Dr. Devgan featured in The Guardian's New Documentary Series on the female body

I was honored to be invited to discuss labiaplasty in The Guardian's new documentary series on the female body. Created by Emmy-winning producer Mae Ryan and brilliant data journalist Mona Chalabi, this project, entitled The Vagina Dispatches, is a long-overdue look at the things we don't know about the female body-- sponsored by one of the world's great news organizations, The Guardian. In this episode, I discuss labiaplasty, which is one of the fastest growing plastic surgery procedures in America and one of the most popular operations in my practice. 

Click to watch The Guardian's documentary, Vagina Dispatches, Episode 1. Dr. Devgan's interview begins at minute 6:18.

The key to a modern facelift and necklift

Actual patient of Dr. Devgan, before and after facelift (short-scar approach).

Actual patient of Dr. Devgan, before and after facelift and necklift (short-scar approach) with fat grafting.

Facelift and necklift are two of my favorite plastic surgery procedures. The face and neck are not only the seat of identity and beauty, but they contain some of the most complex anatomy and delicate tissues on the human body.

When I am addressing the concerns of a patient interested in rejuvenation of an aging face or neck, there are a few key questions that I ask myself to help me achieve natural, beautiful, and durable results:

1. What are the major issues that are concerning the patient? These could be fallen cheeks, jowls, deep wrinkles, neck bands, excess skin, or any combination of the above.
2. What are the patient's tissues like? This is an assessment of skin type, complexion, thickness, sebaceousness, tendency toward scarring, and ability to heal.
3. What are the unique anatomic characteristics that make this patient's face and neck different? Everyone has a set of qualities that give a sense of identity to their features. This could be deep set eyelids, prominent cheekbones, a beauty mark, or a baseline asymmetry-- really anything that makes you look like you.
4. In what way does the patient's overall medical status impact the proposed operation? Major medical problems, allergies, connective tissue issues, use of certain medications like steroids, and substance use all impact my operative decision making, before, during, and after surgery.

From a surgical standpoint, the major differentiating factor between a modern facelift or necklift and the old-fashioned, pulled, tight, shiny, windblown look of Park Avenue in the 1990s is a deliberate treatment of the skin and substructure of the face as two separate anatomic planes. The SMAS (muscular substructure layer of the face) and the skin (the overlying covering) must be addressed separately and systematically in order to achieve a beautiful results.

For questions about facelift and necklift, please contact my office at office@LaraDevganMD.com or 212-452-2400.

Labiaplasty for functional and aesthetic concerns

Actual patient of Dr. Devgan, before and after labiaplasty

Actual patient of Dr. Devgan, before and after labiaplasty

Labiaplasty (or cosmetic rejuvenation of the female genitalia) is one of the most popular procedures in my New York City plastic surgery private practice. As a female plastic surgeon, many of my patients feel comfortable discussing their most intimate concerns with me. Equally important, I am committed to giving superb surgical results to each patient in my practice. Examples of results from my actual patients are displayed at the bottom of this page.

U.S. plastic surgeons have reported a 44% increase in labiaplasty procedures over the past several years, according to the American Society for Aesthetic Plastic Surgery. This makes labiaplasty the fastest growing plastic surgical procedure in America.

WHAT IS LABIAPLASTY?

Labiaplasty is an outpatient surgical procedure designed to make the female genital area more aesthetic and comfortable. Women seek labiaplasty because they are unhappy with the way their private parts look, or because they are uncomfortable with friction caused by exercising, sexual intercourse, or wearing fitted clothes. Labiaplasty can address the inner labia (labia minora), the outer labia (labia majora), the clitoral hood, or any combination of those areas. Atrophy or sagging of the labia majora can also be addressed with filler or fat grafting. 

WHAT IS THE ANATOMIC CONCERN?

