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Cosmetic and asthetic gynaecology
Prof. Narendra Malhotra has had an extensive career in obstetrics and gynecology. He is the president of multiple organizations, has published and presented numerous papers, and has authored and edited several books. He specializes in high risk obstetrics, ultrasound, laparoscopy, infertility treatment and genetics. He currently practices in Agra, India and is the managing director of Global Rainbow Health Care.
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Introduction to Dr. Narendra Malhotra, his qualifications, roles, and contributions in gynecology.
Teaming with associates, focus on unspoken issues in cosmetic and aesthetic gynecology.
Details on common unspoken problems including pelvic organ prolapse, urinary dysfunction, and cosmetic concerns.
Introduction of new subspecialties in gynecology such as Female Pelvic Medicine and Cosmetic Gynecology.
Discussion on causes of tissue aging and laxity including genetics and lifestyle factors.
Prevalence and types of urinary incontinence, common symptoms, and underlying causes.
Overview of treatment options available including lifestyle changes, surgery, and devices like Kegelmaster.
Surgical methods for treating stress urinary incontinence, complications, and effectiveness related to colposuspension.
Emerging treatment methods for pelvic prolapse and vaginal atrophy including new technologies and complications.
Introduction to new non-invasive treatments, their mechanisms, and patient results with laser therapies. Patient testimonials alongside various case studies to demonstrate effectiveness of treatments for SUI and vaginal laxity.
Emphasis on continuous improvement in practice with acknowledgement of colleagues and contributors to the field.
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- 1. PROF.NARENDRA MALHOTRA M.D., F.I.C.O.G.,F.I.C.M.C.H, F.R.C.O.G.,F.I.C.S. • Prof. Dubrovnick International University • V.P. WAPM(world association of prenatal medicinne) • President ISAR • Presiddent Elect ISPAT • Sec Gen SAFOG • Member FIGO guidelines committee • President FOGSI (2008-2009) • Dean I.C.M.U. (2008) • Director Ian Donald School of Ultrasound • National Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC Course • Managing Director GLOBAL RAINBOW HEALTH CARE • Director ART-RAINBOW –IVF • Practicing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy and Infertility, ART & Genetics • Member and Fellow of many Indian and international organisations • Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award, Corion award, Man of the year award, Best Citizens of India award • Over 50 published and 200 presented papers • Over 100 guest lectures given in India & Abroad and 24 ORATIONS • Organised many workshops, training programmes, travel seminars and conferences • Editor 18 books, many chapters, on editorial board of many journals • Editor of series of STEP by STEP books • Revising editor for Jeatcoate’s Textbook of Gynaecology 7th and 8th edition (2015) • Very active Sports man, Rotarian and Social worker MALHOTRA NURSING & MATERNITY HOME PVT. LTD. GLOBAL RAINBOW HEALTH CARE,AGRA 84, M.G. Road, Agra-282 010 Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : 0562-2265194
- 2. HER UNSPOKEN PROBLEMS NARENDRAMALHOTRA MANPREET SHARMA JAIDEEP MALHOTRA NEHARIKA MALHOTRA BORA SHEMI BANSAL GLOBAL RAINBOW HEALTH CARE AGRA [email protected] Cosmetic and Asthetic Gynaecology
- 3. Common UNSPOKEN problems •Pelvic organ prolapse—symptomatic / Asymptomatic • Urinary dysfunction • Stress urinary incontinence • Sexual dysfunction • Overactive bladder • Faecal incontinence • Pelvic pain • Vulval /vaginal itching and pain • Abnormal Vaginal discharge • Cosmetic issues of looking good/sagging breasts • Pregnancy stria marks and other moles and scars • Vulval diseases like LICHEN,WARTS and others
- 4. New subspecialities emerging certifiedsubspeciality…… 1. Female Pelvic Medicine 2. Reconstructive Surgery 3. Cosmetic and Asthetic gynaecology
- 5. • Vaginal tightening •Post delivery rehabilitation • SUI • Vaginal dryness • Vulvar rejuvenation • Scars • Vulvodynia/ Vestibulitis • Lichen sclerosis • Vaginal infections • Bleaching
