65 yo female from Casper, Wyoming referred to the office of Urogynecologist and master cosmetic surgeon Dr. Oscar Aguirre of Englewood, Colorado by her local OBGYN. Her chief complaint is that her “Labia are much too large and sex is painful.” She noticed in her 40s that her labia were longer which has progressed to its current severe state. She describes being unhappy with her long dark labia minora and older-looking vulva in addition to wanting a stronger orgasm and stronger libido. Immediately following a thorough pelvic examination, she and Dr. Aguirre discussed all surgical and non-surgical options. Due to driving from out of state, she was committed to proceeding with definitive surgical therapy the following day. Dr. Aguirre performed an awake, in-office Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction, Clitoropexy with PRP (Platelet Rich Plasma), Anal Tag Excision as well as Excision of Excess Perineal Skin and O-Shot. She also proceeded with Bioidentical Hormone Replacement Therapy. She returned to the office for her regularly scheduled postop visit, with excellent results.