Aesthetic and Regenerative Gynecology

Description

Aesthetic or cosmetic gynecology is a rapidly expanding and much in demand field worldwide. This book covers all aspects of cosmetic gynecology in great details and interdisciplinary fields. It provides information and practical tips on the new evolving and fast growing branch of aesthetic and regenerative gynecology. The book covers basics along with illustrations, practical tips and troubleshooting points.  Chapters include anatomy, physiology, pathology and comprehensive management of diseases in relation to cosmetic gynecology. The book explains the basics of techniques and devices used in this field such as several energy based and high tech devices like lasers, Hifu, HIFEM, their safety profile, scope and uses in an easy to understand language supported by illustrations. It also covers complications, controversies and medicolegal issues surrounding this field. The book includes chapters from national and international experts of each technique and helps in systematic evidence based learning. The book serves as a comprehensive book for postgraduates and consultants in gynecology, plastic surgery, dermatology, urogynecology, vascular surgery, general surgery, for cosmetologists and those interested in regenerative sciences. Acknowledgement Contents Editors and Contributors Co-Editors Chief Editor Contributors 1: Introduction to the Rising field of Aesthetic and Regenerative Gynecology 1.1 Introduction 1.2 Why is There a Sudden Interest in this Field? 1.3 History 1.4 Present Scenario Bibliography 2: Epidemiological Perspective in Aesthetic and Regenerative Gynecology 2.1 Introduction 2.2 Complaints for Which Aesthetic and Regenerative Treatment Is Sought 2.3 Problem Statement 2.3.1 Globally 2.3.2 High-Income Countries 2.3.3 Low- and Middle-Income Countries 2.4 Aesthetic and Regenerative Procedures: History and Current Status 2.5 Cosmetic Indications 2.6 Functional Indications 2.7 Caution 2.8 Conclusion References 3: Anatomy and Physiology in Relation to Invasive and Non-invasive Procedures in Aesthetic and Regenerative Gynecology 3.1 Introduction 3.2 Anatomy And Physiology 3.3 Indication and Contraindications 3.4 Practical Tips 3.5 Various Committee Statements References 4: Counselling Before Cosmetic Gynecology 4.1 Introduction 4.2 Aesthetic and Regenerative Gynecology Counselling 4.2.1 Counselling Environment (Fig. 4.1) 4.2.2 Counselling Should Be 4.2.3 Auditory 4.2.4 Visual 4.2.5 Kinesthetic 4.3 Recommendations for Counselling 4.4 Summary References 5: Medico-legal Aspects in Aesthetic and Regenerative Gynecology 5.1 Introduction 5.1.1 Who Can Do Cosmetic Surgeries? Who is a Cosmetologist? 5.1.2 Counselling 5.2 Ethical Dilemmas 5.2.1 Can We Do Surgery When You Think That it is Not Medically Indicated on Demand? 5.2.2 What to Do When Everything is Normal Physiologically but Still Patient Demands Correction? 