363. Intimate Renewal: The Art of Vaginal Makeovers

Welcome to the Thyroid Fixer podcast. I'm your host, Dr. Amy, and we're diving deep into the world of hormones, especially for all you fierce women in perimenopause and menopause and everyone struggling with hypothyroidism. So if you are battling weight gain, you're feeling like shedding those pounds is an impossible feat. If you're dealing with plummeting energy levels, gut wrenching fatigue, or a libido that seems to have left town, then you're in the right place. And let's not even start on the hair loss. If these symptoms are sounding all too familiar. You have your tribe. My goal is to educate, empower and shake up your world. Remember, I want you to embrace every inch of that badass woman that you truly are. So if you're ready to dive in and fix things, let's go. So this is going to be a game changer for you. And you can probably hear the excitement in my voice. The latest introduction, the latest member of the family to the Fixer line is Metabolism Fixer. And this. Oh, my God. I formulated this just for all my people out there that need to lose weight, that need help in the weight loss department, that can't lose weight no matter what they do, that feel like they have a slow metabolism and that might be thinking of trying all those peptides out there. You know, the Beverly Hills soccer mom drug of choice for weight loss peptides. Or even if you're on them already and you're like, man, these are really expensive and I'm still not losing weight. Add in Metabolism Fixer. Here's what I did. I took the power of T2, which increases your basal metabolic rate while you are sitting there watching Netflix. You're burning fat while you're watching Netflix. I combined it with a very unique patented ingredient called Suppressa. Suppressa has multiple clinical trials backing its efficacy in reducing your appetite, decreasing snacking, and providing way more control over your food intake. It is amazing. We also see improved emotional well being, just decreased food cravings all around, reduced hunger and weight management. Add on top of that, we have green tea extract, we have purple forest purple tea extract, both of which affect the metabolism in a very positive way without the jitters of normal fat burning. Supplements out there from the 1980s and 90s. Right, the ones that made you feel like you're having a heart attack. You will not have that in any of my supplements. Thyroid Fixer or metabolism fixer, but metabolism fixer, oh, yeah, we kicked it up a notch. It is in powder form so you can drink it through your day. It's going to flavor your water. We got Orange Crush and Refreshing Citrus. I love them both. It is going to keep you under control all day long. So you throw a couple scoops in your water bottle in the morning, throw a scoop or two in your water bottle throughout the day. You will have fat burning and appetite control the entire day for what, an eighth of a price of the peptides? Oh my God. You can't go wrong. So grab some metabolism fixer today, please. Let me know how you do on it. I am super excited for you. Super excited. Okay, we're talking vaginas today and this is the beautiful extension of this entire week's theme of libidos and vaginas and women's sexual health. This is the women's Sexual health Revolution week on the Thyroid Fixer podcast. So with me today is Cherie Ong. She is a friend, but she is also a kick ass surgeon. And I mean, if you want to give your vagina a facelift or a vagina lift, you need to see sri. You should not go to anyone else. She is top in her field. She is literally the best of the best because here's what she does. Yes, she's a board certified plastic surgeon for over 15 years. But it's her skill, it's her expertise in solving the external and the internal vaginal issues that you might be having. So she really has this power at separating out which issues are surgical and it makes the most sense for you to go the whole way, all the way down the surgical path or non surgical like dryness and arousal and sensation issues. And Dr. Ong, she uses different modalities and the combinations of treatments in her practice not only to treat but also to speed healing. And we're going to talk about that today. So many different things that you can do. If this sounds like something you want to pursue, want to have a conversation about, then don't worry, we got you on the back end when it comes to healing. But this really is something that needs to be a topic of conversation amongst women. We need to feel confident and empowered in everything we do and in everything we talk about. And we shouldn't be hiding, just like we shouldn't be hiding our bodies. We shouldn't be hiding our vaginas because we don't like the look at them. And we shouldn't be turning off the lights because we don't want to look at our own vagina. We don't want anyone else to look at it. I mean that's as bad as body shaming, right? We have to be open about this topic, and we have to talk about it with the experts, but amongst ourselves as well. So, ladies, this is going to be eye opening again. If you're like me, and I say this in the beginning, when Shree and I start talking flat out, when I sat down to have lunch with her, I was like, well, what's going on down there? What. What. What happens? That things start to change. Maybe mine has already changed and I need to do something about it. So I know that that is on your mind too, or you are one of the many women that Sri talks about who've been thinking about this for 10 years. And y' all didn't tell me about it. You didn't speak up to me about it, but luckily, we're bringing the conversation to you anyways. So if you are one of those women out there that have been thinking about what your vagina looks like and how it feels and how something has changed and what can I do about it? This episode is for you. Is my vagina normal? Does my vagina need a makeover? These are the things that I've asked Sheree about off camera, of course, and these are the things that we're bringing to you to actually discuss and lay out on the table on the podcast. So I already gave you the beautiful intro. This woman is. I mean, when I said that she is the best of the best, I. I meant it. She is top surgeon in this area. I am absolutely blessed to know her. Sree, thank you so much for jumping on the thyroid fixer podcast.

