March 17, 2026 • 30 mins
Do you ever feel uncomfortable, self-conscious, or even in pain… and wonder if it’s just something you’re supposed to live with?
This week on Plastic Surgery Uncensored, Dr. Rady Rahban dives into one of the most misunderstood—and rarely talked about—topics in women’s health: vaginal rejuvenation.
Let’s be honest… even saying the words can feel taboo. But here’s the reality: this isn’t about vanity or trends—it’s about function, confidence, comfort, and quality of life. And it affects far more women than anyone openly admits.In this episode, Dr. Rahban breaks down the full picture—from anatomy to options—so you can finally understand what’s normal, what’s possible, and what actually matters when considering treatment.We cover:
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
This week on Plastic Surgery Uncensored, Dr. Rady Rahban dives into one of the most misunderstood—and rarely talked about—topics in women’s health: vaginal rejuvenation.
Let’s be honest… even saying the words can feel taboo. But here’s the reality: this isn’t about vanity or trends—it’s about function, confidence, comfort, and quality of life. And it affects far more women than anyone openly admits.In this episode, Dr. Rahban breaks down the full picture—from anatomy to options—so you can finally understand what’s normal, what’s possible, and what actually matters when considering treatment.We cover:
- The real reasons women seek vaginal rejuvenation (hint: it’s not what you think)
- How childbirth, aging, and genetics change the body over time
- The most common concerns—from labial discomfort to loss of volume
- A clear, no-BS explanation of procedures like labiaplasty, fat transfer, and more
- What recovery actually looks like (and what no one tells you)
- The biggest risks and mistakes patients need to avoid
- And the truth about who should really be performing these procedures
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Welcome to another episode of Plastic Surgery Uncensored. I'm your host,
doctor Roddy Raubon, and as always, we have an exciting
episode for you. We're going to talk about vaginal rejuvenation.
So I pause there because just saying it is like, ooh,
you said, that's kind of like one of those words
that you're like kids saying the chuckle, penis, vagina, things
(00:30):
like that. But reality is that vaginal rejuvenation is a
real entity. It's very very important. It is way more
poorly understood than breast dog or rhinoplasty, and it impacts millions,
if not hundreds of millions of women. So I think
it's a very very important topic to discuss and discuss
(00:51):
often infrequently, and I think the way to get around
sort of the stigmata of things is to actually discuss them.
The more you discuss it, the less awkward to become.
You know, you say penis once and it's like ugh,
he said penis, and you say penis twenty five times
and it's just like a it's like a medical term.
Now it doesn't really even mean anything except for education.
So what we're going to do is we're going to
(01:11):
tackle the idea of the totality of vaginal rejuvenation or
the aesthetic improvement of the area of the vaginal anatomy,
and we're going to sort of go over what does
that entail, why would I do it, what are the
benefits of it, what's the risk of it, and what's
(01:31):
the recovery of it. It's always we want to comprehensive
understanding of the subject matter so that when you a
you're like, oh shit, I didn't know that was the
thing that I could do. Be Oh, I knew it,
but I didn't know what I needed. See. Oh wow,
I'm going to this doctor in Minnesota, and now I
know what the conversation should be about. Okay, So let's
(01:52):
dive right in and let's talk about vaginal rejuvenation. First
of all, the assumption is it must be just some
vanity or some esthetic thing or some porn thing. Not
at all. First of all, there are two parts to
ninety percent of the things we do in plastic surgery.
There is the esthetic cosmetic part, very important not to
(02:12):
be undermined, and then there's often and very very frequently,
a functional component. And in vaginal rejuvenation it's the same thing.
There is a esthetic as well as a functional component.
So what causes the vaginal anatomy to become either less
esthetically desirable. God, when I was in my twenties, I
(02:34):
didn't have even an issue with this, and now I'm
thirty nine or forty two and it's a concern. And
the other is, you know, I'm having issues, discomfort, etc.
So first of all, childbirth is nuh duh. I mean,
you think about childbirth, you've either undergone it or you've
seen it, and you think to yourself, Oh my god,
(02:55):
I cannot believe what the female human has to go
through in order to give birth. It's actually shocking to
me how amazing and elastic our anatomy is that you
can go back to being essentially more or less normal.
The second is just aging, Right, everything changes with age,
your eyebrows, your neck, your eyelids. There's no reason that
(03:16):
your anatomy of your vaginal region is not going to change.
And lastly, just genetics. Some people are nineteen and they
have ginormous breasts that are sagging and they need of
breast reduction. They didn't have kids, they didn't breastfeed or
any of that stuff. So we're going to get into
all of that, and our goal is to just sort
of become knowledgeable. So let's break down the anatomy and
(03:39):
then break down what's available and what's possible. So, the
most common procedure or the most commonly requested or concerned
the patients have is the labia minori. So if we
look at the opening of a woman's vaginal and trod
it's vaginal vault, there is the outer labia. Those are
the cushions, so to speak. Those are the labia and
(04:01):
the inner labia labia of course in Latin being lips.
The inner labia which are the thinner, more protruding anatomy
that's in the middle. So very frequently, for the above
mentioned reasons I gave birth, I've gotten older, or frankly,
which is born this way, the labia in the middle
become either very long asymmetric, and then as a result
(04:26):
create a host of issues. So when you are looking
at your introitis the opening of your vaginal region, and
you have excess labia, excess meaning protruding beyond the level
of your outer labia, the labia majora sort of set
the plane of your labia. When your laba extend extensively
(04:49):
from that plane protrude. It may or may not cause issues.
First of all, in and of itself, it may be
perfectly fine, awesome. Then this is just kind of interesting.
But for many it that creates the following issues. Number One, Esthetically,
it makes many women feel uncomfortable, whether that is during
intimacy with their partners, during during intercourse, etc. So that
(05:11):
creates a sense of insecurity, doesn't Insecurity is personal, so
no one can judge from the outside and ever should
say anything about insecurity. In other words, why would you
be insecure? It's natural, It's a part of the human anatomy.
Well why are you insecure about I was eating lunch
and I have a seed between my tooth. It just
is what it is. And I'm a firm believer that
(05:32):
if something is an insecurity and becomes a significant disruption
for you in other words, you're constantly thinking about it,
it then intrudes in the organic experience of your life.
