s primary concern about any physician entering this field is that most doctors don’t understand the vast difference between the different lasers. Fotona® was the first and, so far, the only non ablative fractional Erbium laser developed for treatment of the vaginal mucosa. All other lasers have tried to copy the concept but have used more invasive modalities such as fractional CO2 or ablative fractional Erbium. Besides the Fotona Intimalase ® and Incontilase® lasers, the only non-invasive options on the market are the radio frequency devices. Dr. Lee cautions that if a dermatologist or OB/GYN wants to introduce vaginal rejuvenation to their practice, they should only consider a non-invasive option in order to minimize side effects and complications.

    Further, Dr. Lee would caution dermatologists from treating patients with uterine prolapse because they could potentially cause uterine perforation with certain lasers -  uterine perforation is not known to happen with systems such as the Fotona Intimalase®/Incontilase®, but it could potentially happen with a device that relies on manual back and forth thrusts. Also, they may not adequately be able to assess if a patient has uterine or pelvic organ prolapse. She would advise dermatologists to work in conjunction with an OB/GYN to have a complete examination and clearance by the OB/GYN before performing a laser vaginal rejuvenation procedure. Further, OB/GYNs may not feel comfortable learning and investing in expensive laser equipment nor want to invest time and effort to offer these procedures in their practices, so they may also prefer working with or referring to dermatologists to treat these patients after they’ve performed the initial examination. 

    NEXT: Dermatology's domain?

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