5.2.3 Documentation 5.2.4 Complications 5.2.5 Confidentiality 5.2.5.1 Indian Medical Council (Code of Conduct, Etiquette and Ethics) Regulation, 2002 [3] 5.2.6 Disclosure of the Patient’s Secret Without Valid Reason Amounts to Misconduct 5.2.7 Certain Typical Medico-legal Issues in Cosmetic Gynecology 5.2.8 Certain Procedures Not Yet Proved: Can One Practise [4] 5.2.8.1 Ministry of Health and Family Welfare (Department of Health and Family Welfare) by Notification: New Delhi, the 11th March, 2020 [5] 5.2.9 Minor Patient Coming to Take Advice: What to Do? 5.2.10 Insurance 5.3 Conclusion References 6: Energy-Based Devices: Comparisons and Indications 6.1 Introduction 6.2 Lasers 6.2.1 Carbon Dioxide (CO2) Laser 6.2.2 Erbium-Doped Yttrium Aluminum Garnet (Er: YAG) Laser 6.2.3 Fractional Lasers 6.2.4 Lasers in Gynecology 6.3 Radiofrequency (RF) 6.3.1 RF-Tissue Interactions 6.3.2 RF Devices and Configuration 6.3.3 Radiofrequency in Gynecology 6.4 High-Intensity Focused Ultrasound (HIFU) 6.4.1 HIFU in Gynecology 6.5 High-Intensity Focused Electromagnetic Technology (HIFEM) 6.5.1 HIFEM in Gynecology 6.6 Light Emitting Diode (LED) 6.6.1 LED in Gynecology 6.7 Conclusion References 7: Laser in Aesthetic and Regenerative Gynecology: Physics, Types, Applications, Safety Profiles 7.1 Introduction 7.2 Patient Evaluation, Consultation, and Consent 7.3 Contraindications 7.4 Fractional Lasers 7.5 Laser Tissue Interaction 7.6 Histological Changes Seen with Fractional Lasers, RF, and Other Energy-Based Devices 7.7 How to Perform a Fractional Laser? 7.8 Adverse Effects and Complications 7.9 Radiofrequency (RF) Devices 7.10 How to Perform an RF for Vaginal Rejuvenation 7.11 Ultrasound-Based Devices 7.12 Laser Safety 7.13 Hazards Involved Due to Laser Beam 7.14 Non-Beam Hazards 7.15 Laser Hazard Safety Measures 7.16 Safety Measures Against Aerosoles 7.17 Conclusion References 8: Laser in Vaginal Rejuvenation 8.1 Introduction 8.1.1 Histology 8.1.1.1 Collagen 8.1.1.2 Elastin 8.1.2 Tissue Remodelling and Clinical Impacts 8.1.3 Histological Changes [21] 8.1.4 Role of Energy-Based Devices (EBD) [21] 8.2 Lasers 8.2.1 Technology Parameters 8.2.2 Laser Technology Categories 8.2.3 Clinical Applications in Vaginal Conditions 8.2.4 Vaginal Atrophy 8.2.4.1 Mucosal Responses Following Fractional Laser Treatment 8.2.4.2 Biomolecular Effects of EBD Application on Vaginal Mucosa 8.2.5 Stress Urinary Incontinence (SUI) 8.2.6 Laser Tightening for Vulvar Laxity [58] 8.3 Conclusion References 9: Other Lasers in Aesthetic and Regenerative Gynecology 9.1 Erbium Lasers 9.1.1 Introduction and History 9.1.2 Indications for Use in Gynecology (Er: YAG Smooth) 9.1.3 Contra-indications (Er: YAG) 9.1.4 Understanding the Smooth® Mode 9.2 Histological Evidence 9.3 Conclusion Diode Laser in Aesthetic and Regenerative Gynecology References 10: Radiofrequency in Aesthetic and Regenerative Gynecology 10.1 Introduction 10.1.1 Biological Interaction Rationale (Critical and Bibliographical Analysis) 10.2 History 10.3 Conclusions 10.3.1 Action Rational in Neuro-Muscular Tissues 10.3.2 Rationale to Use Different Types of Electromagnetic Energy (Multifrequency, Capacitive, Resistive, Monopolar, Bipolar) 10.4 Bipolar