And for many women, because of their insecurity of the
appearance of their laba, they are then not present during intimacy,
and in my humble opinion, that really ruins the beauty
(05:53):
of intimacy, which is about all presence and being in
that moment. So number one, I don't like the way
they appear. Number Two, when I am intimate during intercourse,
they are getting pulled, tugged on, rubbed, and they are uncomfortable.
I have pain with intimacy, very very common if the
(06:14):
laba has become significantly long. Another is when I am
clothing and wearing clothes. I'm at the beach, I'm wearing
thin garments. You can actually see them and is very
It makes me embarrassed, So I don't wear bathing suits
or have to wear very specific bathing suits. Next, hygiene wise,
(06:36):
I have extra folds. And obviously, to begin with, the
area of the vaginal opening has a lot of bacteria
and a lot of warmth and a lot of rubbing,
so that is a cocktail for infections and irritations and
odor and things of that nature. So those reasons alone
are the reason why knowing about labia, labioplasts, or labial
(07:02):
anatomy is important. So labia the inner labia or labia
minora are the most common complaints the patients have. The
treatment for that is a labioplasty, meaning correction of those
and we'll get into that in a second. The second
next area or commonly requested areas my labia minora. The
inner labia are fine, but over time my outer labia.
(07:25):
The outer labia have lost volume and as a result
have deflated. And as a result, I don't like either. Again,
the aesthetics there, I just don't like the way that looks.
They're hollow and or functionally, when I am intimate or
when I am riding a bicycle or whatever, I have
discomfort because I have no cushion. They are actually the
(07:47):
cushion that protects your android, is your entry to your
vaginal vault, and as a result, they kind of cushion
or the bumpers on the outside. So labia majore restoration
is also known. The next thing is my outer labia
are perfectly fine. My inner vaginal vault. The inside of
(08:11):
my vaginal vault is been stretched out during babies. It's
been torn. I had a episiotomy, I had very very
large natural births, et cetera, et cetera. And so there
is vaginal plasties which involve some type of reconstructing or
tightening the inner cylinder of your vaginal entry. Now I'll
(08:35):
mention it briefly. I don't do that. That's often done
by guynecologists or GYNs. But we will delve into it
a little bit just so it's a complete discussion. So
those are the things that are available now. As I
mentioned to you, the most common one is a labioplasty
for the labio minore, and this is what it's about.
So essentially, the idea is that my inner labia have extended,
(08:57):
have become too long or too large or asymmetric. So
the treatment for it is trimming the excess labia such
that when we're done, they are more term, more never exact,
more symmetrical, and now flush with my outer labia. And
as a result, there's not an extension which can then
(09:19):
tug or grab onto things. Now, in my humble opinion,
the labioplasty surgery is way over complicated by many people.
What do I mean? Essentially, it's a blepheroplasty removing the
eyelid excess above your eyelid. If you think about it,
the upper and lower eyelids are like the two labia,
(09:40):
and your upper eyelid when it has excess skin and
starts to hang. When we get rid of your upper
eyelid skin, we do a little ellipse, and we remove
just the right amount of eyelid skin in a kind
of a in a kind of a football shaped kind
of excision. Well, that is really the way, in my opinion,
labioplasts be done. Find the excess redundancy very accurately and
(10:05):
very carefully, trim it, repair the edge, and call it
a day. Now. It's not without its pitfalls, it's not
without its issues. It's by no means an easy surgery,
but the surgery is made way more complicated, in my opinion,
by other surgeons by creating super asotiric wedges, cutting in shortening.
(10:25):
There's all kinds of stuff online, and as a surgeon
of twenty plus years, I've never found any of those
to be necessary. And I personally think a lot of
the complications associated with labio plases come from over complicating
the surgery. So the surgery that I suggest for a
labia minore resection is one that's a linear transsecting, just
(10:47):
removing the excess such that the labia now sit flush
and more symmetrical to the outer labia. Okay, great, so
that's done. Who does these surgeries? Ah? So this is
an interesting subject matter. In the past, you would go
to your who sees your labia more than anyone in
(11:08):
the world besides your life partner, your OBGYN, and your
obgyn in the past, would you'd go to them and
be like, hey, I'm having this issue and blah blah blah.
They say, oh, okay, great, yeah, there's a great surgery
for that, and they'd send you out to your plastic
surgeon who would then do your labioplasty. Well, today that
doesn't really happen anymore because the obgyns have decided that
(11:30):
they want to do the labioplasts themselves. What drives that
always as economics, I have no concern about that. That's
up to you and the patient. But naturally the gatekeeper
to labioplasts is going to be your ob because at
the end of the day, you're at your ob more
than you are anywhere else, and they're the one looking
at your labia, and that's who you're going to be
complaining to. I don't know their training. I can tell
(11:53):
you our training, our knowledge base of anatomy, our general
fund of esthetics. And I always think, and I'm biased
because I do think that our training in general is
the greatest amongst everybody. To manage wounds, tissue closures, suiture material,
everything in that nature. I think plastic surgery training is
the most superior. Doesn't mean every plastic surgeon is superior.
(12:15):
There are some really shitty plastic surgeons. But now plastic
surgeons are doing fewer and fewer and fewer these because
they're not really getting to the plastic surgeons because the
OBD winds are holding on to them themselves, and that's
between you and your patient and your OB. I tend
to still think the plastic surgeon is the best suited
person to do it, even though your OB is in
(12:36):
the vagina every single day. That doesn't necessarily mean to
me they're the best suited esthetically and refinement wise to
do the surgery. A perfect example is I do C
section closures at the time of delivery for patients who
are very specific and want me to close them during
(12:59):
their delivery. And while ninety nine point nine percent of
ce sex closures are done by OB's, well, when I
go there, it's a much more comprehensive closure. It doesn't
mean that OB's don't do a good job. It doesn't
mean OB's are not capable. I don't want OB's getting upset.
It's just there's they deliver in twenty five minutes, I
close in thirty minutes. They normally close in seven minutes.
