Cosmetic Surgery & Beauty #71

genital
designer vagina) and often viewed perjoratively.
The diode laser is one of the least expensive laser
technologies but remains significantly more expensive than
a scalpel, scissors or cutting diathermy. The advantage of
laser dissection over other dissecting tools includes the
ability to dissect, coagulate, cut and, at the same time,
promote collagen formation which assists healing and
reduces scar tissue formation. Surgeons who offer this
approach believe that their patients tend towards a greater
improvement in sensation during intercourse compared to
conventional cold-knife techniques.
The application of lasers in dermatology has been
a significant driving factor in the development of lasers
designed to be used in the vagina and on the vulva. Nonsurgical
laser vaginal treatment (‘therapy,’ ‘rejuvenation’) is
an expensive technology but is showing signs of fairly rapid
early adoption, particular amongst cosmetic physicians and
plastic surgeons. Gynaecologists have been, comparatively,
late adopters of the technology but there is some evidence
that more gynaecologists are exploring the role of nonsurgical
laser vaginal treatment in their practices.
The two main types of laser used in non-surgical
treatment of the vagina are the CO 2
and Erbium-YAG. Both
produce their effects by photothermal damage to both
the surface epidermal mucosa and more importantly to
the deeper lamina propria where most of the therapeutic
effects are mediated. The CO 2
laser is more aggressive
than the Erb-YAG laser being subablative throughout the
whole application, with the photo thermal damage higher
on similar energy levels and passes. The Erb-YAG laser
system employs two distinct delivery methods: a multipulse
delivery that is not subablative and a single shot, longpulsed
mode that is subablative and produces a deeper
thermal spread.
What does this all mean though? The limited data
available suggests that the photothermal damage
results in the vaginal surface epidermal mucosa becoming
thicker, more dense and cellular, with less keratin. The
arrangement of the
connective tissue in
the lamina propria
The struggle to place women front and
centre of trEATments remains a significant
issue in current gynaecological practice
(deeper layer) is more
dense, suggesting
increased collagen.
The gold standard
for evidence-based
medicine is that
obtained via randomised, placebo-controlled, doubleblind
studies. If the practice of medicine today relied on
these types of investigations alone, the majority of medical
practice in all fields today would have to cease.
However, evaluation of new technology or the application
of pre-existing technology to new indications requires a
robust examination of any available evidence, evaluation of
the technology and monitoring of outcome. It is possible
that the makers of the CO 2
laser are being over cautious
or that the makers of the Erb-YAG laser are being too
optimistic in their indications for use of their technology.
Lasers have a long history of being used in dermatology,
72 www.cosbeauty.com.au