Radiofrequency 10.4.1 Frequency 10.4.2 Monopolar/Bipolar Applicator 10.5 Monopolar Radiofrequency 10.6 Resistive/Capacitive Applicator 10.7 Radiofrequency Treatment Protocol References 11: Carboxytherapy in Aesthetic and Regenerative Dermatology 11.1 Introduction 11.2 Treatment 11.3 Technique 11.4 Precautions 11.5 Advantages 11.6 Disadvantages 11.7 Side Effects 11.8 Complications 11.9 Aesthetic Indications of Carboxytherapy 11.9.1 Flaccidity; Skin Rejuvenation 11.9.2 Periorbital Area 11.9.3 Cellulite and Gynoid Lipodystrophy 11.9.4 Localized Adiposities 11.9.5 Stretch Marks 11.9.6 Chronic Wounds 11.9.7 Skin Grafts 11.9.8 New/Other Indications References 12: Micro-focused Ultrasound in Aesthetic and Regenerative Gynecology 12.1 Introduction 12.2 Pathogenesis of Age-Related Skin Laxity Deterioration 12.3 Mechanism of Action 12.4 Micro-focused Ultrasound (Ultherapy) 12.4.1 Indications 12.4.2 Treatment Time 12.5 Pain and Comfort Management 12.5.1 Recovery and Down Time 12.5.2 Side Effects and Complications 12.5.3 Treatment Protocols 12.5.4 Contraindications 12.5.5 Precautions 12.5.6 Patient Safety 12.5.7 Results 13: Minimal Invasive Treatment of Varicose Veins 13.1 Introduction 13.2 Thermal Tumescent Techniques (TTT) 13.2.1 Methods 13.2.2 Indications of Intervention 13.2.3 Contra Indications 13.2.4 How It Works 13.2.4.1 EVLA (Endovascular Laser Ablation) 13.2.4.1.1 Principle 13.2.4.1.2 Equipment 13.2.4.1.3 Procedure 13.2.4.2 RFA (Radiofrequency Ablation) 13.2.4.2.1 Procedure 13.2.4.3 Steam Ablation 13.2.4.3.1 Procedure 13.2.4.3.2 Principle 13.2.4.4 Endovenous Microwave Ablation (EMWA) 13.2.4.5 Echotherapy Using High Intensity Focused Ultrasound (HIFU) 13.3 Non-Thermal Non-Tumescent Technique (NTNT) 13.3.1 Methods 13.3.1.1 Glue Closure 13.3.1.1.1 Procedure 13.3.1.1.2 Outcomes 13.3.1.2 Mechanochemical Ablation (MOCA) Method 13.3.1.2.1 Mechanism 13.3.1.2.2 Device Description 13.3.1.2.3 Outcomes 13.3.1.3 V-Block 13.3.1.3.1 Outcomes 13.3.1.4 Foam Sclerotherapy 13.3.1.5 Polidocanol Endovenous Microfoam 13.3.1.6 Cutaneous Lasers and Intense Pulse Light (IPL) 13.3.1.6.1 The Various Laser Systems 13.3.1.6.2 Principle 13.3.1.6.3 Lasers 13.3.1.6.4 Procedure 13.3.1.6.5 Complications [30, 41, 42] 13.4 Conventional Surgery 13.4.1 High Ligation 13.4.2 Stripping of GSV 13.4.3 Stripping Under Tumescent Anaesthesia 13.4.4 Saphenous Sparing Operations 13.4.4.1 CHIVA 13.4.4.2 ASVAL 13.4.5 Ambulatory Phlebectomy 13.5 Summary References 14: Chapter on Testosterone Therapy 14.1 Introduction 14.2 Basic Physiology of Testosterone Production, Function, and Metabolism 14.2.1 Testosterone Excess 14.2.2 Testosterone Deficiency 14.2.3 Testosterone Replacement Methods 14.3 Pellet Insertion 14.4 Conclusion References 15: Laser Hair Removal 15.1 Introduction 15.1.1 Laser and Light Assisted Hair Removal 15.1.2 Principle of Hair Removal 15.1.3 Photothermal Destruction 15.1.4 Wavelength 15.1.5 Pulse Duration 15.1.6 Fluence 15.1.7 Spot Size 15.2 Indications for Hair Removal 15.2.1 Contraindications 15.2.2 Laser Therapy 15.3 Procedure 15.3.1 During Procedure 16: Thread Lift in Aesthetic and Regenerative Gynecology 16.1 Introduction 16.2 Facial Aging 16.3 Types of Threads 16.4 Polydioxanone (PDO Threads) 16.5 How Can We Achieve Facial and Body Contour Restoration? 