(13:20):
So obviously we are going to put in a little
bit more energy in my opinion. So just understand who
the gatekeeper and who's doing it and why they're doing it. Okay, great,
so now I understand that. So let's just for a
moment then step into Labia majorare reconstruction. So Labia majority
reconstruction is basically essentially unlike Labia minore, which have extended,
(13:45):
these have deflated and as a result are hollow. There's
a little bit of cushion. And what do we love
about youth. It's full, full face, full breast, And when
labya has become deflated, they tend to be aging and
it's often a case as we get older and or
very skinny. So like other things that get deflated or hollow,
(14:05):
let's just take your cheeks for example. Often and in
this instance the same the treatment is volumizing, replenishing, filling
that area. There are two forms of volume restoration that
pretty much take almost ninety nine percent of volume restoration
in the body, and one of them is filler, and
the other is fat. When it comes to the labia,
(14:28):
in my opinion, by far, the best option is just
fat restoration. You've lost faty tissue and it's a small
area and almost always you can find enough fat to
replenish that area, and I like fat transfer to the
labia majority the best. If for whatever reason you don't
have it, you don't want to undergo a small procedure
because obviously, in order to get the fat, we need
(14:50):
to harvest the fat, and that's a small procedure. Nevertheless, alternatively,
if you just have a little bit of deflation, you
can use filler and again as a always HA hyaluronic acid,
base fillers, restall in restaalin lift, juveiter and juvenile plus
things of that nature. And like in the cheeks, it's temporary.
(15:11):
It volumizes and likely will go away and you'll have
to fill it in again. But definitely adding some volume
will rejuvenate or make it more youthful, and sometimes that's
all it takes to make that area look better. The
last area we touched on, and I'm going to really
just touch on it because again I don't do it
and I don't have any real knowledge about it or
experience is the notion of taking the vaginal vault, the
(15:33):
actual tube the inside of your vagina which can get
stretched enlarged during delivery and childbirth and whatnot, and basically
making the cylinder tighter. And the way they do that
is by generally sowing the back wall. Imagine like I
do during a diastasis or abdominoplasty, I'm sowing the vaginal.
(15:56):
You'll be sowing the vagina to itself and making a
large cylinder into a smaller cylinder, and that's predominantly a
vaginoplasty in what they do. Alternatively, there are devices, because
we're always pushing the envelope on technology, and there are
devices like radio frequency lasers, et cetera that basically heat
(16:17):
the inside of the vagina, hence creating scar tissue which
then tightens the vagina and is supposed to do something similar,
maybe much more mild, maybe temporary, et cetera. That whole
area is an obguin based area. I'm sure there might
be a plastic surgeon or two who does it because
they have experience in it. But in that area inside
(16:38):
the vagina, you're going to end up speaking to your OBI.
But know that it exists, right, because let's say during
intimacy you've lost the ability to have be stimulated, or
you feel uncomfortable when you're with your partner, what have you.
It's not uncommon. The last part of that is the
pelvis right. Often, if you have very very large babies,
you get a pelvic prolapse right, and you get vaginal prolapse,
(17:01):
rectal seals, etc. And that's a conversation for another day.
So let's now go back to the two major procedures
that we talked about, which is the outside right, the
outside of your vaginal anatomy, which is the inner labia
and the outer labia. Okay, so let's talk about now recovery.
So generally, the recovery, even though that area is such
(17:24):
a sensitive area, tends to be pretty pretty tolerable. In
other words, you do the surgery now. I tend to
do all these surgeries under Jennal anesthesia. I do all
my surgeries under jennallytesia for two reasons. One, I feel
it is the most comfortable way for a patient to
undergo an esthetic procedure. They are not feeling it, they
(17:47):
are not stressed and hearing us talking or chatting or whatever.
I just think that it's the most smooth experience for
the patient, and it is the most spooze experience for me.
And I am the one operation, and I like you
a sleep calm, so I can have a complete sterile
environment and I can do what I need to do
with high accuracy. When you are awake and you're discomfort
(18:09):
and you're moving and you're shifting and all that stuff,
I don't think it's ideal. Nevertheless, this area is often
especially with obgyns done in the clinic, you do some
local shots, you get an RCO or a sedative or
a little shot of versat or whatever the case is,
boombang bang, twenty minutes later, they're done and off you go.
So there's a vast spectrum of how this procedures can
(18:32):
be done, and that's your dealer's choice, and you have
to think about it for yourself. I personally think plastic
surgery is a luxurious experience. I personally think surgery should
be comfortable. Otherwise it is very ridden with fear. And
I think that patients for a nominal cost can get
significant more comfort. And I think that the risk of
(18:54):
anesthesia is close to zero. I said it this notion
of doing it awake is basically you're gas lit to
think that general anesthesia is so dangerous and I do
it under local, when in reality it's just a marketing ploy.
Hundreds of thousands of super sick people undergo anesthesia every
day for heart transplant, liver transplant, resection of cancers on
(19:17):
their pancreases, and they're sake as hell and they do fine.
You healthy young lady thirty five years old who runs
triathlons is worried about an hour of anesthesia. That's the
reason they're making you do it under general and just
suffering through it. It's nonsense. It's just a marketing nonsense
to get you to come in because at the end
of the day, who the hell wants any risk. So
(19:39):
the recovery basically is some discomfort for a few days.
There's really no wound care. I use absorbable sutures. Now,
this is very important. It depends on the suture caliber.
That's a very very delicate area. And I've seen other
obs use some really big sutures, big sutures that leave
big marks and stay there and then require long time
to come. They should be delicate, tiny, tiny, sutures that
(20:03):
absorb very quickly. You will do some sitz baths or
sit in a tub and let that soothe with EPs
and salt and things of that nature, and you'll be
back to work in probably a few days, maybe a week,
and you'll be back to exercise in about six. You'll
be back to intimacy in about six and six by
six I'm referring to six weeks. So it is a
(20:24):
very well tolerated, low maintenance procedure. It's not like some
of our other procedures, let's say rhinoplasty. Rhinoplasty takes months
and months to recover. It's good, you look great, you're
living your life, but you're not going to get to
your endpoint for quite some time. Labioplasts are because of
the quality of the tissue and the high degree of
blood supply. It actually does incredibly well, incredibly quick, so
(20:46):
that's the recovery. Follow Ups are maybe one week in
two weeks and one more time at let's say three months,
and the surgery should take really just take about an hour,
whether you're doing the inner labia outer labia. It's really
a relatively straightforward procedure. Okay, now, let's talk about risks
because that's always where I sort of like to push
(21:07):
the envelope because I think that's where this podcast is
the greatest value to you. Because everything I just said
to you can read in everyone's website, But I don't
think anyone's really gonna like highlight for you with great
emphasis on the things that can go terribly wrong, because
that's what I see all the time, right, I'm seeing
revision after revision after revision. So number one is bleeding.