- 6. Causes of TissueAging & Laxity Genetics Menopause Low Estrogen States Pregnancy & Childbirth Smoking Obesity Significant Weight Fluctuation
- 7. Tip of theiceberg
- 8. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 18-24 25-29 30-3435-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 >90 Prevalence Age(years) pPrevalence by Aage Hunskaar S, Lose G, Sykes D, Voss S The prevalence of urinary incontinence in women in four European countries
- 9. laughing and otherstress are more stress
- 10. Stress incontinence A QOLProblem! urine leakage triggered by coughing, sneezing, laughing, lifting, exercising, straining Pads for incontinence – world market P&G's -incontinence an attractive $7 billion global category growing 7% annually. Compared baby diapers, feminine care products and tissue incontinence demonstrates the fastest growth Age and Parity Pelvic floor muscle denervation and endopelvic fascial disruption Physical activity level Individual impact is variable
- 11. Types of UrinaryIncontinence Stress Urinary Incontinence Urge Incontinence Mixed Incontinence Overflow Incontinence Atypical Incontinence
- 12. Urgency Frequency Nocturia / Enuresis Dysuria Symptomsof Urinary Incontinence
- 13. Urinary TractInfection Medications Abnormal Growths (Polyps, Stones, Cancer) Urinary Tract Abnormalities (Fistula, Diverticulum) Neuromuscular Problems Pelvic Support Problems Causes of Urinary Incontinence
- 14.
- 15. Treatment of Urinary Incontinence Lifestyle Changes Bladder Training Physical Therapy Pessary Medications Bulking Agents Surgery NEW: Laser Vaginal Rejuvenation
- 16. General measures • Reduceweight • Stop smoking, treat chronic cough • Treat constipation • Advice regarding pads and garments
- 17. SUI- treatment • Pelvicfloor exercises • Electrical Stimulation Conservative • Implants • Medications? • Surgery
- 18. Kegel Master ? •Helps a woman perform proper and effective Keigel exercises by applying adjustable targeted resistance against the muscles of the female pelvic floor. • The Kegelmaster™ has 15 levels of resistance with a maximum of 4.5lbs of pressure required to close the unit. • The Advanced Kegelmaster has 64 levels of resistance with a maximum of 9.5lbs of pressure required to close the unit. 20
- 19.
- 20. Surgery for Stress Incontinence Vaginal Anteriorrepair Needle suspension Slings MUS Urethral Bulking agents Abdominal MMK Colposuspension Slings Artificial sphincter Laparoscopic Colposuspension Slings
- 21. Colposuspension Cure rate 60-90% ”Goldstandard”??? Complications • Voiding difficulties (10%) • De Novo Detrusor instability (3-15%) • Prolapse (14%) Colposuspension Complications
- 22. STRESS URINARY INCONTINENCE minimalinvasive surgery TVT Ulmsten, 1996 “Integral theory” Monofilament Prolene Midurethral support No fixation of the tape
- 23. Tension-free vaginal tape Cure rate60 - 90% Indications • Primary and failed surgery • Concomitant prolapse surgery Complications • Bladder perforation • Retention • Urgency
- 24. Bladder injury atTVT Bladder perforation rates 2 - 10% Rates ↑ with previous retropubic surgery Remove TVT and site more laterally no IDC required
- 25. Transurethral routePeriurethral route Urethral bulkingagents Cure rate 50 – 70% Temporary
- 26. IMPLANTS UNWANTED EFFECTS • UTI •Urinary retention 1.9% • Urge incontinence 12.6% (21% did not respond to anticholinergics) • Haematuria 5% Stothers L et al J Urol (1998)
- 28. Treatment of PelvicProlapse Lifestyle Changes Bladder Training Physical Therapy Pessary Vaginal Mesh Surgery NEW: Laser Vaginal Rejuvenation
- 32. Surgical Complications SurgicalInjuries (Organ Damage) Voiding Dysfunction Bladder Perforation Pelvic Visceral Injuries & Hemorrhage Mesh Erosion & Extrusion Urinary Tract Infections Groin Pain Dyspareunia
- 35. Symptoms of VaginalAtrophy Vaginal Dryness Vaginal Burning / Irritation Decreased Lubrication During Sexual Activity Painful Intercourse Vaginal Bleeding or Vulvar Fissures Vaginal Discharge Pelvic Pressure or Vaginal Bulging Urinary Tract Symptoms Frequency, Pain, Bleeding or Incontinence
- 36.