Amy, I'm so excited to be here. Thank you for inviting me.

Well, this is an important topic, and, you know, you and I had lunch, we talked about this, and I asked you the very same questions I'm going to ask you today for my audience. But in. In having that discussion with you, I really realized, oh, my gosh, this is not something that is talked about. It's kind of like even nowadays, you and I think about talking about menopausal symptoms. Oh, yeah, we got the hot flashes. We got the dry vagina. Yeah, it sucks. Weight gain in the midsection. And we're very open about it because of the world that we live in. But you step out of our world into normal human being world out there, it's not talked about. You ask ladies. Oh, no, I don't. I don't. I don't talk about menopause. Like, we don't even talk about my friend. I don't talk to my friends about menopause. Cause, well, they can't even talk about a hot flash. You know, they're not talking about their vagina. And I think we have to. So that's why you're on today. We have to lay it all out there and know more about what can be done and what options are out there for ladies.

I love it. I love it. I think this is, as you said, very private. People are very embarrassed to sometimes talk about the normal things that happen. Menopause is a normal thing that happens to all of us. And yet we're still very hesitant to speak about it. And we talk to our girlfriends, like you and I can talk over lunch, but then we're looking over the table and see whether someone's listening to the conversation.

Right, right.

So I think it's really cool. I think women should have the ability and the, the confidence and the freedom to talk about things that are important because it affects our daily lives and we think about it when we're sleeping. Why don't talk about it to our girlfriends and see what they're doing? Because if we do this, then we can get information how we can better ourselves.

Yep, exactly. And it's just like, like you said, you know, people will get plastic surgery to improve upon a body part. Whether it's breast implants or a facelift or a nose shot. You're improving on that body part that you're like, ah, maybe if this was just a little bit here and this was a little fuller there and that's all this is. But it's so hush hush, because like, I came to you with the question, well, what are we looking for exactly to say that, hey, my vagina might need a little something something. A little loving, A little plastic surgery love. Just a little bit of a, of a facelift. So let's start there. Can you tell me, what do you see in your practice? What's the main complaint? What do women come in saying, you know, Dr. Ong, oh my gosh, can you please help me with this?

You know, it's very interesting, the conversations that I get, because when they come to me, they've been thinking about it for a long time. You know, this is not something that they just showed up, I'm going to speak about my vagina today. They've been thinking about it for years. Some of my patients have waited 10 years before they had the courage to pick up the phone and say, I don't know what's going on, but is it even a possibility, you know, So I think a lot of them, when they come in, the words that they use is, you know, things don't look the same down there that they were before. They're a little looser. That's a very common one is, I've had kids, you know, life. You. You do life. And things change. Like your skin gets looser in your face gets looser everywhere else, and the skin is looser down there. It just doesn't feel the same. Just doesn't look the same. And then they bring up, is this normal? And that's one of the big questions that they. They have, is that, is it normal? And that's where they usually start that conversation.