(21:28):
That's right, bleeding. The labia has a ton of blood supply,
and if you do the surgery and one of these
blood vessels is in well cauterized or suture, then you
can get a hematoma. That's a big blood collection in
one of your labia, and that's a big, big problem.
So you need to be accurate and take your time.
(21:50):
Very often, labia policies are just like cut, cut, cut, suture,
let's go, and they're done in thirty forty minutes. They're
done under local, they're done in an office and off
you go. So I am a firm believer the less
respect you give a procedure, the more trouble you get.
That's why I do it under general anesthesia. I want
to take my time. I want to get a cattery.
(22:11):
I want to turn it up hot so I can
cutterize it. You don't feel it, I don't. I want
to just do it right. So bleeding you get, you
can get a hematoma infection is incredibly rare. Well, how's
that possible? I mean, there's thousands of bacteria, there's yeast everything. Yeah,
but that's the beauty of the mouth and the labia
(22:32):
and the anus. That area is blessed because it's designed
to have bacteria. Therefore, the immune system is so amazing
that you can bite inside of your mouth, create a
bleeding wound, and within four days it's healed. And I
don't know if anyone's ever got a mouth infection inside
their mouth, because that's just not the way the immune
(22:53):
system works. So very very rare scars. Again, if it's
done ugly, you're taking huge bites creating irregularities. Then the line,
the outer edge of your labia will be irregular and
not look good. So like a bleufferoplasty, like any other
(23:15):
incision line, the more accurate delicate time consumed it is,
the better it'll heal. In general, there should be no
visible scar because labia, if you know, is kind of rugated.
It's kind of like lumpy bumpy in general. The skin. Two,
it's usually colored, it has a little bit of pigment browner.
And three, the skin is super thin so it heals
(23:38):
incredibly well. So you should almost never see a scar.
If you see a scar from alabia plasty, it was
really poorly done. Next is asymmetry. So you go in
with everybody has some mild symmetry. I don't think in
my entire life hundreds and hundreds of lavioplastis I've ever
seen two labias identical. Some people have significant asymmetry, like
(23:58):
literally one three times large, and at the end you'll
have a little asymmetry. But I'm talking about you go
in there with relatively more or less the same level
of asymmetry and you come out with a significant asymmetry. Well,
that as a surgial error. Right, somebody removed too much
from one side, and now all of a sudden you're lopsided.
So that is one hundred percent preventable, and that happens
during markings. Right, the surgeons in a rush doesn't accurately
(24:21):
mark takes a little more off one side. Now you're
having lopsided labia. And by far the most significant risk,
which is a real risk, which happens all the time,
is over resection of labia. So let me explain that
is too much labia was removed. Why would that happen?
(24:43):
Because labiaplasts, even though they're done under local and quick
and now the obs are doing it and everyone thinks
it's no big deal and they'll do five or six
in a day, is a really tricky surgery. What's tricky
about it? The labia are really stretchy, and it is
very easy to pull the labia a little too hard
(25:07):
when you're marking it, So you're marking the excess right
you're cutting. How much is that extra? You pull on
it so that you can mark it, and then you
remove it and then realize it retracts, and oh shit,
I just removed way too much. And I cannot tell
you how many overresected labias I've seen because you don't
(25:28):
realize how delicate these labia are, and you're like, oh,
look at all this excess, and you go and remove
too much, and what happens? So now you're looking at
your labia majority on the outside, your inner labya of
retracted in so there is and more importantly, when you
open your leg it pulls your labia open. Right, What
(25:50):
is the purpose of your labia minora? Have you ever
wondered what the hell they're doing there? What they're doing
there is they're protecting the opening of your labia. The
inside the mukee area, the area that's moist, has pH
has bacteria, is glistening. The inside of a vagina is
a very moist and delicate environment. The inner labia. One
(26:11):
of their jobs is to seal that close and make
sure it doesn't dry out and desiccate. So when you're
moving and your legs separate a little bit, you just
don't keep opening up your labia. So when they're overly resected,
now all of a sudden you don't have lips, and
that area is prone to get changes in the mucosa,
drying out, accept infections, et cetera. So, believe it or not,
(26:37):
labia plastes minore are very tricky and as a result
require some thought. And yet again, and I will emphasize
why I like to do it with you asleep, because
I need to mark and remark and then check again.
And this and that the other. So at any rate,
that is my in my opinion, the main concern that
you need to be careful of when you do it.
(26:59):
All right, guys, I think think that covers the entirety
of vaginal rejuvenation. Oh there is one more thing in
vaginal rejuvenation which I know nothing about, and I think
it's mostly nonsensical. But you can do your homework. You
can go on Reddit. Is G spot enhancement. So in
an female vagina, inside the vaginal vault, there is an
(27:22):
area called the G spot, which is basically a collection
of sensory nerves, right, sensory nerves, and those nerves come
together and then for certain women are critical for orgasm stimulation.
It's very very important and as a result, it occurs
(27:42):
often with rubbing during intercourse and there are obs that
have advocated And maybe maybe there's truth to this that
by enhancing filling, like putting filler or other volume in there,
you make that area larger, hence more prone to getting
rubbed and then get extra extra stimulation. Again outside my wheelhouse,
(28:04):
don't know, but for completeness sake, I'll mention it to you.
I am just a big homework. Do your homework research fan.
I find that so many things, especially the easier the procedure,
the more problematic it is because the more doctors will
push it, and the more patients will want it because
(28:25):
it's easy, it's affordable, and a doctor can do high
volumes of it without any headache. So I don't know.
In a weird way, I think the more sophisticated, more complicated,
more involved, more costly surgeries and somehow are more realistic
because I don't think you can shamboozle your way through
it at any rate. That's a wrap. That's the episode
(28:49):
on vaginal rejuvenation. I hope you enjoyed it. I hope
that we tackled some of those concepts, and moreover, I
hope it allows you to realize, huh, maybe there is
something here that I want to explore any rate. I
have two requests at the end of each of our episodes.