The most frequent complaint related to labiaplasty is protruding or enlarged labia minora (inner labial lips). This is also the most common reason for women to seek labiaplasty in my practice. As women get older, some experience atrophy or sagging of the labia majora (external labial lips). Occasionally, women also complain of enlargement of the clitoral hood, looseness of the perineal tissues, sagging of the labial majora, or bulkiness of the mons pubis.

Labiaplasty is tailored to your individual anatomic considerations and concerns, as each woman is different. Labiaplasty does not affect sexual sensation, enjoyment, or ability to have an orgasm. The female erogenous zones, such as the clitoris and "g-spot" are not operated on and experience no changes during the operation.

WHAT IS THE SURGERY LIKE?

Labiaplasty is done under local anesthesia with or without light sedation ("twilight"), which is always supervised by my board-certified female anesthesiologist. About 70% of my patients elect to have the surgery done under local anesthesia alone. The surgery itself typically takes under 1 hour. When surgery is complete, you will have ointment and a maxi pad placed as a dressing. If you have had local anesthesia only, you will feel fine immediately after surgery. If you have had sedation, you will feel a bit tired and you will recover in one of our private recovery room suites, where you will be able to relax, sleep, watch TV, or read a magazine. Once you are feeling fully awake and alert, usually after about half an hour, you will be able to go home the same day. 

WHAT ARE THE SCARS LIKE?

Scars for labiaplasty are hidden in locations that are not visible under most circumstances. Even when scars are closely examined, as in during intimacy or mirror examination, the female genitalia generally heals extremely well. Any scars that are present will heal in a camouflaged manner, and care is taken to design your scar placement in a buried or hidden location.

EDGE OR WEDGE?

There are two well-described techniques for performing labiaplasty that addresses the labia minora: the external trimming technique (excising the "edge" of the protruding tissue-- the edge technique) and the v-shaped surgical excision (excising a "wedge" of the protruding tissue-- the wedge technique). I am well-versed and facile in both techniques and will tailor the procedure to your individual desires. Both procedures have their role in labiaplasty, however, generally speaking, I prefer the wedge technique in most women, as I consider it to provide a superior cosmetic result.

In general, the wedge technique is considered the gold standard of labiaplasty technique, and it has supplanted the edge technique in the hands of many modern and experienced surgeons. The wedge technique is more technically challenging from a surgical perspective, and for this reason, it is less common to find a plastic surgeon to perform this procedure. However, the wedge technique is considered a superior operation in most women for several reasons:

• The Edge technique creates a linear scar along the edge of the external genitalia, which can appear scallopped or irregular when the stitches heal. The Wedge technique has a buried scar that is less noticeable and leaves the external genitalia with a smooth contour.
• The Edge technique is associated with occasional complaints about dysparunia, or pain with sexual intercourse. These complaints are almost unheard of with the Wedge technique.
• The Edge technique is more traumatic to the tissues and has an increased amount of swelling, as well as an increased risk of wound breakdown. While swelling is also present with the Wedge technique, it resolves more quickly. Wound breakdown is not common with the Wedge technique.

WHAT IS THE RECOVERY LIKE?

After surgery, you will wear a maxi pad with a small amount of ointment on it, and use ice packs for comfort. All of your stitches will be dissolvable. You will use a "peri bottle" or water bottle to cleanse yourself after going to the bathroom. When you are resting at home, I advise pelvic elevation by keeping your pelvis propped up on 1-2 pillows to help the swelling come down.

Swelling after labiaplasty peaks in the first 2 weeks. During this time frame, swelling is gravity-dependent, so you will notice that spending more time doing pelvic elevation helps the swelling decrease. Even if you are up and about right after surgery, this will not effect your long term result, although it may take a bit longer for your swelling to go away. After the first 2 weeks, swelling continues to decrease on its own. You will have about 80% of the final surgical result at 1 month after surgery and 90% after 6 weeks, although it takes a full 6 months for all swelling to completely dissipate. 

WHEN CAN YOU RETURN TO WORK AND PLAY?