Yeah. And there's so many different rabbit holes. There's so many different things going through my mind. I'm going to start here. Our idea of normal is that built upon, let's say, porn, let's say the amount. I mean, really, porn is Instagram now you can go on Instagram and see people's hoo has halfway hanging out. Where do women get their idea of, we'll say, the perfect vagina look?

That's a good question. I think that with social media and with the porn industry, for sure, this, this ideal, right? So there is a lot of things that people think are ideal, but I just tell everyone your vagina is normal. It's normal for you, right? And so that doesn't mean you can't improve on it if your hair is curly, you know, make it straight. You know, you can do that if it. It makes you feel better about yourself. So I always start there. It's normal for you. But tell me about what you think you're not really happy with or what, what do you think you're not. You're looking at in, like you're not really feeling good about yourself. And if you start from that conversation, then they are, you know, they are in the mindset that there's nothing wrong with me. You know, things change and there's nothing wrong in deciding if this is an option for you, if I want to do something about it. And that's where we start having that conversation. And they feel a little bit more relaxed because we're not having a conversation about there is something wrong with you. Because just like everything else, you know, vaginas come in different shapes and sizes, and that's who you are.

Yeah, yeah, exactly. And so you're just bringing women back to what they were used to. Almost just like rewinding the clock a little bit. Except for rewinding the clock on your vagina.

Yeah, exactly.

I love it. Okay, so the normal things to expect that a woman should expect, going through childbirth, and I mean, a lot of the listeners are already going, I already know what to expect there. It gets ugly. But going through childbirth and then just going through the different hormonal changes in perimenopause and menopause. Can you get more detail into what we can anticipate happens to our vagina during those times?

Just like every place in your body, you lose collagen with age. And so when you lose collagen, your face, you get laxity, which is loose skin, and things get looser. So specifically when we have hormonal changes, that's a big one. There's two things that really affect the vagina. One is hormonal changes, and the second one is loss of collagen. So when you go through big changes in your life, pregnancy is one of them. There's a ton of estrogen being pushed out during pregnancy. Your breast gets larger, and so things change with hormones. And when you hit menopause, then you have a lack of. As a better word, your hormone production decreases. When that happens, estrogen is a very important hormone, as you know, for our skin. And the skin of the outer labia is no different than the skin in your face. And so what women will feel is that now their skin is looser, and when they wear clothes, it hangs a little bit and it doesn't look the same. Now, specifically for childbirth, there are certain things that happen when you actually deliver a baby, right? There's actually mechanical stretching and trauma that happens. And so what happens is that the vagina canal, the vaginal canal, stretches out a little bit, and things may be looser down there. So what as a result of that? The two things that happen. One is a functional issue where as you change with your hormonal tonal changes, things may get a little dry. You may complain of vaginal dryness, or you may have leaky urine, cough, laugh, and sneeze, and then you have that urine incontinence. And then thirdly, they just don't like the way it looks. So. So I think we need to differentiate between aesthetics of the way it looks and then versus functional. How am I supposed to have sexual activity if I can't keep up with the moisture?

Now, we used that. What age will you see? Because you mentioned that with pregnancy, after pregnancy, the vagina walk and stretch out and. And dryness can occur. Will you even have women in their 20s and 30s saying they have vaginal dryness and pain during intercourse already. And they haven't gone through that menopausal change yet.

Not as common. But the younger women have a step. They usually come in for aesthetics because genetically they may be born with, you know, their inner labia being larger. One side is normally bigger than the other or the genetically larger, and it feels really uncomfortable. So the women who are younger, as early as, you know, true puberty, what happens is the labia minora, which is the inner labia stretches and grows and they don't like the way it looks because they can't do exercise the way they want when they have sex is super uncomfortable. And they don't like the color, you know, gets really dark. And so these are the concerns that younger women would have even before menopause. So this is truly cosmetic considerations that they just don't like the way it looks.