Number one is, if you like the show, if you
find it entertaining, if you find it educational, do us
a huge favor. Would you go write something nice about
(29:11):
our episodes or our show. We appreciate it. It makes
everyone feel good. It actually helps our ranking so that
we can be read and seen by more people, and
I think it's very very sweet of you. So that's that.
And second, if you know anyone you're like, friends, family,
that you think might find this kind of interesting. You
(29:31):
never know who's about to go get a procedure. Usually
it's too late when you find out someone had a
cash strat rhinoplasti, or they had a tummy tuck that failed,
or a labioplasti that didn't work out. You're like, oh,
you should have heard this. It's too late because you
didn't know that they were going to do it. So
go ahead and send this to the people you love.
You'll be doing them a huge favor. All right, guys,
Until next week, I'm your host, doctor Roddy Rabon, and
(29:52):
I look forward to being with you again on plastic surgery,
Uncensored Football m
Welcome to another episode of Plastic Surgery Uncensored. I'm your host,
doctor Roddy Raubon, and as always, we have an exciting
episode for you. We're going to talk about vaginal rejuvenation.
So I pause there because just saying it is like, ooh,
you said, that's kind of like one of those words
that you're like kids saying the chuckle, penis, vagina, things
(00:30):
like that. But reality is that vaginal rejuvenation is a
real entity. It's very very important. It is way more
poorly understood than breast dog or rhinoplasty, and it impacts millions,
if not hundreds of millions of women. So I think
it's a very very important topic to discuss and discuss
(00:51):
often infrequently, and I think the way to get around
sort of the stigmata of things is to actually discuss them.
The more you discuss it, the less awkward to become.
You know, you say penis once and it's like ugh,
he said penis, and you say penis twenty five times
and it's just like a it's like a medical term.
Now it doesn't really even mean anything except for education.
So what we're going to do is we're going to
(01:11):
tackle the idea of the totality of vaginal rejuvenation or
the aesthetic improvement of the area of the vaginal anatomy,
and we're going to sort of go over what does
that entail, why would I do it, what are the
benefits of it, what's the risk of it, and what's
(01:31):
the recovery of it. It's always we want to comprehensive
understanding of the subject matter so that when you a
you're like, oh shit, I didn't know that was the
thing that I could do. Be Oh, I knew it,
but I didn't know what I needed. See. Oh wow,
I'm going to this doctor in Minnesota, and now I
know what the conversation should be about. Okay, So let's
(01:52):
dive right in and let's talk about vaginal rejuvenation. First
of all, the assumption is it must be just some
vanity or some esthetic thing or some porn thing. Not
at all. First of all, there are two parts to
ninety percent of the things we do in plastic surgery.
There is the esthetic cosmetic part, very important not to
(02:12):
be undermined, and then there's often and very very frequently,
a functional component. And in vaginal rejuvenation it's the same thing.
There is a esthetic as well as a functional component.
So what causes the vaginal anatomy to become either less
esthetically desirable. God, when I was in my twenties, I
(02:34):
didn't have even an issue with this, and now I'm
thirty nine or forty two and it's a concern. And
the other is, you know, I'm having issues, discomfort, etc.
So first of all, childbirth is nuh duh. I mean,
you think about childbirth, you've either undergone it or you've
seen it, and you think to yourself, Oh my god,
(02:55):
I cannot believe what the female human has to go
through in order to give birth. It's actually shocking to
me how amazing and elastic our anatomy is that you
can go back to being essentially more or less normal.
The second is just aging, Right, everything changes with age,
your eyebrows, your neck, your eyelids. There's no reason that
(03:16):
your anatomy of your vaginal region is not going to change.
And lastly, just genetics. Some people are nineteen and they
have ginormous breasts that are sagging and they need of
breast reduction. They didn't have kids, they didn't breastfeed or
any of that stuff. So we're going to get into
all of that, and our goal is to just sort
of become knowledgeable. So let's break down the anatomy and
(03:39):
then break down what's available and what's possible. So, the
most common procedure or the most commonly requested or concerned
the patients have is the labia minori. So if we
look at the opening of a woman's vaginal and trod
it's vaginal vault, there is the outer labia. Those are
the cushions, so to speak. Those are the labia and
(04:01):
the inner labia labia of course in Latin being lips.
The inner labia which are the thinner, more protruding anatomy
that's in the middle. So very frequently, for the above
mentioned reasons I gave birth, I've gotten older, or frankly,
which is born this way, the labia in the middle
become either very long asymmetric, and then as a result
(04:26):
create a host of issues. So when you are looking
at your introitis the opening of your vaginal region, and
you have excess labia, excess meaning protruding beyond the level
of your outer labia, the labia majora sort of set
the plane of your labia. When your laba extend extensively
(04:49):
from that plane protrude. It may or may not cause issues.
First of all, in and of itself, it may be
perfectly fine, awesome. Then this is just kind of interesting.
But for many it that creates the following issues. Number One, Esthetically,
it makes many women feel uncomfortable, whether that is during
intimacy with their partners, during during intercourse, etc. So that
(05:11):
creates a sense of insecurity, doesn't Insecurity is personal, so
no one can judge from the outside and ever should
say anything about insecurity. In other words, why would you
be insecure? It's natural, It's a part of the human anatomy.
Well why are you insecure about I was eating lunch
and I have a seed between my tooth. It just
is what it is. And I'm a firm believer that
(05:32):
if something is an insecurity and becomes a significant disruption
for you in other words, you're constantly thinking about it,
it then intrudes in the organic experience of your life.
And for many women, because of their insecurity of the
appearance of their laba, they are then not present during intimacy,
and in my humble opinion, that really ruins the beauty
(05:53):
of intimacy, which is about all presence and being in
that moment. So number one, I don't like the way
they appear. Number Two, when I am intimate during intercourse,
they are getting pulled, tugged on, rubbed, and they are uncomfortable.
I have pain with intimacy, very very common if the
(06:14):
laba has become significantly long. Another is when I am
clothing and wearing clothes. I'm at the beach, I'm wearing
thin garments. You can actually see them and is very
It makes me embarrassed, So I don't wear bathing suits
or have to wear very specific bathing suits. Next, hygiene wise,
(06:36):
I have extra folds. And obviously, to begin with, the
area of the vaginal opening has a lot of bacteria
and a lot of warmth and a lot of rubbing,
so that is a cocktail for infections and irritations and
odor and things of that nature. So those reasons alone
are the reason why knowing about labia, labioplasts, or labial
(07:02):
anatomy is important. So labia the inner labia or labia
minora are the most common complaints the patients have. The
treatment for that is a labioplasty, meaning correction of those
and we'll get into that in a second. The second
next area or commonly requested areas my labia minora. The
inner labia are fine, but over time my outer labia.