- 37. Treatments of VaginalAtrophy Hormonal Medications Estrogens Estrogen Agonist-Antagonist (Osphena) Non-Hormonal Vaginal Lubricants Vaginal Moisturizers Regular Sexual Activity NEW: Laser Vaginal Rejuvenation
- 38. Atrophic Vaginitis • Pre-pubertal– lactating – postmenopausal • Reduced endogenous estrogen • Causing thinning of the vaginal epithelium • Vaginal epithelium susceptible to trauma and infection • pH high pH 5-7 d/t reduction in lactic acid production and decrease in lactobacilli decreasing h2o2
- 39. Symptoms of Vaginitis •Abnormal vaginal discharge • Pruritus • Irritation • Burning • Soreness • Odor • Dyspareunia • Bleeding • Dysuria
- 40. Patient Complaints • Genital Dryness/Itching/Burning Dyspareunia Vulvarpruritus Feeling of pressure Yellow malodorous discharge /leukorrhea Spotting Irritation/tear • Urinary Dysuria/ Frequency/Hematuria Urinary tract infection Stress incontinence
- 41. Treatment for AtrophicVaginitis • Treated with estrogen replacement (vaginal/oral) • Oral BCP (ethinyl estradiol up to 50ug) • Conjugated estrogen up to 1.25mg in combo w/medroxyprogesterone acetate to prevent endometrial hyperplasia • Vaginal cream 1g daily qhs x1m then ½ dose 2X/week (1g vaginal cream=.625mg conjugated estrogen) –should give w/ 2.5mg medrxyprogesterone x14d • Estrogen vaginal ring (change q3m) (Estring) delivers 6-9ug estrodiol daily • Vagifem 1tab intravaginally x2w then 3x/w for 3-6m
- 42. VRS – VaginalRelaxation Syndrome it is a quite common medical condition described as a loss of optimal vaginal structure and is usually associated with vaginal delivery and natural aging..
- 43. VRS leads to……. •Sexual dysfunction • Urinary incontinence (Specially stress urinary incontinence) • Urogenital syndrome of menopause
- 44. Vestibulodynia vulvodynia unexplained pain aroundintroitus 1 million cases per year,all ages,hypersenstivity to touch infections and local cause for unexplained tt very diff
- 45. Lichen sclerosus • Comprises70% of benign epithelial disorders → epithelial thinning, inflammation & histological changes in the dermis. • Aetiology: unknown • Sx: Itching (commonest), vaginal soreness + Dyspareunia. Burning and pain are uncommon. • Signs: crinkled skin, L. minora atrophy, constriction of V. orifice, adhesions, ecchymoses & fissures. • Dx: Biopsy is mandatory • Rx: - emollients, topical steroids. - Testosterone: not effective than petroleum jelly & → pruritus, pain & virilization. - Surgery: avoided unless malignant changes
- 46. Lichen Planus • GeneralAppearance – Erosive lesions at vestibule w/without adhesions resulting in stenosis – May have associated oral mucotaneous lesions and desquamative vaginitis – Patient c/o irritating vaginal , vulvar soreness, intense burning, pruritus, and dyspareunia w/post- coital bleeding – Types: Papulosquamous LP/Hypertrophophic LP /Errosive LP
- 47. Treatment • Intravaginal hydrocortisone suppositories BIDx 2m • Steroid creams (medium- high potency) • Vaginal estrogen cream if atrophic epithelium present • Vaginal dilators for stenosis • Surgery for severe vaginal synechiae • Vulvar hygiene • Emotional support
- 48. Vulvar Psoriasis • PhysicalAppearance –Red moist lesions w/without scales • Treatment: Topical corticosteroids