Okay. And speaking of that younger crowd, now I'm thinking about my PCOS group, which I see a lot of. And even, I mean, PCOS will even see into, you know, perimenopause before menopause hits the true androgen dominant ones. And I'm thinking of this because I'm also thinking about my days in bodybuilding where I'll never forget, I walked backstage and a friend of mine was giving a spray tan. And I remember thinking, wait, she only spray tans women. That's odd that she's spray tanning a man and it wasn't a man. And I'm talking about my picture of the genitals. It was. And that I was like, oh, wait a minute, I'm trying to make sense of that. So these poor women now, I mean, the bodybuilder, that's an extreme example, ladies. This is a lot of testosterone being used and abused. But what about my poor PCOS patients that they have this overproduction of androgens? Will they get what Karen Martell and I lovingly call a clatinus, but will they get an enlargement of the clitoral region?

Absolutely. No. It's funny you said that, because one of the effects of testosterone, androgens, is enlargement of the clitoris. Anatomically, when we're born, the clitoris is the penis, right? The head of the penis. And so that's how we were built when we were babies. Like the same thing that becomes the penis becomes a clitoris. And that's where we get all the sensitivity from. So when I see women and I examine them, I'll know those are the ones on testosterone therapy, as you said, increase androgens in their body and they have a larger clitoris. Now, that is something that they would have to make a decision, obviously, quality of life, etc. With testosterone replacement therapy that they choose to do versus PCOS with some medical condition where there's too much estrogen.

Right.

And I think that counseling is important for them in terms of if we are going to do some improvement of the aesthetics. Let's look at the whole picture and let's see how we can create a balance of what it will look like afterwards. Because what I want to do is make sure that everything's in balance, because if I remove more tissue around that area, then your clitoris gets more prominent, and that's not what they want. So it's very important to have that conversation with them.

Right. So is that something that can be fixed? Can you actually shorten the clitoris to bring it back, like, to a smaller position, to a smaller look?

Yeah. So we can't really do much for the clitoral body because the important nerve endings and everything is in the body itself. So going into and reducing that body is going to be probably not the best way to think about it. But there's a lot of skin around the clitoris. This is what we call the clitoral hood. And the clitoral hood, we can actually. I've done a few procedures where we can either lift it or. Or what I call a clitoral pexi, where we actually pin and push back the clitoral body a little bit so it's not so prominent.

Yeah.

So there are ways to kind of allow that, to kind of, you know, tuck in a little bit, so to speak.

Right. See, this is all fascinating. This is fascinating. So the labia. It's interesting that you said that you worked with a patient who had, you know, different sizes on each side. And I guess that's something that you don't really think about as a thing. But then when you say it, you're like, wait a minute, maybe I am a little bit lopsided. You start thinking about yourself and how you look and just the different anatomical changes. And that's so true. When you really start to pay attention to just the changes that have gone on throughout the years, and especially, like you said, with hormones. Hormones, hormonal changes, everyone is so much fun.

You know, symmetry is an illusion. My plastic surgery attending used to tell me, the sisters, not twins. Right. So right and left breast, the sisters not twins. And labia is the same. Almost everyone one side is bigger than the other. And so when women come to me, what they're looking for is they want smaller and they want more symmetrical. They want things straighter so they don't want the inner labor flopping around. I just want it clean and straight. And so, you know, we can create that during surgery. We can, you know, remove more one side versus the other and try to make it symmetrical as possible. And then many women also don't like the dark edges at the, at the, at the edges getting dark. And so we will trim that out and make it look, you know, cleaner, but also by removing the dark edges. Now things are a little, I. To call it, like tucked in a little bit.

Yeah.

So it looks cleaner and it looks straighter.

