Feminine Rejuventation: What You Need to Know


Aging is inevitable, and most people tend to think of it in terms of changes in their skin, their weight, their mental function and athletic abilities. Historically, aside from the prevalence and popular ads regarding Viagra, reproductive/sexual wellness and function have fallen somewhat wayside but that is now changing! Women’s magazines, blogs, physicians and celebrities are speaking out about women’s gynecological health with aging (hello Grace and Frankie?). 
Changes in both appearance and function are totally normal, but can change day by day which can be disconcerting! So following puberty, what’s generally normal? 

  • In your 30’s (or following childbirth)
    • Pelvic floor muscles can weaken and distend; this can lead to incontinence and lack of support in activities.
    • Vaginal tears can occur with birth – this can also change the outer appearance.
    • Redundant tissue can appear following children or just as a part of age
    • Hormones, particularly post-partum estrogen, can increase dryness (although this may just be temporary).
  • In your 40’s and 50’s
    • Perimenopause (5-10 years before menopause) keeps up with estrogen. Estrogen keeps collagen and surrounding soft tissue flexible and healthy which promotes good blood flow to the area. 
    • When estrogen levels start to decrease, the tissue gets thinner and less flexy. Less lubrication is produced. Following menopause (on average this occurs at 51) the vagina and clitoris can diminish in size with labia becoming less full (this can increase the appearance of sagging or increase ‘hang’). These changes can be related to vulva-vaginal atrophy – an occurrence that can cause sex to become painful. 
  • In your 60’s and 70’s
    • Continued increase in atrophy and consequent dryness is to be expected – however, there is good news! 

Breaking the silence on these female issues is happening across a broad front, from increased publication and research, popular writings in blogs and magazines, female-specific sexual wellness products such as lubricants. Conversations about personal dryness, tissue laxity, burning sensations, itching, discomfort during sex, and even urinary incontinence can make life extremely difficult, embarrassing and may also take a toll on your relationships, both social and intimate.

Plastic Surgical Associates offers feminine rejuvenation with the Votiva system: a safe, effective treatment for feminine health that offers immediate results with continued improvement over time. 

What can be done?

Common Concerns:

  • Elasticity and wrinkle appearance of the labia and vulva
  • Low blood flow and sensitivity
  • Pain sensation caused by labial hypertrophy
  • Level of sexual interest and self esteem
  • Weakening of the vaginal muscles

‘Feminine rejuvenation’ covers a lot of ground within a single term, but frequently refers to non- or minimally-invasive platforms that address the causes of the above concerns, rather than simply the symptoms. Votiva is an FDA approved radio-frequency (RF) based platform by InMode that uses a FormaV ‘wand’, gently inserted into the vaginal canal, to heat and stimulate the cells of the vagina and vulva. This stimulation encourages tissue remodeling through increased collagen production in the area, thereby restoring elasticity, promoting increased blood flow and vaginal lubrication. This treatment requires no anesthesia and takes just a few minutes to perform. Although results can be felt immediately, improvement will continue over the following weeks. This process of rejuvenation induces the vaginal tissue to become more supple and elastic, while restoring moisture and natural lubrication. Women can sometimes notice a difference after their first treatment, although significant improvement is typically seen after three sessions with Dr. Laurie Niles.

Who would be performing this?

Nobody understands the intimate changes that occur to the female body like another woman. Life can create changes that can affect the look, feel and function of their vaginas. These changes can affect a woman’s lifestyle and self-esteem. Previously, women did not have many options to improve these issues. Dr. Laurie Niles, DNP will work with each woman to create a personalized treatment plan to achieve her desired outcome.

Wait, questions!

Does it hurt? 

You can expect to feel a heating sensation during treatment. 

Might I be a candidate? 

Women who are experiencing changes to their vaginal health post-menopause are generally the idea Votiva candidate. However, patients who also have a history of estrogen-sensitive cancer (like many breast cancers) or others who don’t like to use estrogen-based creams or lubricants may be candidates when experiencing vaginal atrophy, personal dryness or uncomfortable tightness, urinary incontinence and/or uncomfortable sexual intercourse.

How much does Votiva cost?

A single session of Votiva is $1,100, however, if purchased in a package of 3 (the usual number of treatments needed for desired goals to be met), the package price is $3,000. More sessions are available based on personal preferences and desires – we recommend at least 4-6 weeks between treatments.


Women considering vaginal rejuvenation often feel more comfortable discussing their goals with a female plastic surgeon (Dr. Diane Duncan) or female FNP (Dr. Laurie Niles). We understand that pursuing options in this area takes courage, and recognize it’s not necessary to simply sit back and accept changes to your body if it creates unhappiness or negatively impacts life and lifestyle. As a board-certified female plastic surgeon, Dr. Diane Duncan or board certified DNP, Dr. Laurie Niles can work with you to develop a personalized vaginal rejuvenation plan with the non-surgical Votiva radio-frequency treatment. Contact our office today to schedule your consultation at Plastic Surgical Associates of Fort Collins, P.C.

What’s the deal with exosomes?