- 49. Squamous Cell Hyperplasia (AtopicEczema/Neurodermatitis) Physical Appearance Benign epithelial thickening and hyperkeratosis ◦ Acute phase with red/moist lesions ◦ Causing pruritus leading to rubbing & scratching ◦ Circumscribed, single or unifocal ◦ Raised white lesions on vulva or labia majora and clitoris Treatment: Sitz baths, lubricants, oral antihistamines, Medium potency topical steroid twice daily
- 50. Lichen Simplex Chronicus •Physical Appearance – Thickened white epithelium on vulva – Generally unilateral and localized • Treatment: Medium potency steroid twice daily prn
- 51. Benign Vulval lumps •Bartholin’s cyst. • Epidermal inclusion cyst. • Skene’s duct cyst. • Congenital mucous cysts: arise from mesonephric ducts remnants. • Cyst of the canal of Nuck: can give rise to hydrocele in labia maqjora. • Sebaceous cyst. • Papillomatosis (solid). • Fibroma (solid). • Lipoma (solid). • Condylomata (solid). Cysts are either congenital or arise from obstructed glands. Manifestations arise from the cysts (cosmotic) or from infection.
- 52. So what NEWcan we offer to HER ?
- 53. Non-Invasive Measures ExternalEnergy Application CO2 Laser (with certain settings) Er: YAG Radiofrequency Ultrasound
- 54. WHAT IS THERMIVa • It’s a Non-invasive temperature controlled radiofrequency device . • RF energy delivered deeply into vulva ,vagina • Tissue tightening immediately • Newer and tighter collagen stimulation – new softer and smoother skin
- 55. THERMI Va Non –surgical No anesthesia Painless OPD procedure Immediate results
- 56. No pain Treat outside (labia) Treatinside (vagina) No downtime For any age For loose vagina For loose labia For dry vagina For leaky bladder For orgasmic problems
- 57. Heating of theskin and mucosa promotes 3 different kinds of effect: • Immediate contraction of collagen • Immediate collagen remodeling and elasticity • Long term stimulation of production of new collagen HOW WORKS
- 58. HOW WORKS THERMAL NEUROGENESIS increases blood flowand restores nerve signaling resulting in normal vaginal lubrication. - Red Alinsod, MD
- 59. TREATMENT TIME :what it takes ?? • External labia : 5-10 min, atrophy/lax • Full vagina : 30 min • SUI &OAB :10-15min • Atrophic vaginitis: 10 min • Cystocele : 7-10 min • Rectocele : 7-10min • Orgasmic dysfunction : 15-20 min
- 60. NEWER MODALITY Vaginal LaserTherapy Clinical Solution For A Better Feminine Life
- 61.
- 62. Alma FemiLift Key Differentiator:Treatment Time and Efficiency The Alma FemiLift allows Selective Targeted Treatment Areas meaning practitioners can target specific areas or zones 45 degrees at a time i.e. protocol choosing between 11 o’clock and 2 o’clock for maximum thermal efficacy and penetration depth. ThermiVA ThermiVA uses a disposable wand to deliver RF energy to the external and internal vagina. Requires time to increase temperature into the “therapeutic range” of 40-45° C. Thermal reaction only, no ablative reaction reduces long term neocollagenisis. Requires topical numbing cream for external use (30-45 min)
- 63. 3. ThermiVA hasa single use probe which times out after 1 treatment and can’t be reused on the same patient for treatments 2 & 3. Per patient costs are $450 vs $120 for Femilift. Femilift has a much better ROI. ThermiVA is Monopolar and also requires a grounding pad. Push downside of “old” mono RF technology and importance of positioning grounding pad in the correct spot. How are we different?
- 64. FemiLift Probe Key Differentiator ThermiVAWand Small shape – can’t be reused – slow with small spot size Slim Shape – ease of use. Comfortable for practitioner and patient.