16.6 Concept 16.7 Two Stage Effect 16.8 History of Thread Lifting 16.9 Introduction of PDO 16.9.1 PDO (Polydioxanone) as Shown in Fig. 16.1 16.9.2 PDO (Polydioxanone) 16.10 Types of Thread (Fig. 16.1) 16.10.1 Vaginal Threads 16.10.2 Procedure of Tightening 16.10.3 The Uses of Vaginal Threads 16.10.4 Benefits of this Procedure 16.10.5 Complication of Vaginal Looseness 16.10.6 Contraindications 16.10.7 Functions of PDO 16.10.8 Effects (Post-Procedure) 16.10.9 Mechanotransduction 16.10.10 Sequen.ce of Events 16.10.11 Effect at the Tissue Level 16.11 Applications (Fig. 16.4) 16.11.1 How to Perform the Procedure 16.11.2 Procedure Protocol 16.11.3 Factors Determining the Success of the Procedure 16.11.4 Aftercare Instructions 16.11.5 Complications 16.11.5.1 Issues from Technical Problem (Improper Procedure) 16.11.5.2 Generate Elasticity and Contour Changed 16.12 Conclusions 17: Chemical Peels and Vulval Whitening in Aesthetic and Regenerative Gynecology 17.1 Introduction 17.1.1 Scope of This chapter 17.1.2 Definition 17.2 Classification of Peels 17.3 Mechanism of Action 17.4 Common Superficial Peeling Agents 17.4.1 Glycolic Acid 17.4.2 Salicylic Acid 17.4.3 Lactic Acid 17.4.4 Mandelic Acid 17.4.5 Jessner’s Solution 17.5 Medium-Depth Peels 17.5.1 Trichloroacetic Acid 17.6 Deep Peels 17.7 Indications and Contradications of Chemical Peels 17.7.1 Indications 17.7.2 Contraindications [2, 7] 17.7.2.1 Absolute 17.7.2.2 Relative 17.8 Procedure of Peeling 17.8.1 General Steps 17.8.2 Pre-Peel Steps 17.8.3 Peel 17.8.3.1 Termination of Peel 17.8.4 Post-Peel Steps 17.8.5 Complications 17.9 Emerging Concepts in Chemical Peels 17.9.1 Newer Peels 17.9.2 Combination Peels 17.9.3 Party Peels 17.10 Combination Treatments [2] 17.10.1 Microdermabrasion 17.10.2 Microneedling 17.10.3 Lasers 17.11 Conclusion References 18: Scars in Aesthetic and Regenerative Gynecology 18.1 Introduction 18.2 Management of Acne Scars [4–7] 18.3 Management of Striae/Stretch Marks [8–11] 18.4 Conclusion References 19: Hypo and Hyperpigmentary Disorders of Vulva 19.1 Introduction 19.2 Disorders of Hyperpigmentation 19.3 Physiological Pigmentation 19.4 Lichen Simplex Chronicus 19.5 Lichen Planus (LP) 19.6 Fixed Drug Eruption (FDE) 19.7 Contact Dermatitis (CD) 19.8 Post-Inflammatory Pigmentation (PIH) 19.9 Acanthosis Nigricans (AN) 19.10 Pigmented Condyloma Acuminate/Anogenital Wart 19.11 Vulval Lentiginosis 19.12 Genodermatosis Characterized by Lentigines 19.13 Benign Melanocytic Nevi 19.14 Melanoma 19.15 Pigmented Basal Cell Carcinoma 19.16 Disorders of Hypopigmentation 19.17 Vitiligo 19.18 Lichen Sclerosus Et Atrophicus (LSA) References 20: Breast Lifting and Reduction in Aesthetic and Regenerative Gynecology 20.1 Introduction 20.1.1 Surgical Anatomy of the Breast 20.1.1.1 Anatomically the Woman’s Breast Extends From 20.1.2 The Breast Suspensions 20.1.3 