54 yo mother of two from Denver, Colorado located the office of Board Certified, Fellowship-Trained Urogynecologist and Master Cosmetic Surgeon Dr. Oscar Aguirre of Parker, Colorado through a friend of hers. She presents with a greater than 10 year history of undesired cosmetic appearance of her vulva. Since turning 40, she has noticed an enlargement of her labia minora as well as darkening. She stated this creates physical discomfort as well as aesthetic concerns. Dr. Aguirre performed a thorough pelvic examination which revealed bilateral labial hypertrophy with hyperpigmentation, right side greater than left. There is also redundant lateral prepuce on the right side and excess perineal skin. There are 2 anal tags present as well, but these are not bothersome to the patient. Dr. Aguirre consulted with patient and discussed all surgical and non-surgical options in detail. She decided to proceed with definitive surgical therapy in the form of an in-office aesthetic vulvar surgery. Dr. Aguirre performed Laser Reduction Labiaplasty of Bilateral Labia Minora, Excision of Redundant Lateral Prepuce, right side only, and Excision of Excess Perineal Skin. She returned to the office for her regularly scheduled postop appointments, very happy with her results.