- 65. Femilift™ is anFDA-approved pixel CO2 laser designed and invented by Alma Lasers™ to treat vulvo-vaginal dryness, vaginal laxity mild to moderate urinary incontinence, mild prolapse Vulval diseases Definition
- 66. Rationale for usinglaser therapy • 1970 • Late 80s’-90s’ Full field ablation for facial rejuvenation • 2004 Fractional phothermolysis • 2009 Vaginal Fractional phothermolysis • 2014 FDA approves vaginal fractional co2 for: Skin tightening Vaginal atrophy
- 67. Effect of Laseron Tissues Photostimulation Photodianamic Reaction Photothermolytic Action
- 68. What is VaginalLaser • Vaginal Laser Stimulates Production Of Collagen, Elastin And Fibroblast Activity. • Treat And Improve: Stress Urinary Incontinence , Vaginal Laxity And Dryness.
- 69. Er:YAG laser • 2940Nm Wavelength • Maximum Absorption By Water • Minimal Penetration Depth • Short Thermal Relaxation Time • A Short Pulse Width Can Provide Precise Control With Minimum Damag • Can Be Used To Be Ablative In High Fluence Ranges –Either Very Superficial Or Very Aggressive And Deep In Turbo Mode
- 70. Some Satisfied and Happycustomers contacts: 1. MRS. REENA JAJPURIYA 99260-44117 2. MRS. GARIMA VYAS 98264-23061 3. MRS. NARMADA SEPTA 99934-40608 4. MRS. ANITA JIRATI 83191-85301 5. MRS. NIRMALA GOSWAMI 88899-97235 6. MRS. LALITA PANCHOLIA 99260-71802 6. MRS. JYOTI ARYA 97558-98762 7. MRS. ANJALI DEMBLE 95454-00085 8. MISS. SONAM RAJPUT 96442-21056 9. MRS. BINDU MANDLOI 94259-93231 10. MRS. KANCHAN ARORRA 88899-78620 11. MRS. TANYA WADHWANI 89624-76347 Successfully Completed INCONTINENCE THERAPY FOR STRESS URINERY INCONTINENCE = 67 INTIMALASE THERAPY FOR VAGINAL TIGHTENING = 16 RENOVALASE THERAPY FOR UROGENITAL SYNDROME = 17 TOTAL THERAPY= 100 Therapy at INDORE centre on Erb laser INTILASE
- 71. What is • vaginalCO2 laser stimulates production of collagen, elastin and fibroblast activity. • Treat and improve: stress urinary incontinence , vaginal laxity and dryness. • Utilizing CO2 Pixel Laser Technology: Long term thermal effect Micro ablative effect Gold standard in Face Treatment & Skin Tightening
- 72. 74 The Technology of FEMILIFT BEING USEDWIDELY IN INDIA BY DEMRA ABOUT 10 GYNAECS USING FEMILIFT IN INIDA KOLKATA BANGLORE JAIPUR AGRA SURAT DELHI NASIK NELLORE MUMBAI
- 73. 75 Pixel CO2 laser DeepThermal Heating and Micro-ablation • Laser energy is delivered to the vaginal tissue through a DOE - Diffractive Optical Element • DOE pixelates the beam to 81 microscopic pixels in a 9x9 pattern • Pixel pattern promoting faster healing • Deep thermal effect for vaginal collagen
- 74. 76 Pixel CO2 laservs. Scanner 1 Laser Beam81 Micro Beams
- 75. 77 Pixel CO2 laservs. Scanner 1 Laser Beam81 Micro Beams At the same fluence the Pixel CO2 is 81 times longer than the Scanner 30W * T = 100 mj/Pixel T=100/30 T=3.33 msec (Pick Power ; Ablative) 30W/81 Pixel * T = 100 mj/Pixel T=100*81/30 T=270 msec Thermal Effect Treatment Energy 80-120 mj/Pixel Enhanced thermal effect
- 76. 78 Pixel CO2 laser Strongand Impactful Thermal Effect • High-powered laser • Utilization of much higher energy levels by longer pulse duration • Microscopic columns of thermal zone penetrates deep into the submucosa, leaving the surrounding tissue intact, with minimal ablation
- 77. structural support How doesthe FemiLift Pixel CO2 Works? Alma Pixel CO2 surgical laser utilizes fractional technology to create micro-ablation and thermal damage to the mucosa and sub-mucosa • fractional laser through holographic lenses pixelating the beam to 81 microscopic beams (pixels) • ablated mucosa and microscopic columns of thermal damage that penetrate deep into the sub- mucosa • Strongly stimulates the growth of new collagen • Collagen remodeling allows tissue re- firming, causing CO2 Laser