Breast Reduction 20.1.3.1 Tenets of an Ideal Breast Reduction 20.1.3.2 Preoperative Evaluation 20.1.4 Patient Profiles Coming for Breast Reduction [9] 20.1.5 Operative Technique 20.1.5.1 Breast Ptosis 20.1.5.2 Principles of Mastopexy 20.1.6 Surgical Approach 20.1.7 Postoperative Advice 20.1.8 Complications [27, 28] 20.1.8.1 Early 20.1.8.2 Late 20.1.8.3 Summary References 21: Butt Reshaping/Gluteal Recontouring Surgeries in Aesthetic and Regenerative Gynecology 21.1 Introduction 21.2 Gluteal Aesthetics 21.2.1 Aesthetic Units/Zones 21.2.2 Relevant Anatomy 21.3 Gluteal/Butt Reshaping Surgery [10] 21.4 Implants 21.4.1 Implant Size 21.4.2 Implant Shape 21.4.3 Post Operative Care 21.4.4 Buttock Augmentation with Fat Grafting (AFG) 21.5 Autologous Gluteal Flap (AGA) Surgeries 21.5.1 Operative Technique (Fig 21.12) References 22: Hymenoplasty, Vaginoplasty, and Perineoplasty in Aesthetic and Regenerative Gynecology 22.1 Introduction 22.1.1 Hymenoplasty 22.1.1.1 Definition 22.1.1.2 Anatomical Consideration 22.1.1.3 Why Females Request for Hymen Restoration? 22.1.1.4 Patient Selection and Preoperative Considerations 22.1.1.5 Contrindications 22.1.1.6 Procedure 22.1.2 Technique 22.1.2.1 Other Methods Discussed in Literature Are 22.1.2.2 Postoperative Risks, Complications, and Follow-Up Instructions 22.2 Maintenance of Cleanliness and Local Hygiene 22.2.1 Medico Legal Consideration 22.3 Vaginoplasty and Perineoplasty 22.3.1 Definitions 22.4 Anatomical Considerations 22.4.1 Pelvic Floor 22.4.1.1 The Vagina—Anatomy, Orientation, and Structural Support 22.4.2 Epithelium 22.4.3 Lamina Propria 22.4.4 Muscularis 22.4.5 Adventitia 22.5 Embryology and Innervation of the Vagina 22.6 External Genital Anatomy 22.6.1 Labia Majora 22.6.2 Labia Minora 22.6.3 Clitoris 22.6.4 The Vulvar Vestibule 22.6.5 Bartholin’s Gland 22.6.6 Skene’s Gland 22.6.7 Patient Selection 22.6.8 Contraindications 22.6.9 Evaluation 22.6.10 Operative Technique 22.6.11 Patient Evaluation 22.6.12 Preoperative 22.6.12.1 Perioperative Care 22.6.12.2 Postoperative Care and Instructions 22.6.12.3 Take-Home Message References 23: Labiaplasty and Cliteroplasty 23.1 Labiaplasty 23.1.1 Definition 23.1.2 Introduction 23.2 Anatomy of Labia Minora 23.2.1 Desire for Labiaplasty (L. Minora) 23.2.2 Labia Minor Hypertrophy Classification 23.2.3 Contraindications 23.2.4 Techniques of Labioplasty for Labia Minora 23.2.4.1 Edge Resection 23.2.5 Advantages 23.2.6 Disadvantages 23.3 Diagram 23.3.1 Wedge Resection 23.3.1.1 Advantages 23.3.1.2 Disadvantages 23.3.2 De-Epithelialization Technique 23.3.2.1 Advantages 23.3.2.2 Disadvantages 23.3.2.3 Special Notes 23.4 Diagram 23.4.1 Labia Minoraplasty with Zig-Zag Incision 23.4.2 Labiaplasty Done with Extended W Plasty Incision 23.5 Diagram 23.5.1 Labioplasty with Clitoral Hood Resection 23.5.1.1 Method 23.6 Diagram 23.6.1 Laser Labiaplasty 23.6.1.1 Advantage 23.6.1.2 Disadvantage 23.6.1.3 Post-Operative Care 23.6.1.4 Post-Operative Complications, Risks and Side Effects 23.7 Labia Majora Plasty 23.7.1 Definition 23.7.2 Introduction 23.8 