21 yo from Englewood, Colorado referred to Board Certified, Fellowship-Trained Urogynecologist and renowned Cosmetic Surgeon Dr. Oscar Aguirre of Denver, Colorado by a local OBGYN for a Labiaplasty consultation. Patient has a seven year history of undesired cosmetic appearance of her vulva. At age 14 she first noticed large labial tissue, which bothered her with gymnastics and made her self conscious in front of girlfriends, with formfitting clothing, bathing suits, or showering at health clubs. Since becoming sexually active she has experienced significant discomfort with penetration due to pulling and dragging. This has also affected her ability to relax during intimacy which has also created a significant strain in her relationship. Pelvic examination performed with a chaperone present and patient observing with a handheld mirror. This revealed bilateral labial hypertrophy with hyperpigmentation as well as redundant lateral prepuce with ptosis. She has low volume labia majora which is also distressing to her. All history and findings were discussed in detail with the patient as well as all surgical and nonsurgical options and realistic expectations. Dr. Aguirre recommended Laser Reduction Labiaplasty of the Labia Minora, Clitoral Hood Reduction and Clitoropexy but encouraged her to postpone any intervention of her labia majora, and perhaps consider a Vampire Puff in the future, but only after assessing the results of her Labiaplasty. She was eager to move forward and scheduled to have Dr. Aguirre perform the recommended procedures in an in-office surgical setting. She returned to the office for her regularly scheduled postop appointments thrilled with the results of her new look.