You will be able to do normal activities, such as walking around the block and running an errand, the day after surgery. Depending on the nature of your job, many women are able to return to work within 2-3 days. For more strenuous types of work, this may vary. Strenuous activity is not advised for the first four weeks after surgery, although pending Dr. Devgan's recommendations for your individual case, you may be able to resume some light exercises at 2-3 weeks. You will be able to return to sexual intercourse, strenuous exercise, swimming, and normal activities after approximately 6 weeks.

WHAT IS THE NEXT STEP?

Patient satsifaction with labiaplasty is extremely high. For questions about the procedure or to set up an in-person consultation, please call our office at (212) 452-2400 or email info@LaraDevganMD.com.

 

Microneedling for Glowing Skin

Actual patient of Dr. Devgan, before and immediately after Microneedling treatment

Truly beautiful skin is soft, supple, and glowing. Yet with sun damage, acne, wrinkles, fine lines, freckles, and sun spots, a luminous complexion can be difficult to achieve. A large body of research supports the use of an exciting technique to aid in getting great skin: Collagen Induction Therapy.

Collagen Induction Therapy, also called Dermapen Microneedling, or Microneedling, is a minimally invasive technique that boosts your skin's production of collage and elastin, two of the most important substances in maintaining plump, youthful, glowing skin.

HOW DOES IT WORK?

Microneedling involves using a mechanized device called a dermapen to make thousands of miniscule needle punctures in the outermost layers of the skin. By precisely controlling the depth, spacing, frequency, and pattern of these needle pricks, the dermapen stimulates your body to make more collagen in the areas where it needs it the most. Microneedling has been scientifically demonstrated to show improvement in fine lines, freckles and sun spots, scars, burns, pitted and non-pitted acne scars, stretch marks, and large pores. 

CAN MICRONEEDLING BE COMBINED WITH OTHER TREATMENTS?

Microneedling can be combined with a liquid treatment on the skin surface-- such as growth factors, vitamin C, or platelet rich plasma (PRP)-- to further improve skin quality, evenness, and texture. This is highly effective because the skin absorbs more of these growth factors as a result of microneedling treatment. The so-called "vampire facelift" (shown on Bar Rafaeli and Kim Kardashian, above) is an example of this combination.

HOW IS THIS DIFFERENT FROM A MICRONEEDLING OR DERMAROLLER TREATMENT IN A SPA?

Spa & home needles are shorter and less effective.

In a spa or home-use setting, microneedling devices and dermal rollers have needles that are much shorter than the ones used by a plastic surgeon. A spa or home device will have short, fine needles that are 0.2 mm in depth and can be used two times a week or more. In contrast, medical microneedling performed by a qualified plastic surgeon uses long, fine needles with depths ranging from 2 to 7 mm, depending on your concern (in other words 10 to 35 times deeper than the spa model).

Spa & home needles can hurt your skin and cause scarring.

Microneedling must be done with a device that hits your skin surface at a 90 degree (perpendicular) angle, in order to minimize scraping, scratching, or other trauma that could cause scarring. Inexpensive spa devices often have poor quality needles that are slightly angled or bent and can thus hurt your skin. Similarly, circular devices like dermal rollers don't hit the skin at a straight 90 degree angle and can be injurious for this reason as well.

A licensed physician or medical professional is required to supervise any procedure that breaks your skin. A vigourous Dermapen Collagen Induction Therapy session should do this, and thus should be medially supervised.

WHY NOT JUST USE A LASER OR CHEMICAL PEEL?

Microneedling is preferable to laser and chemical peels in many patients because it is safe for use in all skin tones, all parts of the body (including stretch marks on the abdomen), and all times of life (including pregnancy and breastfeeding). In addition, the downtime with Microneedling is quite short, with transient redness usually lasting less than a day (as compared to one week or more with peels or laser).