(07:25):
The outer labia have lost volume and as a result
have deflated. And as a result, I don't like either. Again,
the aesthetics there, I just don't like the way that looks.
They're hollow and or functionally, when I am intimate or
when I am riding a bicycle or whatever, I have
discomfort because I have no cushion. They are actually the
(07:47):
cushion that protects your android, is your entry to your
vaginal vault, and as a result, they kind of cushion
or the bumpers on the outside. So labia majore restoration
is also known. The next thing is my outer labia
are perfectly fine. My inner vaginal vault. The inside of
(08:11):
my vaginal vault is been stretched out during babies. It's
been torn. I had a episiotomy, I had very very
large natural births, et cetera, et cetera. And so there
is vaginal plasties which involve some type of reconstructing or
tightening the inner cylinder of your vaginal entry. Now I'll
(08:35):
mention it briefly. I don't do that. That's often done
by guynecologists or GYNs. But we will delve into it
a little bit just so it's a complete discussion. So
those are the things that are available now. As I
mentioned to you, the most common one is a labioplasty
for the labio minore, and this is what it's about.
So essentially, the idea is that my inner labia have extended,
(08:57):
have become too long or too large or asymmetric. So
the treatment for it is trimming the excess labia such
that when we're done, they are more term, more never exact,
more symmetrical, and now flush with my outer labia. And
as a result, there's not an extension which can then
(09:19):
tug or grab onto things. Now, in my humble opinion,
the labioplasty surgery is way over complicated by many people.
What do I mean? Essentially, it's a blepheroplasty removing the
eyelid excess above your eyelid. If you think about it,
the upper and lower eyelids are like the two labia,
(09:40):
and your upper eyelid when it has excess skin and
starts to hang. When we get rid of your upper
eyelid skin, we do a little ellipse, and we remove
just the right amount of eyelid skin in a kind
of a in a kind of a football shaped kind
of excision. Well, that is really the way, in my opinion,
labioplasts be done. Find the excess redundancy very accurately and
(10:05):
very carefully, trim it, repair the edge, and call it
a day. Now. It's not without its pitfalls, it's not
without its issues. It's by no means an easy surgery,
but the surgery is made way more complicated, in my opinion,
by other surgeons by creating super asotiric wedges, cutting in shortening.
(10:25):
There's all kinds of stuff online, and as a surgeon
of twenty plus years, I've never found any of those
to be necessary. And I personally think a lot of
the complications associated with labio plases come from over complicating
the surgery. So the surgery that I suggest for a
labia minore resection is one that's a linear transsecting, just
(10:47):
removing the excess such that the labia now sit flush
and more symmetrical to the outer labia. Okay, great, so
that's done. Who does these surgeries? Ah? So this is
an interesting subject matter. In the past, you would go
to your who sees your labia more than anyone in
(11:08):
the world besides your life partner, your OBGYN, and your
obgyn in the past, would you'd go to them and
be like, hey, I'm having this issue and blah blah blah.
They say, oh, okay, great, yeah, there's a great surgery
for that, and they'd send you out to your plastic
surgeon who would then do your labioplasty. Well, today that
doesn't really happen anymore because the obgyns have decided that
(11:30):
they want to do the labioplasts themselves. What drives that
always as economics, I have no concern about that. That's
up to you and the patient. But naturally the gatekeeper
to labioplasts is going to be your ob because at
the end of the day, you're at your ob more
than you are anywhere else, and they're the one looking
at your labia, and that's who you're going to be
complaining to. I don't know their training. I can tell
(11:53):
you our training, our knowledge base of anatomy, our general
fund of esthetics. And I always think, and I'm biased
because I do think that our training in general is
the greatest amongst everybody. To manage wounds, tissue closures, suiture material,
everything in that nature. I think plastic surgery training is
the most superior. Doesn't mean every plastic surgeon is superior.
(12:15):
There are some really shitty plastic surgeons. But now plastic
surgeons are doing fewer and fewer and fewer these because
they're not really getting to the plastic surgeons because the
OBD winds are holding on to them themselves, and that's
between you and your patient and your OB. I tend
to still think the plastic surgeon is the best suited
person to do it, even though your OB is in
(12:36):
the vagina every single day. That doesn't necessarily mean to
me they're the best suited esthetically and refinement wise to
do the surgery. A perfect example is I do C
section closures at the time of delivery for patients who
are very specific and want me to close them during
(12:59):
their delivery. And while ninety nine point nine percent of
ce sex closures are done by OB's, well, when I
go there, it's a much more comprehensive closure. It doesn't
mean that OB's don't do a good job. It doesn't
mean OB's are not capable. I don't want OB's getting upset.
It's just there's they deliver in twenty five minutes, I
close in thirty minutes. They normally close in seven minutes.
(13:20):
So obviously we are going to put in a little
bit more energy in my opinion. So just understand who
the gatekeeper and who's doing it and why they're doing it. Okay, great,
so now I understand that. So let's just for a
moment then step into Labia majorare reconstruction. So Labia majority
reconstruction is basically essentially unlike Labia minore, which have extended,
(13:45):
these have deflated and as a result are hollow. There's
a little bit of cushion. And what do we love
about youth. It's full, full face, full breast, And when
labya has become deflated, they tend to be aging and
it's often a case as we get older and or
very skinny. So like other things that get deflated or hollow,
(14:05):
let's just take your cheeks for example. Often and in
this instance the same the treatment is volumizing, replenishing, filling
that area. There are two forms of volume restoration that
pretty much take almost ninety nine percent of volume restoration
in the body, and one of them is filler, and
the other is fat. When it comes to the labia,
(14:28):
in my opinion, by far, the best option is just
fat restoration. You've lost faty tissue and it's a small
area and almost always you can find enough fat to
replenish that area, and I like fat transfer to the
labia majority the best. If for whatever reason you don't
have it, you don't want to undergo a small procedure
because obviously, in order to get the fat, we need
(14:50):
to harvest the fat, and that's a small procedure. Nevertheless, alternatively,
if you just have a little bit of deflation, you
can use filler and again as a always HA hyaluronic acid,
base fillers, restall in restaalin lift, juveiter and juvenile plus
things of that nature. And like in the cheeks, it's temporary.
