Reasons for Training in Genital Plastics

With the corporatization of medicine, with insurance companies and other “entities” taking control of gynecologists and physicians practices and lives, with the debacle of EMR, there appears little gynecologists can do to take back control of their lives from these corporate entities.  For  the Plastic Surgeon untrained in surgery on the vulva, adding training and skills in female genital plastic/cosmetic surgery and labiaplasty in particular, is a means to add value to one’s practice, not losing your patient to another surgeon, cosmetic gynecologist, gynecologist, or P.S. because you are not trained in genital plastics. Ditto for the general gynecologist, familiar with the anatomy and with surgical skills involving the vulva and vagina, but untrained in the art of plastic surgery, the use of fine suture materials, and the absolute “Rules” involved in female genital plastic/cosmetic surgery.

Additionally, I believe physicians truly wish to HELP their patients, which is why so many gynecologic surgeons untrained in their Residency in the performance of aesthetic and functional labiaplasty still endeavor to help their patients by performing aesthetic surgery, especially labiaplasty, that unfortunately they are ill-prepared to perform correctly with respect to design, with respect to technique, with respect to suture choice, and with respect to proper informed consent and post-operative instructions. Results from this surgeon population is not unexpectedly often disastrous, and if a malpractice action follows, defense for surgeons lacking formal training is difficult.

Aesthetic medicine offers the gynecologist on an ever-shortening leash the opportunity to add cash procedures to an ever-shrinking revenue stream, without concomitant increase in practice hours. Struggling Gyns have realized that one aesthetic procedure in an afternoon can generate as much revenue as the remainder of the day combined. Genital plastics is no exception, with average fee collected similar to the entire intake from two full days of practice.

But it is rarely the economics and practice burnout alone that motivate Ob/Gyns and Plastic Surgeons to seek individual training in labiaplasty, vaginoplasty and perineoplasty (vaginal reconstruction), and O-Shot and laser techniques. Our patients are inquiring, asking questions, requesting. We know a little about the field. Often we have done a labiaplasty or 3, but we know that knowledge of patient selection, techniques, pitfalls and personal experience trumps just muddling our way through, or missing the boat as these procedures become more mainstream.

An additional reason to consider training is the change in privileging and insurance payments presently occurring. Where historically, with the diagnosis of “labial hypertrophy,” and both booking the case, and billing insurance using the procedure code for “Partial Vulvectomy,” hospital boilerplate privileging, and the fact that the partial vulvectomy code is not a plastic surgery code have allowed the surgeon to both be privileged for the procedure, and to be paid by insurers for an ostensibly non-cosmetic procedure (which frequently it turned out to be..!) So often, women expecting an aesthetic reduction of their labial hypertrophy ended up with a decidedly non-cosmetic result, justified by the surgeon by the fact that, despite what the patient expected, the procedure was booked and billed as non-cosmetic. This will change, as hospitals and insurers are becoming more savvy.

So, then, what are the reasons to be trained in Labiaplasty? In vaginal reconstruction (aka “vaginoplasty + perineoplasty”)

Reasons to consider training in “Genital Plastics:”

1. Professionally performed labial reduction (aka”labiaplasty”) should be, and is, a cosmetic procedure, When performed by an Ob/Gyn generalist without added training in FGCS under the “boilerplate” privileging of “partial vulvectomy” it decidedly is not a “cosmetic” procedure, and as such is submitted for what is quite minimal monetary insurance reimbursement. Likewise, a posterior colporrhaphy (posterior repair) is decidedly not a sexually and aesthetically enhancing procedure. It does not tighten the vagina nor functionally or aesthetically support or enhance the introitus, vulvar vestibule, or perineum. As these procedures are considered (or should be considered!) “cosmetic, as such they are not not covered by insurance, and as such may be billed “cash” to the patient. True cosmetic or sexually enhancing procedures are not covered by insurance. Bringing this “cash business model” into your practice frees you up from the ties that bind physicians and surgeons to the third-party entities that endeavor to make money off of our labors.
2. Female patients present either to their gynecologist or P.S. for labial reconstruction, and to their gynecologist for vaginal tightening. Are you prepared to lose the revenue stream potentially generated by these women with their very reasonable requests? Potential patients are now quite savvy in researching on the web and winnowing out untrained surgeons.
3. Hospitals are in the process of tightening up their privileging requirements. Presently, surgeons perform labiasplasty under boilerplate “Partial Vulvectomy” privileging. Any surgeon who has received specialized training in aesthetic labiaplasty, and vaginal tightening/vaginoplasty can legitimately ask for special privileges for these procedures, similar to the specialized endoscopic CO2 laser privileging, or other privileging which requires evidence of advanced training. This privileging sets the surgeon apart as one who has trained and is competent to perform these surgeries. It also then makes it difficult for the general gynecologist without training to continue to be able to perform labiaplasty at that facility, and establishes the mindset that there is a difference between a site-specific repair and a true vaginal and perineal sexually enhancing tightening procedure, and between a non-aesthetic labiaplasty/partial vulvectomy and cosmetic labiaplasty with reduction of redundant clitoral hood.
4. Surgery is stressful. The fact of good training in all aspects of FGCS including patient selection, pre-and post-op counselling, and choice of techniques and suture material serves to make the whole aspect of genital plastics, of sexual medicine, of the uses of platelet-rich plasma (PRP), etc. less formidable for the gynecologic surgeon.

Surgical training at LaVaTI includes:

1. The ONLY training program in the U.S. or abroad to include BOTH linear and V-wedge modification techniques in training
2. Professionally produced full length videos of linear/trim labiaplasty, wedge LP, vaginal reconstruction (perineoplasty+ vaginoplasty) and a full-length video of a patient consultation interview. **These videos and ALL course materials are available online for re-viewing for one year after the training program.
3. Training in composition and administration of local anesthesia in both LP minora and majora, and vaginal reconstruction.
4. Lots of information and instructions involving marketing and training of office staff. Also the only program to include and welcome office staff members at a very minimal $250 fee which includes all meals. Training in setting up an office suite. Full information re: where to purchase all materials involved in office-based genital plastic/cosmetic surgery.
5. Information in performance of O-Shot™ and other uses of PRP. (Dr. Goodman is an official O-Shot™ Trainer)
6. Training in patient selection, rationale for surgery, surgical design, choice of wedge vs. linear/trim procedure, and surgical design.
7. Careful, complete training involving patient acquisition, patient selection, informed consent, recovery protocol, patient expectations, etc.
8. One-on-one close personal instruction, and the ability to observe live office surgery if desired.
9. Ongoing personal communication with Dr. Goodman for consultation and advice regarding trainees specific cases.
10. This is a “Certificated” program with 14.5 official Category 1 AMA CME credits, and sufficient for award of official hospital privileging for aesthetic procedures.
11. Ongoing communication for office staff with Ms. Sanders-Pardi as regards to patient communication and marketing.
12. “Animal lab” allowing trainees to work with animal material similar to female labial epithelium.
13. All meals, snacks, coffee provided. Courses held at a hotel adjacent to Sacramento International Airport for easy come & go to the Friday/Saturday course.

Take back your professional life! Add “genital plastics” to your practice. Become certificated in your local hospital, well-trained and comfortable in performance of labiaplasty, clitoral hood reduction, and vaginal tightening procedures. One to two procedures will reimburse cost of course!