Aesthetic gynecology – which substances used for injections rejuvenate intimate areas most effectively
Aesthetic gynecology—and aesthetic medicine in general as we see it today (I will not mention the history of this field reaching back to ancient Egypt)—has flourished in the 21st century. Since the 2000s, both women and men have, at an exponentially increasing pace, begun to use methods to “halt” the aging process or even to “rejuvenate” themselves using ever more modern and effective methods, including various substances. Of course, by using quotation marks I did not make a mistake. Current science does not know a way to obtain “the water of life from the fountain of eternal youth.” This does not mean, however, that medicine today is powerless. We do, of course, know how to help people maintain a “youthful” appearance, but in this case we are speaking only about the surface, that is, the skin, and not the whole body. Within it, the processes of aging continue, and we still do not know how to stop them. Of course, an appropriate diet or lifestyle can keep the whole body in good condition; nevertheless, they will still not stop or delay the natural end of life, which, according to current knowledge, depends solely on genetically encoded information (not taking diseases or accidents into account here). It follows, therefore, that the main goal of physicians working in this field of medicine is to work on the skin and improve its quality and appearance, that is, to maintain or restore its elasticity and tightness.
To this end, we can use both EBD (Energy Based Devices), such as lasers, radiofrequency, or ultrasound, as well as bioactive substances injected into or under the skin with the aim of achieving the desired effect. In this article, I will focus only on the latter, namely the substances used for injections to improve the appearance of the skin in intimate areas.
I deliberately used the term “improving appearance” rather than “rejuvenation,” because, as I mentioned earlier, we cannot “rejuvenate” anything; we can only improve the appearance, in effect pretending that a given area looks younger. Of course, from a marketing point of view the term “rejuvenation” sounds much better than “improving appearance”; that is why this name has caught on and is used interchangeably with “revitalization,” although to me personally it is associated with the restoration of works of art, to which, on the other hand, the female vulva undoubtedly belongs.
Among the most commonly used substances in injectable therapy to improve the trophism of the skin of the intimate areas are: hyaluronic acid (HA), platelet-rich plasma (PRP), and mesenchymal stem cells (MSC). The effects of these three are well documented scientifically, and therefore I will focus only on them. There is another substance, also well documented scientifically, but not available in Europe and, recently, not even in the USA, where it had previously been used—amniotic fluid (AF). Therefore, I will mention it at the end only for informational purposes, given the lack of product availability. Of course, ever-new preparations appear on the market (e.g., growth factors) with allegedly effective action; however, as a physician, scientist, and practitioner, I cannot say anything more about them than that we still have to wait for more scientific data in order to fully assess the effectiveness of their action. It is quite possible that the effect of such therapies will be very good, and accordingly, if a given substance is legally approved for marketing—that is, it does not harm people—it can be used. How else would we learn about its effectiveness in a larger number of patients than those reported by the companies distributing the product?
In aesthetic gynecology, high-density hyaluronic acids (HA) find their greatest use. As a result, the acid molecules bind more water on their surface. Another very important feature of hyaluronic acid suitable for gynecology is its cross-linking, as a result of which the product and the water bound to it do not migrate, and the absorption period is prolonged. Hyaluronic acid in gynecology has two uses: therapeutic and aesthetic. In the former, indications may include: vaginal dryness, cracking of the vestibular mucosa during intercourse, a painful scar after a peripartum perineal incision (episiotomy), and, finally, a traumatically deformed (also postpartum) vaginal vestibule. In these cases, the preparation is administered subcutaneously and intradermally. This technique increases the vascularization of the area where the acid is administered and improves mucosal hydration and elasticity. An added benefit is that in cases of a painful scar after a peripartum perineal incision, the skin of the perineum is separated from the deeper layers of the scar, leading to a resolution of symptoms. In the case of a post-traumatic deformation of the vaginal vestibule producing the appearance of a “gaping introitus,” thanks to
the volumetric effect of the acid, the walls of the vestibule are evened out and the entrance to the vagina is closed.
In aesthetics, the most common use of HA in gynecology is to improve the tone and elasticity of the skin of the labia majora by filling them with the product in question. Thanks to sub- and intradermal injection of the preparation, their volume and skin tension increase. In this case, the acid can also be implanted into deeper layers – adipose tissue. With such use, the effect of increased labial volume will last longer.
Another indication for the use of hyaluronic acid is
Injection of the anterior vaginal wall in the area of the G-spot to improve sexual sensations, or of the bladder neck in cases of stress urinary incontinence. However, these procedures fall outside the scope of this study.
Platelet-rich plasma (PRP) is also a natural product; however, unlike the previous one, which is produced by bacteria, this substance is obtained from the patient undergoing therapy. PRP is nothing more than blood previously drawn from the patient and centrifuged in such a way as to obtain three separate fractions—the formed elements of blood (red cells, white cells, and others) and plasma with a low platelet count (platelet-poor plasma—PPP) and platelet-rich plasma (PRP). The latter can bear this name if it contains more than 1 million platelets. In practice, PPP and PRP are mixed (because the PRP “layer” is very thin and most of the product spun down from the formed elements is PPP) and administered subcutaneously or intradermally. This procedure initiates a cascade of inflammatory changes at the cellular level, thereby activating fibroblasts (inflammatory cells) and the production of collagen, which is precisely the goal of the treatment. An additional effect is increased vascularization (new micro blood vessels are formed). As a result of these processes, the skin becomes firmer and more elastic. The same applies to the vaginal mucosa. Such therapy is nothing more than a natural way to “force” the body to regenerate. Thanks to its natural character, it carries no risk of side effects other than the human factor, that is, incorrect performance of the procedure.
Stem cells are so-called multipotent cells, meaning they can develop in any direction and form the required tissue. The largest amount in an adult’s body is found in the bone marrow (the bone marrow fraction), but for that reason it is more difficult to obtain and has little application in aesthetic medicine. In the latter, the mesenchymal fraction is used most often, that is, obtained from adipose tissue. Everyone has fat, even very slim people. As such, it has many uses, but aside from the volumetric effect, that is, as a filler, it can be used precisely as a source of stem cells. It must, of course, be properly prepared. After fat is harvested, it is processed into so-called “nanofat,” meaning clusters of several cells. A preparation made in this way can be injected with a “normal” syringe and injection needle. In addition to the cell-mediated inflammatory cascade discussed above, this therapy induces the formation of collagen fibers and blood vessels to a much greater extent. It is therefore the most advanced therapy, but it requires a broader preparation process and is thus more expensive.
The final therapy is amniotic fluid (AF). It is obtained from pregnant women during a cesarean section. Donors are of course screened for any infections, and the cesarean section is performed electively. The product is then appropriately prepared and stripped of substances that could trigger rejection reactions. This product is the best and one of a kind. Amniotic fluid is rich in many cellular growth factors, and thus it induces regeneration of any tissue into which it is administered. It essentially serves as a revitalizing serum. Unfortunately, its production in the USA has been halted despite prior FDA (Food and Drug Administration) approval. We are currently awaiting the resumption of production. It appears that this product will be the future, but as a human-derived product it is subject to greater restrictions.
Aesthetic medicine, including aesthetic gynecology, continues to develop, and the variety of products used to improve skin quality is also changing. However, safety should be kept in mind, so I recommend that all patients ask their doctor about the safety of the product being used and its certification. Only legally approved products are safe, but even these do not guarantee success.