That's just, I mean, I'm just blown away that you can do all this because we think of it as such a delicate area. And that's going to lead into my next question. Such a delicate area. But that again, what I said in the beginning, not one that can be improved upon, but it can be just to up level your confidence. Now, one thing that comes to mind when you're talking about all this is recovery time. Now, I'm saying this because I want to give the audience an idea of recovery time because I'm sure a lot of women are cringing right now and they can't imagine having any kind of surgery done on their vagina. But how bad is the recovery time? And I know you up level your patient's recovery with so many different tools that you have. So let's talk about the baseline recovery and then all the different things that you offer to really speed that up.

Recovery is the number one obstacle in any surgery. And so for me, I love that you asked that question because first of all, I want to say something that I think is important. Most women are doing this for themselves. So if they feel, they feel they're doing it for themselves, never ever as a plastic surgeon and a cosmetic surgeon, never, ever do it for someone else. You need to do it for yourself. And in terms of recovery, it depends on how much surgery you do. Right. So out of labia, in the labia hood, all of that. But roughly, the nice thing about this type of surgeries, at least the surgery I do, it can be done without general anesthetic. So I've really created a way that it can be done in the office. The nice thing about that is private, you don't have to go to hospital. You have, you know, risk of infections, things like that. And women having cosmetic surgery want to be, especially in this really intimate Highly sensitive area. They want to do it in the office, so it can be done in the local. Now, the recovery for something like that, if done correctly, you would be able to, you know, walk. You don't have to have general ancestors, you can actually walk the next day. You can move around. The biggest thing is swelling. So just like you have your tooth removed, like your mouth are going to be swollen. So in terms of recovery, you know, some amount of discomfort over the couple days, and then we can talk about all the stuff we do to make that better. A couple of days are going to be a little sore, and then no sex and nothing to your vagina for about four to six weeks. Full recovery back to where it needs to be for the swelling and all that is about three months. But within a few days you can basically walk, you can go back to work on a desk job, things like that. We just don't want women to exercise or do anything that increases the blood pressure and increases that swelling. So in terms of what we do, I truly understand that recovery is the number one obstacle for women having surgery. The first thing they are fearful about is obviously pain, because there's a lot of sensitive things and nerves down there. And then secondarily is how much downtime they have. And so when I approach a patient with having these type of surgeries, I prepare them before, during and after surgery. So for example, one of the things we can do is we can inject a long acting numbing medicine that lasts for 72 hours instead of just a few hours. And that would take away the bulk of the discomfort in the first 24 to 40 hours, because that's when it hurts the most. And then we really hone in, into the recovery. Icing is important. We do specific things in our practice that are a little different. So before surgery I usually help. We do a lot of IV therapies and we use the modalities of ozone and peptides and all these things to get people ready. And then we do it before and after. So in the before surgery part, you get them ready, get their bodies ready, tell them what the foods they need to stay away from. Because one of the things that can happen after surgery is itching. So we keep them on a low histamine diet, we give them supplements to prepare for surgery. And then during the surgery, the specific things that I do is I use certain techniques to reduce the amount of swelling. So like most doctors or surgeons would use a knife in order to do the surgery, I use a very fine wire in order to do the Surgery that reduces less trauma to the surgical site and just allows things to heal faster. So specific things that we do during the surgery and then after the surgery, we set them up with, you know, IV therapies and things like that to speed it up. Certain creams that we also give them to speed up the healing process. And with this whole process of able to bring down the recovery up to 50% better, and the faster they can recover, the faster they can get back to their kids, get back to their lives and move on. So that's, I think, a very big thing that I advocate for patients. In fact, in fact, this is something I want everyone to know about because you can really impact your recovery.