- 78. Effective Mechanism ThermalDamage Superficial Shrinkage Deep Asceptic Wound Collagen Remodeling
- 79. Collagen Remodeling & Stimulation-Mechanismof Action Acute Thermal Damage Phase (48-72 hours) Edema Release of Chemical Mediators Collagen Shrinkage Proliferation Phase (30 days) Fibroblastic Recruiting New Dermal Molecular Matrix New Collagen Fibers Remodeling Phase (? months) Mature Collagen Fibers New Elastic Fibers
- 80. Beam Splitter –Alma’s CO2 Pixel Solution • Fractional CO2 combines micro-ablative approach with longer pulse for deep thermal effect • Allows short, easy and efficient treatment protocol reducing procedure time
- 81. 83 Mechanism of Action TheAction Process Has Three Phases: Edema Release of chemical mediators Shrinkage of collagen and elastic fibers Early thermal effect Phase I Within 48-72 hr. Fibroblastic recruiting New extracellular matrix New collagen fibers Proliferation Phase II In the following 30 days Mature collagen fibers Increase of collagen fiber strain Neovascularization: new blood vessel formation Improved lubrication, pH (acidity) Remodelling Phase III After 30- 40 days Physiologic and functional recovery of the vaginal mucosa.
- 82. + Normal tissueis comprised of a thin top layer (the epidermis) that rests on a deeper layer (the dermis). The dermis contains a matrix of collagen (the basic building block of skin) and elastin that provides structure and support to the vaginal tissue. Dermis Epidermis Elastin Fibers Collagen Fibers + Aging and obesity degrades the vaginal tissue’s normal collagen and replaces it with abnormal tissue that does not stretch and recoil. This creates tissue laxity. Elastosis + CO2 laser removes the abnormal upper tissue layers, and stimulates new collagen growth in the dermis to effectively restructure and restore it to a state that resembles undamaged tissue. New Collagen Collagen Remodeling Process
- 83. Vaginal wall coloscopicimage immediately post FemiLift treatment
- 84. Micro Ablative Effect Colposcopicpicture of vaginal wall post FemiLift treatment • Smooth treatment without damages or carbonizat ion Immediately post treatment Two weeks post treatment
- 85. Histology histological HE samples fromthe time just after the ablative effect (A), the filling of the vaporized space" as a column shape (B) at 72-96 h, the progress of healing in the vaporized area (C) (D) at 14 and 28 days respectively, and finally the rejuvenated fascia at two months (E).
- 86. Collagen re-growth 6months post FemiLiftTreatment Before After
- 87. 89 Histologies Thick vaginal epithelium,rich in glycogen Atrophic vaginal mucosa. Thin epithelium with mild parakeratosis Neovascularizatio n in the sub-epithelial, lamina propria Courtesy of Jorge Alberto Eias, MD , Buenos Aires, Argentina Pre-treatment Post laser treatment Post laser treatment
- 88. Menopause: The Journalof The North American Menopause Society Vol. 22, No. 8 Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study Stefano Salvatore, Umberto Leone Roberti Maggiore, ,Stavros Athanasiou, et al
- 89. Advantages • non invasiveprocedure • Office procedure • “coffee break” procedure -lasting approximately between 10-20 min • Easy and safe procedure • Minimal discomfort and pain • Effective • Rapid healing • Single use and hygienic vaginal probe
- 90. To achieve safeand effective collagen remodeling for vaginal tissue rejuvenation, it is important to have thermal effect and avoid ablative damage. FemiLift™ Safety
- 91.
