Hyaluronic acid for the vulva
It is used both to provide volume and to stimulate tissues. Hyaluronic acids vary significantly from one another. The choice of the right product is key to the success of the treatment.
Hyaluronic acid for the labia majora and vulvar beance
Indications
large emptied lips and beanza
Surgical Technique
hyaluronic acid implant
Procedure
20/30 minutes, local anesthesia
Complications
rare (edema, infections)
Postoperative Pain
no
Recovery
immediate
Hyaluronic acid for revitalization
Indications
dryness
Technique
hyaluronic acid implant
Procedure
10/20 minutes
Pain
no
Complications
rare (edema, infections)
Recovery
immediate
The term filler (from the English ‘to fill’) refers to a set of injectable substances of various natures into soft tissues to correct wrinkles, furrows, and depressions caused by aging or to increase the volume of the treated areas. The use of fillers generally allows for immediate correction and, when done regularly, provides lasting results over time.
General premises
It is advisable to use only absorbable and authorized products specifically for use in the vulvar area, which are currently all based on hyaluronic acid. The spontaneous absorption of such substances is an essential requirement to ensure their safety. It is prudent to avoid the use of permanent synthetic products (non-absorbable) or absorbable products in areas previously treated with non-absorbable fillers: possible allergic reactions or infections would be very difficult to treat. To date, there is no injectable product completely free from potential risks of irreversible complications. These substances persist permanently in tissues as foreign bodies, and the long-term consequences are not yet fully known. Such substances are NOT approved for use in the vulvar area.
Hyaluronic Acid
It is a polysaccharide, that is, a complex sugar, naturally present in our body. Hyaluronic acid constitutes in particular the extra cellular matrix of the dermis (the deepest part of the skin), giving firmness and firmness to the skin.
Hyaluronic acid based gel
It is an extremely biocompatible gel, with modulated hygroscopic (water recall) and plastic capacities, made up of water and synthetic hyaluronic acid, obtained from bacterial fermentation. The product is made more stable – that is, better protected from natural degradation processes by enzymes (jaluronidase) – through a process called “cross-linking”, which consists in the use of some molecules – BDDE and PEG – which form bridges chemicals that bind the hyaluronic acid chains together. Some gels contain other substances that strengthen the anti-free radical power and protect against biological reabsorption processes (mannitol, etc..). After infiltration of the hyaluronic acid-based gel, the corrective effect is achieved largely by virtue of the recall of water in the context of the injected molecules; this eventuality can in some cases produce an “overcorrection” of the treated areas, with the possible formation of “beads” or “accumulations” visible on the skin for a few days or weeks. The corrective action of hyaluroic acid is also expressed in part thanks to the interaction with fibroblasts, particular cells present in the skin, which are stimulated to greater production of new collagen, elastin and hyaluronic acid. Hyaluronic acid is the most popular filler for the treatment of wrinkles, furrows, small depressed areas and for increasing the volume of the lips, cheekbones and other areas of the face. There are five different types of hyaluronic acid on the market. Low density products are indicated for correcting upper lip wrinkles and peri-orbital “crow’s feet”. The duration of the corrective effect is only 2-3 months. Medium density products are mainly used for filling the lips and treating deep wrinkles and have a duration ranging from 4 to 6 months. High density products are mainly used for the treatment of nasolabial folds and even higher density products for filling cheekbones and restoring facial volumes. For the genital area, gels are marketed characterized by a specific density specifically modulated for the genital area. The functional or aesthetic genital advantage lasts from 3 to 12 months depending on the type of product used.
Indications and treatment methods
For the female genital area, two types of hyaluronic acid-based gels are available:
1) The first type is indicated to improve symptoms related to skin and mucosal hypotrophy (dryness, dyspareunia or pain during sexual intercourse, idiopathic itching); it is infiltrated into the mucosa of the vaginal entrance with a small wheal technique and, when necessary, throughout the entire vulvar area with the aim of hydrating the area and improving the trophism of the mucosa and skin.
2) The second type of filler is indicated to improve the appearance of the labia majora, the mound of Venus, atrophic and/or depressed post-cesarean and post-episiotomy scars. It is infiltrated with a needle or cannula in the subcutaneous area, based on the degree of the initial volumetric reduction of the labrum major or the severity of the cicatricial depression of the area to be treated.
The implant session lasts from ten to thirty minutes, based on the indication (Functional or Aesthetic) and the patient’s condition. The inoculation, especially on the large lips, can be painful, but lasts a few seconds. To limit pain, the parts to be treated are cooled with ice and/or with products that contain minimal quantities of anesthetic; in some cases, local anesthesia may be appropriate through the infiltration of small quantities of 2% Lidocaine.
After treatment, a thin layer of antibiotic cream is applied to the treated areas and the skin is usually only slightly red and swollen. After cannula implantation it is advisable to take antibiotics by mouth, according to the doctor’s prescriptions.
Post-treatment conditions
The treatment does not limit, except partially and for a short period, social and work activities. After the implantation of hyaluronic acid-based gel in the vulvo-vaginal area, it is still good practice to avoid:
• sexual intercourse for 3-10 days, depending on the type of treatment
• for 7 days any activity that induces pressure on the treated area (cycling, horse riding, etc.) and wear clothing that constrains the treated area;
• for 10 days crowded and/or humid places (swimming pools, gyms, Turkish baths, whirlpools, etc.);
• for 15 days to shave the treated area or to use drugs or cosmetics unless you have obtained specific authorization from the Doctor.
Pace of treatments
For functional goals: 3 successive sessions spaced about two months apart; the treatment cycle is repeated when symptoms reappear, which typically occur 6-12 months after the last infiltration.
For aesthetic goals: The optimal appearance is achieved after a variable number of infiltrations, typically ranging from 2 to 4, depending on individual conditions.
Duration of the corrective effect
The duration of the corrective effect – whether it is aesthetic or functional – varies from 3 to 12 months, depending on the chemical characteristics of the product used, the initial conditions of the treated area, the type of skin, and the patient’s lifestyle. Hyaluronic acid is gradually absorbed, making the slow reappearance of skin depressions or symptoms related to mucocutaneous atrophy inevitable.
Possible complications
After the use of injectable fillers, mild swelling that subsides in 4-6 hours is normal. In some cases, post-implant edema or swelling can occur and may last up to 3 days. The hydrodynamics of the genital area (the ability to retain fluids, especially during certain moments of relational life, such as during sexual intercourse, in fertile age, and during the menstrual cycle) can contribute to this occurrence.
If the needle has passed through a small skin vein, bruises or small hematomas (bruises more or less evident and lasting) may appear. Occasionally, the formation of small cords or accumulations of product at the treated defects may occur, and regression is often spontaneous. Very rarely, pigmentation at the injection site, localized granulomatous reactions, bacterial infections, palpability or visibility of the implant, nodularity, and hypersensitivity reactions may occur.