Diagram 23.8.1 Anatomy 23.9 Diagram 23.9.1 Desire for Labiaplasty 23.9.2 Procedure 23.9.2.1 Hanging Lip of Labia Majora (Fig. 23.12) 23.10 Diagram 23.10.1 Labia Majora Plasty 23.11 Diagram 23.11.1 Key to Successful Healing 23.11.2 Conclusion 23.11.3 Rejuvenation of Labia Majora by Non-Surgical Procedures 23.11.3.1 Use of Hyaluronic Acid 23.11.3.2 Contraindications 23.11.4 Complications 23.11.4.1 Fat Augmentation 23.11.5 Side Effects 23.11.5.1 CO2 Laser 23.11.5.2 Radio Frequency Laser Treatment of Labia Majora and Labia Minora 23.11.5.3 Platelet-Rich Plasma 23.11.6 Clitoral Hood Resection 23.11.7 Complications 23.11.8 Contraindications 23.11.9 Clitoral Reduction Surgery References 24: Vulvodynia 24.1 Background 24.2 Classification of Vulvar Pain 24.3 Pathophysiology 24.4 Evaluation 24.5 Treatment 24.6 CO2 Laser 24.7 Conclusion References 25: Non Energy Based Modalities in Cosmetic Gynaecology 25.1 Introduction 25.2 Physiological Changes in the Female Genitals 25.2.1 Indications 25.2.2 Evaluation for Procedures: [7] 25.2.3 Contraindications 25.2.4 Modalities for Vulvovaginal Rejuvenation 25.2.5 Aesthetic Medicine 25.2.5.1 Fillers 25.2.5.2 Labia Majora Augmentation: 25.2.6 G-Shot 25.3 Fat Transfer 25.4 Botulinum Toxin 25.4.1 Regenerative Medicine 25.4.1.1 Platelet-Rich Plasma Therapy 25.4.1.2 O-Shot Therapy 25.4.1.3 PRP in Vaginal Rejuvenation 25.4.2 Stem Cells 25.4.3 Chemical Peels: 25.4.4 Other Therapies 25.5 Conclusion References 26: Genitourinary Syndrome of Menopause 26.1 Introduction 26.1.1 Anatomy and Physiology 26.2 Clinical Manifestations 26.2.1 Assessment 26.2.2 Treatment 26.2.3 Principle 26.3 Conclusion References 27: Management of Urinary Incontinence in Aesthetic & Regenerative Gynecology 27.1 Introduction 27.1.1 Pathophysiology of SUI 27.1.2 History 27.2 Medical Diagnosis 27.2.1 Incontinence Symptom Classification System with S/UIQ 27.3 Examination 27.3.1 Endoscopy 27.3.2 Treatment 27.3.2.1 Behavioral Therapies 27.3.3 Weight Loss 27.4 Who Is a Candidate for Behavioral Therapy? 27.4.1 Physiotherapy 27.5 Pessaries and Devices for Stress Urinary Incontinence 27.5.1 Increasing Outlet Resistance (Table 27.1) 27.5.1.1 Antidepressants Duloxetine Imipramine Estrogens 27.5.2 Injectable Bulking Agents 27.6 Which Bulking Agent to Choose? 27.7 Complications 27.7.1 Surgery for Stress Incontinence 27.7.2 Retropubic Suspension 27.7.2.1 Colposuspension Versus Laparoscopic Colposuspension 27.8 Complications 27.8.1 Perioperative Complications 27.8.2 Postoperative Complications 27.8.2.1 Overactive Bladder 27.8.2.2 Voiding Difficulties 27.9 Conclusions 27.9.1 Transvaginal Suspension 27.9.2 Pubovaginal Slings 27.9.3 Synthetics 27.9.3.1 Tension-Free Vaginal Tapes 27.9.3.2 Author’s Conclusion References 28: Non-cosmetic Uses of Laser in Aesthetic and Regenerative Gynecology: Vulvodynia, Urinary Incontinence, Infections, Warts 28.1 Introduction 28.1.1 Vaginal Atrophy 28.2 Pathophysiology 28.3 Treatment 28.4 Principle of Laser 28.4.1 Procedure 28.5 Vulvodynia 28.6 Pharmacological Measures 28.7 How Does Laser Help in Vulvodynia? 