These little guys are hot the aesthetic buzz; but what are they and how do they work? When you look at a cell, all have an intracellular structure called an endosome (meaning that the vesicle is inside the cell). These tiny compartments contain smaller nanoparticulate containers measuring 20-100 nanometers – smaller than the diameter of the human hair. Initially, these were considered to be the ‘trash cans’ of the cell, but now we know that these endosomal particles contain valuable cell signaling biomarkers such as cytokines, chemokines, mRNA, miRNA, and genetic messengers. Their job is to influence neighboring cells to change their behavior.

Exosomes are formed when these endosomes fuse with the plasma membrane of the outer cell wall. A gap in the cell wall is created, and the tiny particles are released into extracellular fluid (ECF). These newly extracellular vesicles were initially associated (a little over 30 years ago) with cell to cell signaling. More recently, they are exploding onto the aesthetic scene as the better-than-stem-cell alternative as stem cells have the potential to become a variety of things ‘at will’ whereas exosomes can be programmed to be more specific and targeted. They are lipid vesicles that shuttle various proteins and genetic informatics between cells (including distant cells – they don’t need direct cell to cell contact!). Messages from exosomes can include rapid healing sequences, tissue repair promoters, and reparative biomarkers that improve tissue quality. Interestingly, about 91% of the effects of stem cells are transmitted in exosomes through a process known as paracrine cell signaling.

So exosomes or stem cells? Stem cells are unprogrammed, transformative cells that encourage regeneration in damaged or diminished tissues. Dr. Duncan frequently combines autologous stem cells into her fat grafting procedures as a way to brighten the skin, remove lining and creasing from underneath, and ensure optimal graft take. Exosomes are naturally present messengers for stem cells that encourage unhealthy cells to begin improving. According to Scientific Reports Journal, “exosome secreted by human adipose mesenchymal stem cells promote scarless cutaneous repair by regulating extracellular matrix” remodeling. The human adipose mesenchymal stem cells are what Dr. Duncan targets when refining fat for fat grafting, and supplement grafted fat with extracted stem cells.
However, not all patients want something as invasive as fat grafting in order to obtain autologous stem cells or exosomes. Currently about 15% of people wanting to improve their appearance choose surgery while the other 85% opt for minimally or noninvasive options. The logic is simple. No one will choose a procedure that creates a significant temporary deformity unless the payoff (8 to 10 years’ worth of improvement) is guaranteed. Instead of destructive procedures, most are interested in restoration of their own existing tissue. What does the field look like for those patients? Stem cell serums from cryopreserved human umbilical cord MSCs are entering the market (check into InfiniViveMD Stem Cell Serum) and lab-grown exosomes (see Benev products) are also becoming available. Exosomes are cultured from stem cells in conditioned media. They are not FDA regulated if applied topically, but they are not FDA-approved for injection.

At PSA, we use exosomes primarily to accelerate healing following a resurfacing treatment such as Neogen or Erbium laser. Stem cell and exosome facials are also available at Dr. Duncan’s office here in Fort Collins; give us a call to see how these non-invasive modalities might glow up your game!

Wang, Lu, et al. “Author Correction: Exosomes Secreted by Human Adipose Mesenchymal Stem Cells Promote Scarless Cutaneous Repair by Regulating Extracellular Matrix Remodelling.” Scientific Reports, vol. 8, no. 1, Jan. 2018, doi:10.1038/s41598-018-24991-y.

BIA-ALCL; A Patient’s Story

As awareness of breast implant complications rises, so do concerns about the safety of breast augmentations. While some complications range from swelling and minor numbness post-operatively, others are more serious, such as BIA-ALCL.

Plastic Surgical Associates got to witness one of the rarer ones, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), first hand. A patient came in when her original surgeon dismissed her concerns. Although BIA-ALCL is rare (estimated rate of incidence varies from one in a million to 1 in 2,832*), Dr. Duncan felt that something was off and reached out again following the initial assessments.

Here is the patient’s side:

“Dr. Duncan’s diagnosis of BIA-ALCL in my right breast was missed by my original plastic surgeon. I had [severe] swelling in one side that came and went over the course of a few weeks. I brushed it off, attributing it to lifting a heavy weight, or a post breastfeeding change. I had minimal pain and never thought it couldn’t have been something so serious. After meeting with Dr. Duncan about downsizing my implants, I received a notice from her office explaining her concern that I could have BIA-ALCL. She wanted me to take precautionary measures whether I used her as a surgeon or not.

She absolutely saved my life.

Not only is this women a genius and an incredible plastic surgeon but she is extremely tasteful and truly cares about her patients. She is so up to date with her practice that she diagnosed something many doctors haven’t even heard of at the time.

I had two surgeries to fully removed my textured implants and the cancerous capsule. I was prepared for my breasts to be completely destroyed since I went from over a DD cup to a small B. Dr. Duncan made me look great, and more importantly, I am healthy! Dr. Duncan is amazing and so is the entire staff!”

We are so grateful to be able to assist patients with difficult turning points in their lives, and this was one of those cases. Finding a surgeon who stays up to date on advances and events in the field, as well as assessing those changes from an academically rigorous viewpoint, is incredibly important! For more about Dr. Diane Duncan check out some information here.

*Note: these rates of incidence are for patients with textured implants. Textured implants with more surface area (i.e. larger implants) seem to show a higher chance of BIA-ALCL within the current RESEARCH.

Diane Duncan, M.D., FACS

Award-winning plastic and reconstructive surgeon, Diane Duncan, MD, FACS has been recognized both regionally and globally for over 30 years. Read More