54 yo mother of two from Castle Rock, Colorado initially located the office of Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado, from an add she saw in the Women’s Edition magazine. She presented four years ago for evaluation of stress incontinence as well as undesired cosmetic appearance of her vulva and vaginal looseness. At that time she underwent a series of CO2 fractional resurfacing of the vagina with excellent improvement in vaginal lubrication and urinary incontinence. She continues to be an avid athlete and notices stress incontinence only with very exertional activity. She returns to the office ready to address the aesthetic appearance of her Vulva. Dr. Aguirre performed a thorough pelvic examination which revealed bilateral and symmetric major hypertrophy with hyperpigmentation of labia minora, excess redundant bilateral lateral prepuce with ptosis, anal skin tags and a perianal tag. After discussing with Dr. Aguirre all surgical and nonsurgical options, she chose to move forward with Aesthetic Vulvar Surgery, but wanted to avoid a mesh sling so she chose The Viveve Treatment to reduce her stress incontinence. Dr. Aguirre performed an in-office awake Labiaplasty of the Labia Minora, Clitoral Hood Reduction, and Clitoropexy with PRP (Platelet Rich Plasma) to surgical site, Excision of Anal Skin Tags and Excision of Perianal Skin Tag. She followed up in the office for her regularly scheduled postop appointments with excellent results.