28.8 Urinary Incontinence 28.9 Treatment of Urinary Incontinence 28.10 Procedure Protocol 28.11 Recurrent Vaginal Infections 28.12 Warts 28.12.1 Procedure References 29: Gender Reassignment Surgery in Aesthetic and Regenerative Gynecology 29.1 Introduction 29.2 Magnitude of Problem 29.3 Etiopathogenesis 29.4 Embryology 29.5 Surgical Procedure 29.6 Male to Female 29.7 Female to Male 29.8 Practical Tips from Author 29.9 Discussion 29.10 Conclusion 29.10.1 Myths versus Reality, and the Decision to Undergo SRS Illustration: Illustration: Bibliography 30: Anaesthesia in Procedures of Aesthetic and Regenerative Gynecology 30.1 Introduction 30.1.1 Nerve Supply of External Female Genitalia and Perineum (Fig. 30.1) 30.2 Anaesthesia for Aesthetic Gynecology 30.2.1 Anaesthesia for Invasive/Major Cosmetic Gynecological Procedures 30.2.2 Various Measures Are Taken to Reduce DVT/PE-Associated Risk 30.2.3 Some Other Important Intraoperative Concerns Are 30.2.4 Anaesthesia for Minimally Invasive Cosmetic Gynecological Procedures 30.2.5 Few Considerations for Successful and Less Painful LA Injections 30.2.6 Contraindications for Neuraxial Anaesthesia (Spinal/Epidural/CSEA) Are 30.2.7 Anaesthesia for Non-invasive Cosmetic Gynecological Procedures 30.2.7.1 Daycare Guidelines 30.3 Conclusion 31: Stem Cells and Recent Advances in Aesthetic and Regenerative Gynecology 31.1 Introduction (Incidence, Effect on Society, etc) 31.2 Historical Aspects 31.2.1 Spontaneous Growth of Aesthetic Medicine 31.2.2 For AM Doctors, It Is an Ongoing Personal Process 31.2.3 Doctors Duty to Respond Responsibly and Ethically to Demand 31.2.4 The Ovarian Cycle 31.2.5 Procedure Details (Investigations, Techniques, and Anesthesia) 31.2.6 Role of Fat Transfer and Adipose-Derived Stem Cells (ADSCs) in Rejuvenation and Treatment of Female Genital Area 31.2.6.1 Fat Injections to Improve the Changes by Weight Lost or Aging 31.2.6.2 Labiaplasty of Labia Majora (Augmentation and Rejuvenation) 31.2.6.3 Role of Stem Cell Therapy in the Management of (Postmenopausal Female Genital Atrophy) 31.2.7 Pathological Vulvar Dystrophy 31.2.8 The Scientific Evidence Behind Using Stem Cells for Female Genital Rejuvenation 31.2.9 Stem Cells and Cell Therapies 31.2.10 Best Methodology of Fat Transfer 31.2.11 Process of Fat Transfer Lipo-Aspiration (Harvesting the Fat) Technique 31.2.12 Factors Affecting the Outcome (How to Get the Best Stem Cell Quality from Adipose Tissue) 31.2.13 According to Conde´-Green et al. (2010) 31.3 More Complex Protocols 31.3.1 Platelet-Rich Plasma (PRP) Enriched Lipotransfer 31.3.2 Stem Cell-Enriched Fat Transfer 31.3.2.1 Cell-Assisted Lipotransfer (CAL) 31.4 ADSCs-Enriched Fat Transfer (Cultured Stem Cells) 31.5 Indications and Contraindications 31.6 Conclusion References 32: PRP and Exosomes in Regenerative Gynecology References 33: Setting Your Practice and Future of Aesthetic and Regenerative Gynecology 33.1 How to Set up Aesthetic Clinic? 33.2 A Promising Future for Lasers 33.3 Newer Upcoming Technologies in Cosmetic Gynecology References Index