(15:11):
It volumizes and likely will go away and you'll have
to fill it in again. But definitely adding some volume
will rejuvenate or make it more youthful, and sometimes that's
all it takes to make that area look better. The
last area we touched on, and I'm going to really
just touch on it because again I don't do it
and I don't have any real knowledge about it or
experience is the notion of taking the vaginal vault, the
(15:33):
actual tube the inside of your vagina which can get
stretched enlarged during delivery and childbirth and whatnot, and basically
making the cylinder tighter. And the way they do that
is by generally sowing the back wall. Imagine like I
do during a diastasis or abdominoplasty, I'm sowing the vaginal.
(15:56):
You'll be sowing the vagina to itself and making a
large cylinder into a smaller cylinder, and that's predominantly a
vaginoplasty in what they do. Alternatively, there are devices, because
we're always pushing the envelope on technology, and there are
devices like radio frequency lasers, et cetera that basically heat
(16:17):
the inside of the vagina, hence creating scar tissue which
then tightens the vagina and is supposed to do something similar,
maybe much more mild, maybe temporary, et cetera. That whole
area is an obguin based area. I'm sure there might
be a plastic surgeon or two who does it because
they have experience in it. But in that area inside
(16:38):
the vagina, you're going to end up speaking to your OBI.
But know that it exists, right, because let's say during
intimacy you've lost the ability to have be stimulated, or
you feel uncomfortable when you're with your partner, what have you.
It's not uncommon. The last part of that is the
pelvis right. Often, if you have very very large babies,
you get a pelvic prolapse right, and you get vaginal prolapse,
(17:01):
rectal seals, etc. And that's a conversation for another day.
So let's now go back to the two major procedures
that we talked about, which is the outside right, the
outside of your vaginal anatomy, which is the inner labia
and the outer labia. Okay, so let's talk about now recovery.
So generally, the recovery, even though that area is such
(17:24):
a sensitive area, tends to be pretty pretty tolerable. In
other words, you do the surgery now. I tend to
do all these surgeries under Jennal anesthesia. I do all
my surgeries under jennallytesia for two reasons. One, I feel
it is the most comfortable way for a patient to
undergo an esthetic procedure. They are not feeling it, they
(17:47):
are not stressed and hearing us talking or chatting or whatever.
I just think that it's the most smooth experience for
the patient, and it is the most spooze experience for me.
And I am the one operation, and I like you
a sleep calm, so I can have a complete sterile
environment and I can do what I need to do
with high accuracy. When you are awake and you're discomfort
(18:09):
and you're moving and you're shifting and all that stuff,
I don't think it's ideal. Nevertheless, this area is often
especially with obgyns done in the clinic, you do some
local shots, you get an RCO or a sedative or
a little shot of versat or whatever the case is,
boombang bang, twenty minutes later, they're done and off you go.
So there's a vast spectrum of how this procedures can
(18:32):
be done, and that's your dealer's choice, and you have
to think about it for yourself. I personally think plastic
surgery is a luxurious experience. I personally think surgery should
be comfortable. Otherwise it is very ridden with fear. And
I think that patients for a nominal cost can get
significant more comfort. And I think that the risk of
(18:54):
anesthesia is close to zero. I said it this notion
of doing it awake is basically you're gas lit to
think that general anesthesia is so dangerous and I do
it under local, when in reality it's just a marketing ploy.
Hundreds of thousands of super sick people undergo anesthesia every
day for heart transplant, liver transplant, resection of cancers on
(19:17):
their pancreases, and they're sake as hell and they do fine.
You healthy young lady thirty five years old who runs
triathlons is worried about an hour of anesthesia. That's the
reason they're making you do it under general and just
suffering through it. It's nonsense. It's just a marketing nonsense
to get you to come in because at the end
of the day, who the hell wants any risk. So
(19:39):
the recovery basically is some discomfort for a few days.
There's really no wound care. I use absorbable sutures. Now,
this is very important. It depends on the suture caliber.
That's a very very delicate area. And I've seen other
obs use some really big sutures, big sutures that leave
big marks and stay there and then require long time
to come. They should be delicate, tiny, tiny, sutures that
(20:03):
absorb very quickly. You will do some sitz baths or
sit in a tub and let that soothe with EPs
and salt and things of that nature, and you'll be
back to work in probably a few days, maybe a week,
and you'll be back to exercise in about six. You'll
be back to intimacy in about six and six by
six I'm referring to six weeks. So it is a
(20:24):
very well tolerated, low maintenance procedure. It's not like some
of our other procedures, let's say rhinoplasty. Rhinoplasty takes months
and months to recover. It's good, you look great, you're
living your life, but you're not going to get to
your endpoint for quite some time. Labioplasts are because of
the quality of the tissue and the high degree of
blood supply. It actually does incredibly well, incredibly quick, so
(20:46):
that's the recovery. Follow Ups are maybe one week in
two weeks and one more time at let's say three months,
and the surgery should take really just take about an hour,
whether you're doing the inner labia outer labia. It's really
a relatively straightforward procedure. Okay, now, let's talk about risks
because that's always where I sort of like to push
(21:07):
the envelope because I think that's where this podcast is
the greatest value to you. Because everything I just said
to you can read in everyone's website, But I don't
think anyone's really gonna like highlight for you with great
emphasis on the things that can go terribly wrong, because
that's what I see all the time, right, I'm seeing
revision after revision after revision. So number one is bleeding.
(21:28):
That's right, bleeding. The labia has a ton of blood supply,
and if you do the surgery and one of these
blood vessels is in well cauterized or suture, then you
can get a hematoma. That's a big blood collection in
one of your labia, and that's a big, big problem.
So you need to be accurate and take your time.
(21:50):
Very often, labia policies are just like cut, cut, cut, suture,
let's go, and they're done in thirty forty minutes. They're
done under local, they're done in an office and off
you go. So I am a firm believer the less
respect you give a procedure, the more trouble you get.
That's why I do it under general anesthesia. I want
to take my time. I want to get a cattery.
