Cosmetic Procedures


O-Shot

Jose Nodarse MDWhat is PRP?

Well over ten years ago, medical scientists began to realize that a specific “fraction” of human blood contained special growth factors and healing-inducing properties. This portion of blood, known as Platelet-Rich Plasma (PRP), is devoid of red blood cells but contains blood serum. It is what’s responsible for blood clotting and tissue healing. In everyday life, we know PRP as that yellow goo around a scab from whence healing generates. In addition to speeding healing, platelet rich plasma also contains a significant array of growth factors that make it an enhancer of function of the tissue areas that it comes into contact with.

Platelet-rich plasma can be isolated from one’s own blood and re-injected into an area of the body where it may induce healing or growth-enhancing properties including cell growth, new tissue generation and repair, neovasculogenesis (formation of new blood vessels), and collagen production. These effects are similar in many aspects to those seen from human stem cells.

PRP is created in the office. We use your own blood via a process that involves having small amount of your blood drawn, similar to that performed in the lab during a routine venipuncture. After being drawn, the growth factors are isolated from the blood plasma via centrifugation in a special fraction-isolating tube. Then it is mixed with calcium chloride or calcium gluconate to initiate the activation process.

PRP is all about the isolation of growth factors. PRP induces new collagen, fibroblastic activity, and healthy blood vessels. It can be used to increase sensation and diminish scar formation.

Gynecologic uses of PRP and development of the “O-Shot®.”

PRP found its first widespread medical use by orthopedic surgeons beginning about 10 years ago. They injected it into the immediate post-surgical area to enhance the healing process after orthopedic joint surgery. Their efforts resulted in elite athletes healing from joint surgery in 6-8 weeks rather than 6-8 months. It was only a matter of time before isolation and use of growth factors and multipotential cells began to find widespread use, and other specialties began research into uses for their areas. I first became aware of PRP’s potential gynecologic uses 4 to 5 years ago, and have followed research into gynecologic and aesthetic applications closely since that time. I am now convinced and confident that PRP has a safe and unique role for the specialized gynecologist.

Five years ago, a doctor from Alabama, Charles Runels MD, also became interested in gynecologic and sexual uses for PRP. He was spurred on by a request from a personal friend who had researched the safety of re-injecting this blood product into a specific area of the body (her vagina). Seriously wondering if injection specifically into the clitoris and/or the “G-spot” would serve to enhance orgasmic function, Dr. Runels prepared her platelet-rich plasma and re-injected it at the base of the external clitoral glans, and in the general area of the G-spot under the anterior vaginal wall ~ 1 inch in from the urethral opening. The results were striking and, since the recipient was actually Dr. Runels’ girlfriend, unforgettable!

The “O-Shot® was born!

Beginning with that one woman, the word got out and soon several other women lined up to get the same procedure. In almost every case the results were reproducible: orgasms — both clitoral and vaginally activated — were both easier to accomplish and enhanced in quality, amplitude, and frequency. Unexpected at the time, a secondary benefit was noticed. Many of the women who received the O-Shot® had also suffered from occasional bothersome urinary incontinence before the shot. Their symptoms were diminished or cured by the O-Shot®.

Why would injecting PRP around the urethra in the “G-area” help with incontinence?! It may be that PRP leads to new cellular and vascular growth of tissues in the area. There is also the possibility that because the tissue planes under the upper vaginal wall allow for free flow of the PRP around the urethra and around the base of the bladder (a total of 5cc’s or ~ 1 teaspoon of PRP is injected), the tissues of the bladder base and the urethral sphincter muscles are strengthened.

The O-Shot® has found other gynecologic uses. Lichen sclerosis is an insidious and progressive skin disorder of the vulva that can cause significant itching and eventually severe atrophy. In some cases it can even lead to disappearance of the vulvar clitoral and labial structures. Experts in this not-uncommon disease, — including Dr. Andrew Goldstein of the Center for Vulvovaginal Disorders of Washington D.C. and New York City, along with Dr. Runels — are completing a study using the O-shot®. They are placing PRP under the skin in areas of lichenoid changes and are having success with previously recalcitrant cases.

The sexual improvements noted with the O-Shot® and improvements in stress urinary incontinence are documented by reams of anecdotal information, but have yet to be evidence-based. This may change soon, as data is currently being collected by O-Shot® researchers.

Risks of injecting one’s own PRP into the body have been discussed, but no actual drawbacks (see below) have been put forth, nor have complications been reported. The O-Shot® involves re-injecting a fraction of one’s own blood back into the body, albeit a highly processed and select portion of the blood. The only complication reported from utilizing PRP has been when sterility was broken and the sterile nature of the entire blood withdrawal, processing, and re-injection had been seriously compromised.

A majority of women feel significantly improved sexual arousal and orgasmic intensity beginning a day (unusually early) to 1-3 weeks after injection. If no improvement is noted, the injection may be repeated 4-6 weeks later. Sexual function improvements from the O-Shot® have been reported in an estimated 80-90% of women (anecdotal data from papers presented at meetings; not sustained at this time by published evidence-based research). Effects appear to last between 1 to 3 or 4 years, with 2 to 3 years appearing to be the median, but these reports are anecdotal rather than research based. When improvements wane, the shot can be repeated. With the exception of sepsis (rare!) where sterile technique is violated, there are no reported risks.