- 92.
- 93.
- 94. Objectives Improving VaginalDryness & Pain Vaginal Tightening & Improving Sexual Experience Treating Mild to Moderate Stress Incontinence
- 95.
- 96. 98 Pixel CO2 Integrating Technologyand Convenience for Optimal Results • Uses an 10,600 nm CO2 laser • Power up to 30W/ 70W • Intuitive, user friendly interface • Adaptable to most surgical microscopes and colposcopes
- 97. FemiLift Single UseHygienic Vaginal Probe: Femilift reusable hand-piece with a single-use sheath
- 98. All in One,Multi Package FemiLift Probe FemiLift Slim Probe FemiLift Smart FemiTight LiteScan FemiCam
- 99. Protocol • Femilift probe •Apply liquid lidocaine 2% on the introitus, Waite 3 minutes • The inner part of the introitus 25 mj/p , 3 passages • Outer part of the introitus. 15 mj/p , 3 passages • Repeat if necessary after one month
- 100.
- 101. 103 Vaginal Tightening • Powerfulthermal heating and micro-ablation is applied to the various layers of the vaginal tissue in a 360 degree pattern • Vaginal tissues remodelling The Treatment
- 102. Objectives Improving VaginalDryness & Pain Vaginal Tightening & Improving Sexual Experience Treating Mild to Moderate Stress Incontinence
- 103. Vaginal Wall Tightening Remodelingtissue throughout the vagina
- 104. Collagen Remodeling process Dermis Epidermis CollagenFibersElastin Fibers + Normal tissue is comprised of a thin top layer (the epidermis) that rests on a deeper layer (the dermis). The dermis contains a matrix of collagen (the basic building block of skin) and elastin that provides structure and support to the vaginal tissue. + Aging and overweight degrades the vaginal tissue’s normal collagen and replaces it with abnormal elastic fibers that do not stretch and recoil. This creates tissue laxity. Elastosis + Co2 laser removes the abnormal upper tissue layers, and stimulates new collagen growth in the dermis to effectively restructure and restore it to a state that resembles undamagedtissue. New Collagen
- 105. Fractional microablative CO2laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study. Menopause 2016 Oct;23(10):1108-13 Pagano T et al Fractional microablative CO2 laser treatment is associated with a significant improvement of VVA symptoms in women affected by hormone-driven breast cancer. This procedure has the advantage of relieving iatrogenic/physiological VVA symptoms without resorting to contraindicated estrogen preparations, which have been the most effective therapy thus far.
- 106. Urethra Support –can be achieved with FemiLift URINE URINE Normalsupport under the muscle URINARY INCONTINENCE Loose collagen fibers NO URINARY INCONTINENCE Firmed collagen fibers Loss of support under the muscle
- 107. The effect ofmicroablative fractional CO2 laser on vaginal flora of postmenopausal women Climacteric 2016 Oct;19(5):512-8. Athanasiou S et al MFCO2-Laser therapy increased Lactobacillus (p < 0.001) and normal flora (p < 0.001) after the completion of the therapeutic protocol, which decreased vaginal pH from a mean of 5.5 ± 0.8 (initial value) to 4.7 ± 0.5 (p < 0.001). The prevalence of Lactobacillus changed from 30% initially to 79%
- 108. 110 FemiTight For Labia MajoraTightening • Treatments conducted with this probe use a low fluence beam laser that gently heats the tissue • Effectively restoring and reviving collagen growth