(22:11):
I want to turn it up hot so I can
cutterize it. You don't feel it, I don't. I want
to just do it right. So bleeding you get, you
can get a hematoma infection is incredibly rare. Well, how's
that possible? I mean, there's thousands of bacteria, there's yeast everything. Yeah,
but that's the beauty of the mouth and the labia
(22:32):
and the anus. That area is blessed because it's designed
to have bacteria. Therefore, the immune system is so amazing
that you can bite inside of your mouth, create a
bleeding wound, and within four days it's healed. And I
don't know if anyone's ever got a mouth infection inside
their mouth, because that's just not the way the immune
(22:53):
system works. So very very rare scars. Again, if it's
done ugly, you're taking huge bites creating irregularities. Then the line,
the outer edge of your labia will be irregular and
not look good. So like a bleufferoplasty, like any other
(23:15):
incision line, the more accurate delicate time consumed it is,
the better it'll heal. In general, there should be no
visible scar because labia, if you know, is kind of rugated.
It's kind of like lumpy bumpy in general. The skin. Two,
it's usually colored, it has a little bit of pigment browner.
And three, the skin is super thin so it heals
(23:38):
incredibly well. So you should almost never see a scar.
If you see a scar from alabia plasty, it was
really poorly done. Next is asymmetry. So you go in
with everybody has some mild symmetry. I don't think in
my entire life hundreds and hundreds of lavioplastis I've ever
seen two labias identical. Some people have significant asymmetry, like
(23:58):
literally one three times large, and at the end you'll
have a little asymmetry. But I'm talking about you go
in there with relatively more or less the same level
of asymmetry and you come out with a significant asymmetry. Well,
that as a surgial error. Right, somebody removed too much
from one side, and now all of a sudden you're lopsided.
So that is one hundred percent preventable, and that happens
during markings. Right, the surgeons in a rush doesn't accurately
(24:21):
mark takes a little more off one side. Now you're
having lopsided labia. And by far the most significant risk,
which is a real risk, which happens all the time,
is over resection of labia. So let me explain that
is too much labia was removed. Why would that happen?
(24:43):
Because labiaplasts, even though they're done under local and quick
and now the obs are doing it and everyone thinks
it's no big deal and they'll do five or six
in a day, is a really tricky surgery. What's tricky
about it? The labia are really stretchy, and it is
very easy to pull the labia a little too hard
(25:07):
when you're marking it, So you're marking the excess right
you're cutting. How much is that extra? You pull on
it so that you can mark it, and then you
remove it and then realize it retracts, and oh shit,
I just removed way too much. And I cannot tell
you how many overresected labias I've seen because you don't
(25:28):
realize how delicate these labia are, and you're like, oh,
look at all this excess, and you go and remove
too much, and what happens? So now you're looking at
your labia majority on the outside, your inner labya of
retracted in so there is and more importantly, when you
open your leg it pulls your labia open. Right, What
(25:50):
is the purpose of your labia minora? Have you ever
wondered what the hell they're doing there? What they're doing
there is they're protecting the opening of your labia. The
inside the mukee area, the area that's moist, has pH
has bacteria, is glistening. The inside of a vagina is
a very moist and delicate environment. The inner labia. One
(26:11):
of their jobs is to seal that close and make
sure it doesn't dry out and desiccate. So when you're
moving and your legs separate a little bit, you just
don't keep opening up your labia. So when they're overly resected,
now all of a sudden you don't have lips, and
that area is prone to get changes in the mucosa,
drying out, accept infections, et cetera. So, believe it or not,
(26:37):
labia plastes minore are very tricky and as a result
require some thought. And yet again, and I will emphasize
why I like to do it with you asleep, because
I need to mark and remark and then check again.
And this and that the other. So at any rate,
that is my in my opinion, the main concern that
you need to be careful of when you do it.
(26:59):
All right, guys, I think think that covers the entirety
of vaginal rejuvenation. Oh there is one more thing in
vaginal rejuvenation which I know nothing about, and I think
it's mostly nonsensical. But you can do your homework. You
can go on Reddit. Is G spot enhancement. So in
an female vagina, inside the vaginal vault, there is an
(27:22):
area called the G spot, which is basically a collection
of sensory nerves, right, sensory nerves, and those nerves come
together and then for certain women are critical for orgasm stimulation.
It's very very important and as a result, it occurs
(27:42):
often with rubbing during intercourse and there are obs that
have advocated And maybe maybe there's truth to this that
by enhancing filling, like putting filler or other volume in there,
you make that area larger, hence more prone to getting
rubbed and then get extra extra stimulation. Again outside my wheelhouse,
(28:04):
don't know, but for completeness sake, I'll mention it to you.
I am just a big homework. Do your homework research fan.
I find that so many things, especially the easier the procedure,
the more problematic it is because the more doctors will
push it, and the more patients will want it because
(28:25):
it's easy, it's affordable, and a doctor can do high
volumes of it without any headache. So I don't know.
In a weird way, I think the more sophisticated, more complicated,
more involved, more costly surgeries and somehow are more realistic
because I don't think you can shamboozle your way through
it at any rate. That's a wrap. That's the episode
(28:49):
on vaginal rejuvenation. I hope you enjoyed it. I hope
that we tackled some of those concepts, and moreover, I
hope it allows you to realize, huh, maybe there is
something here that I want to explore any rate. I
have two requests at the end of each of our episodes.
Number one is, if you like the show, if you
find it entertaining, if you find it educational, do us
a huge favor. Would you go write something nice about
(29:11):
our episodes or our show. We appreciate it. It makes
everyone feel good. It actually helps our ranking so that
we can be read and seen by more people, and
I think it's very very sweet of you. So that's that.
And second, if you know anyone you're like, friends, family,
that you think might find this kind of interesting. You
(29:31):
never know who's about to go get a procedure. Usually
it's too late when you find out someone had a
cash strat rhinoplasti, or they had a tummy tuck that failed,
or a labioplasti that didn't work out. You're like, oh,
you should have heard this. It's too late because you
didn't know that they were going to do it. So
go ahead and send this to the people you love.
You'll be doing them a huge favor. All right, guys,
Until next week, I'm your host, doctor Roddy Rabon, and
(29:52):
I look forward to being with you again on plastic surgery,
Uncensored Football m
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