ThermiVa

ThermiVa

Genital Cosmetic surgery (Labioplasty, Vaginoplasty, Vaginal Rejuvenation, etc)  trained at  The Labiaplasty and Vaginoplasty Training Institute of America™ (“LaVaTi™)

Labiaplasty—“Labial Reduction/Beautification” for Large Labia

A woman’s labia minora (the lips) of the vulva, which stretch on each side of the vaginal opening from the clitoral hood to the perineum, come in all shapes and sizes. There is a large span of normality in size, ranging from small strands to larger “elephant ears. The fact that something is in the range of normality doesn’t mean that you as an individual are comfortable with the size and appearance. Just as the size of your nose or breasts may make you unhappy, the same can be true of your labia.

In many instances, women are born with large labia; others may develop the condition following childbirth or with age. Labiaplasty is surgery to reduce/modify labial size. Women seek labiaplasty consultation for possible revision of the size of their labia for two reasons: functional or aesthetic (or a combination of the two).

Functional reasons for labiaplasty/labial reduction can include discomfort or irritation experienced when wearing tight pants or while engaging in sports such as cycling or other physical activities. Other functional reasons include hygiene difficulties and large lips getting in the way sexually.

Aesthetic (beautification) reasons for labiaplasty, whether with or without reduction of “floppy” hood size, include self-consciousness and self-esteem issues or simply a desire to achieve a better look. Women seeking aesthetic labiaplasty do not wish to see a large protrusion of their hypertrophic hood or labia dangling out from between the outer lips (labia majora.)

There are several different techniques that a physician may use to reduce the labia and their appearance, and a qualified physician will take the time to determine which is most appropriate for your specific situation and goals. All involve reduction and resculpting. The two most popular techniques are Linear Resection and V-wedge. A linear resection involves the use of a straight or arced incision along the outer edge of the labia minora in order to remove excess tissue. This can then be closed with an absorbable, under the skin suture line. The V-wedge resection removes a v-shaped wedge of tissue on the outer edge of the labia. The edges of the incision are then closed together and sutured to maintain a natural looking outer edge. Both techniques, and variations that a specific physician may choose, provide good results with little to no nerve damage as long as they are performed by physicians with considerable skill and experience in the procedure.

Labiaplasty—“Labial Reduction/Beautification” for Large Labia

A woman’s labia minora (the lips) of the vulva, which stretch on each side of the vaginal opening from the clitoral hood to the perineum, come in all shapes and sizes. There is a large span of normality in size, ranging from small strands to larger “elephant ears. The fact that something is in the range of normality doesn’t mean that you as an individual are comfortable with the size and appearance. Just as the size of your nose or breasts may make you unhappy, the same can be true of your labia.

In many instances, women are born with large labia; others may develop the condition following childbirth or with age. Labiaplasty is surgery to reduce/modify labial size. Women seek labiaplasty consultation for possible revision of the size of their labia for two reasons: functional or aesthetic (or a combination of the two).

Functional reasons for labiaplasty/labial reduction can include discomfort or irritation experienced when wearing tight pants or while engaging in sports such as cycling or other physical activities. Other functional reasons include hygiene difficulties and large lips getting in the way sexually.

Aesthetic (beautification) reasons for labiaplasty, whether with or without reduction of “floppy” hood size, include self-consciousness and self-esteem issues or simply a desire to achieve a better look. Women seeking aesthetic labiaplasty do not wish to see a large protrusion of their hypertrophic hood or labia dangling out from between the outer lips (labia majora.)

There are several different techniques that a physician may use to reduce the labia and their appearance, and a qualified physician will take the time to determine which is most appropriate for your specific situation and goals. All involve reduction and resculpting. The two most popular techniques are Linear Resection and V-wedge. A linear resection involves the use of a straight or arced incision along the outer edge of the labia minora in order to remove excess tissue. This can then be closed with an absorbable, under the skin suture line. The V-wedge resection removes a v-shaped wedge of tissue on the outer edge of the labia. The edges of the incision are then closed together and sutured to maintain a natural looking outer edge. Both techniques, and variations that a specific physician may choose, provide good results with little to no nerve damage as long as they are performed by physicians with considerable skill and experience in the procedure.

Many women requesting labiaplasty surgery also wish to reduce the size of a robust clitoral hood. Occasionally a patient wants hood reduction as a stand-alone procedure, or separation of a hood that has become so fused as to disallow protrusion of the clitoris during arousal. Artistically reducing the hood is the pinnacle of genital plastic expertise.

I perform almost 100% of my surgeries in my office surgical suite under local anesthesia, a safer and less invasive method and certainly a cheaper option, though the “asleep-in-the-hospital” option is available for those who find it more comfortable.


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Boynton Beach Location

2828 S. Seacrest Blvd.
Suite 102
Boynton Beach
Florida, 33435

Office Number: (561) 413-2850
Office Fax: (561) 509-7102
Email: info@nodarseobgyn.com

West Palm Beach Location

1495 Forest Hill Blvd.
Suite D
West Palm Beach
Florida, 33406

Office Number: (561) 651-9056
Fax Number: (561) 509-7102
Email: info@nodarseobgyn.com

Copyright by Dr. Jose Nodarse MD. All rights reserved.