With the prevalent media coverage of “external genitalia grooming,” the demand for female genital aesthetic procedures has been steadily increasing. According to the American Society for Aesthetic Plastic Surgery, a 15% increase in 2019 compared to 2018. Like other body areas, female genitalia are affected by the normal process of aging. The decrease in hyaluronic acid, collagen, and fat result in volume loss, rhytids development, and an increased minora to majora ratio with a seemingly prominent labia minora. These age-related changes not only affect the physical appearance of the female external genitalia but also disrupt sexual functioning. The sexual self-esteem decreases, resulting in a significant psychosocial impairment. In this live surgery on external genitalia, we are going to rejuvenate the area by performing the technique of Stromal Enriched Lipograft™. We are going to revert the age related signs of aging by injecting fat enriched by adipose derived stem cells.
Which technique will be used?
The Stromal Enriched Lipograft™ technique will be used in this case. Fat will be aspirated using the syringe method. The 2/3 of the aspirated fat will be used in order to isolate the SVF. Digestion will be done with 0.075% collagenase. Separation of the SVF containing ADSCs will then be done by using centrifugation at 1200 x g for 5 minutes. The Automatic Cell Station will be used. The SVF is located in the pellet derived from the centrifuged fat at the bottom of the lipoaspirate. The remaining 1/3 of the aspirated fat will be treated in the following manner: with the syringe held vertically with the open end down, the fat and fluid will be separated. Isotonic saline is added to the syringe, the fat and saline are separated and the exudate discarded.

The procedure is repeated until the fat becomes yellow in colour, free of blood and other contaminants. In Stromal Enriched Lipograft™ (SEL™), freshly isolated SVF is attached to the aspirated fat, with the fat tissue acting as a living bioscaffold before transplantation. This whole procedure is done inside the operating theatre, and the time required is about 90 minutes.The adipose tissue graft enriched with SVF will be woven into the external genitalia area, injecting only a tiny amount with each pass as in order to obtain the most reliable clinical outcome. Tissue planes are created by using specific cannulas in different trajectories, always from the deeper aspect to more superficial areas. The fat is injected as the cannula is withdrawn in order to avoid intravascular fat injection.

What are the results of this procedure? Labia majora augmentation by Stromal Enriched Lipograft™ is a safe, efficient technique with a high satisfaction rate. It can be done for aesthetic, reconstructive, or functional indications, alone or in conjunction with other procedures. What are the benefits, when compared to conventional techniques? Regenerative cell-based strategies such as those encompassing the use of stem cells hold tremendous promise for augmentation of the soft-tissue space. Published clinical series show that adipose-derived stem cells offer the possibility of finally fulfilling the key principle of replacing an aesthetic filler, without the drawbacks of old methods of lipofilling. Stromal Enriched Lipograft produce superior results without the need for repeat treatment sessions, which are necessary with autologous fat transplantation. The presence of adipose-derived stem cells in adipose tissue transplantation may contribute to neoangiogenesis in the acute phase by acting as endothelial progenitor cells or angiogenic-factor-releasing cells. The number of functional ADSCs is likely to be important for tissue repair and remodelling and ADSCs differentiate into vascular endothelial cells which contribute to neoangiogenesis in the acute phase of transplantation. ADSCs up regulate also their proneovascular activity in response to hypoxia, and may harbour the capacity to home to ischemic tissue and function cooperatively with existing vasculature to promote angiogenesis. Successful SEL graft requires attention to patient preparation, meticulous planning, and optimizing the harvesting, storage, and transplantation of adipose tissue. SEL graft is a living tissue that must be in close proximity to a nutritional and respiratory source to survive.