Microneedling Collagen Induction Therapy is also a great technique for those who are concerned with their complexions but are relunctant to try Botox or fillers. Because it is mechanical and doesn't involve any chemicals or neurotoxins, the technique is reassuring to many.

DOES IT HURT?

Although Microneedling sounds scary (thousands of needles going into your face!), it is actually quite painless. Dr. Devgan uses lidocaine numbing cream on your face to keep you completely comfortable, and you are wide awake during the procedure. The experience feels similar to a deep facial with a bit of extra vibration. At the end of the procedure, your face will be slightly red and tingly, as the growth factors, vitamin C, or platelet rich plasma absorb into your skin. By the next day, you will be able to return to work and play, with minimal downtime.

Improved skin appearance begins to occur almost immediately and continues for 4 to 6 weeks. For best results, Microneedling can be repeated as frequently as every 6 weeks, or as infrequently as 2-3 times a year, depending on your concerns.

IS IT EFFECTIVE?

The before and after photos of Microneedling speak for themselves. Although individual results and situations vary, this technique has been demonstrated to be effective in facial wrinkles, acne scars, hyperpigmentation, burns, surgical scars, and stretch marks.

WHAT IS THE DATA?

The scientific literature supports the use of Collagen Induction Therapy using a Dermapen Microneedling device. More detailed data can be found here:

• Fernandes D. Minimally invasive percutaneous collagen induction. Oral Maxillofac Surg Clin North Am.2006;17:51–63. [PubMed]
• Aust MC, Fernandes D, Kolokythas P, Kaplan HM, Vogt PM. Percutaneous collagen induction therapy: An alternative treatment for scars, wrinkles and skin laxity. Plast Reconstr Surg. 2008;21:1421–9. [PubMed]
• Fernandes D, Signorini M. Combating photoaging with percutaneous collagen induction. Clin Dermatol.2008;26:192–9. [PubMed]
• Aust MC, Reimers K, Repenning C, Stahl F, Jahn S, Guggenheim M, et al. Percutaneous collagen induction: Minimally invasive skin rejuvenation without risk of hyperpigmentation-fact or fiction. Plast Reconstr Surg. 2008;122:1553–63. [PubMed]

HOW DO YOU SET UP YOUR NEW YORK CITY DERMAPEN MICRONEEDLING TREATMENT?

If you are interested in Collagen Induction Therapy (microneedling dermapen treatment), please call our Manhattan office at (212) 452-2400 to schedule a consultation and treatment with Dr. Devgan. If you have specific questions, you can also reach out to us at info@LaraDevganMD.com.

HOW DO YOU MAKE YOUR MICRONEEDLING RESULTS LAST?

As amazing as collagen induction therapy with Dermapen Microneedling is, its effect on your skin is best combined with synergistic and scientifically proven skin care products. Prescription strength retinol, vitamin A, vitamin C, vitamin E, ferulic acid, and titanium are medical-grade products that will improve your skin and make your microneedling results last longer. For my recommendations, shop my custom-formulated line, Dr. Devgan Scientific Beauty, developed exclusively with a skin science laboratory in California. Microneedling makes your skin more permeable to absorption of medically active ingredients, so use of these products after your treatment is the best way to get great skin.

Dr. Devgan featured in the Hamptons Magazine hot list

The Hamptons Magazine Hot List, August 2016.

We are thrilled to announce that Dr. Devgan has been named to the Hamptons Magazine hot list, "The List." Featuring movers and shakers throughout the New York City, greater New York, the Hamptons, and surrounding areas, Dr. Devgan is honored to be listed with esteemed company, including:

Emily Ratajkowski, Brooke Shields, Mary-Kate Olsen, Oliver Sarkozy, Bebe Neuwirth, Alec Baldwin, Lauren Bush Lauren, Nacho Figueras, and more.

For more information on Dr. Lara Devgan, please contact office@LaraDevganMD.com or email 212-452-2400.

The Hamptons Magazine Hot List, August 2016.