- 109. 111 LiteScan For Labia MajoraRejuvenation • Char-free tissue ablation with multiple scanning patterns • Promotes accelerated re- epithelization, allowing for faster healing and tissue regeneration • Significantly improved overall skin tone, elasticity and texture, and reduced superficial pigmentation
- 110. 112 The System Our experienceUSING SINCE6 MONTHS AGRA 35 SUI CASES 10 VAGINAL TIGHTENING :4 post delivery 5 GENITAL PROLAPSE UNFIT FOR SURGERY 1 WARTS 1 RESHAPING 1 LICHEN LIKE 3 VULVAL VAGINAL ITCHING 2 VAGINAL DRYNESS ALSO BEING USED BY COSMETIC DEPPT COLLECTIVE INDIAN EXPERIENCE OF OVER A YEAR WITH OVER 200 CASES OF SUI
- 111. Pre-Treatment Consultation CompleteHealth History Questionnaire Vaginal / Bladder Questionnaire Complete OB/GYN History, Including Pap Smear Results Pelvic Exam
- 112. Contraindications Active HPV/ Herpes Abnormal Pap Smear Active Vaginal Infection GYN Cancer Undiagnosed Vaginal Bleeding Uncontrolled Diabetes Pregnancy Recent Vaginal Injury Any Active Bleeding (Including Menses)
- 113. Treatment Protocol OfficeProcedure No Anesthesia 2-3 Passes of Entire Vaginal Canal 3 Sessions 1 Month Interval 1 Memory Session After 1 Year May Repeat Full Course After 2 Years
- 114. NON GYN USESIN WOMEN • PREGNANCY STRETCH MARKS • FACIAL LASER • WARTS ANYWHERE • DARK SPOTS AND MOLES • SCAR MARKS POST C.S. KELOIDS • EVOLVING INDICATIONS • OPERATIVE EXTERNAL ALSO WITH CUT LASER
- 115. Case 1 • 45y, G3P2, nurse, patient zero • Healthy, no operations • For 2 years pain in the introitus on 12 o'clock. Affect work, avoidance from sex. trial of various local treatment -failed. Work up - no infection, normal colposcopy, diverticula-ruled out • Started femilift • Before tx VAS 90, after first tx VAS 60 , after second tx VAS 40, after third tx VAS 1/2,resumed sexual activity VISUAL ANALOG SCORE FOR PAIN SEVERE 75-100 45-74 MODERATE 5-44 MILD 0-4 NO PAIN
- 116. Case 2 • 32y, G1 P1 • Healthy no operation • Since delivery Vulvodynia , local tx, behavioral tx, physiotherapy, local anesthetics - no improvement . Infection- ruled out, normal colposcopy • Started femilift • VAS before tx 10, after one tx 7/8, after second tx,5 after. Third 3
- 117. Case 3 • 36y G2P2 • Healthy no operations • 2 years pain during intercourse, siting • No infection normal colposcopy • Vas before 9 after one tx 7 after second 4
- 118. Case 4 • 28y G0 • Healthy no operations • 5 y pain in introitus , no infection, normal colposcopy • Trial of various local tx , behavioral tx, physiotherapy - no improvement refers for vestibulectomy • VAS before tx 9, after one tx 3 satisfied
- 119. • Vaginal tightening •Post delivery rehabilitation • SUI • Vaginal dryness • Vulvar rejuvenation • Scars • Vulvodynia/ Vestibulitis • Lichen sclerosis • Vaginal infections • Bleaching THE NEED IS REAL THE NEED …NEEDS TO BE RESPECTED SHE SHOULD DECIDE ITS HER WHICH MATTERS WHY SHOULD SHE SUFFER IN SILENCE
- 120. Domestic & International Experience 87% of patients report significant improvement in Vaginal Rejuvenation and Tightening 78% of patients report improvement of Stress Incontinence 88% reported complete dryness afterwards 12% have less leakage afterwards 22% with insignificant or no improvement
- 121. There is nosuch thing as PERFECT or COMPLETE… only continuous improvement. GIVE H.E.R. WINGS AND LET H.E.R.SOAR PRACTICE WITH QUALITY,ETHICS AND DIGNITY
- 122. FOGSI 2018 ISFOR H.E.R.WITH Q.E.D.
- 124. Thank you Acknowledgements toprof ronen gold,dr ruby ruprai,dr carolyn ,dr vidya pancholy Dr rashmi chaar khandelwal,dr lila vyas and ALMA lasers FOR HELPING TO MAKE THIS PRESENTATION AND SHARING DATE AND SLIDES