Well, and when your patients are happy and they're recovering faster, I mean, not that you're going to have a whole lot of comparables, right? You're not going to have your neighbor Susie down the street being like, hey, it took me 11 months to recover from my vagina. You know, you're not going to have talk about it, but you're going to know it. I mean, you're going to know in your, your own body when you tune into it, like, hey, this is really moving along faster than any other procedure I've ever had. Whether you've had something cosmetic done or knee surgery, you know how your body heals. And I'll tell you, when you have peptides on board, you can actually tell that you are healing at a faster rate. So I got to pick your brain here. What peptides do you like to use before, if you use any before and definitely after surgery.

So we compound a peptide cream and it is a copper peptide, anti inflammatory peptide. So we use ghkcu, we compound with hyaluronic acid. So ha, so ha, which hyaluronic acid is very widely absorbed into the body. So we compound that with GHKCU and also BPC to help reduce the inflammation. We also use exosomes. And so after the surgery, I do inject exosomes into the area too, just to help with the speed, speed up the healing process.

Talk about those. What are the benefits? What are exosomes and what are the benefits of them?

So exosomes are growth factors that your body makes in order to heal an area. So when your body is an injury, surgery is one example of injury is trauma to the tissues. The body will secrete certain growth factors to help bring the stem cells in your body to help, you know, recruit the stem cells to heal. So the exosomes are those signaling proteins that will call Most themselves, to your area to help it heal. And so by harvesting your body's capacity, natural capacity to heal, but just build up that army. So now we're getting that army to go specific to the area and help reduce the inflammation and heal the area much, much quickly.

Oh, wow, that's fascinating. I've heard of exosomes being used, like, in direct injuries, if someone tears the mcl and they'll use exosomes in the knee. But I've never heard of it used post surgery for recovery, but it just makes sense to do it.

Mm. And the nice thing about the surgery that I do is very minimal scarring. I think that's a big one too, because that area usually has blood flow, lots of good blood flow. Like if you did surgery in your lips and your upper lips, for example, because we're talking about the lower lips here. Right. So the upper lips, for example, like, there's very little scarring because the blood flow is good. And so typically the area heals very well. We want to maximize that healing. And so there is very, very minimal scarring. There's no scarring because we're working on specific type of tissue. And so I like, you know, I know you're a big proponent of estrogen replacement in your practice as well. And estrogen is one thing that. That area. And so we would also provide some estrogen support in terms of estrogen cream to the area to help the area heal faster. And so if your patients are on hormone replacement and they're having the surgery, they're already. The body already has that estrogen, they're just going to do better. And so that's, that's. That's one of the great effects, positive effects of estrogen that I love because that tissue loves love, loves estrogen.

Well, and it's that whole. Whole holistic technique of. Of addressing. You're not just going in and doing surgery. You're saying, how can we get your hormones balanced? How can we get you optimized so that you go into surgery a more just your body in that more optimal state for healing, and then how do you come out the other side and speed things up? So I. I love all of this, all of it. Now, you mentioned ozone, and you said that you just got back from a conference, just diving deeper into ozone therapy. Tell us about that. Like, where does that fit in and what does it do?

So ozone is a medical gas. And there's so many things about ozone therapy. We use ozone a lot in our practice for, you know, other things for health and longevity. But specifically what it does is that it really helps improve oxygen delivery to your tissues. And so by harnessing the effects of ozone before and after surgery, we can maximize the amount of oxygen that gets into your tissue. It also modulates the immune response, which I really, really like. And so modulation of immune response just gets your, your cells ready to reduce the risk of infections right after surgery. We hardly like almost zero infections in these types of surgeries. And so that is a big one. And before surgery, we get your body ready. I love that approach of you're not going to run 100 meter race if you haven't prepared. So the outcomes that we usually get is how we get our bodies ready. And people don't really. That's the conversation I want to change with people. Whether you're having surgery with me or you're having knee replacement. Like we can affect and control the factors that allow us to heal better. And so by harnessing your own body's capacity, let's get ready for that. Let's prepare your body, let's reduce the stress that you have. Let's, let's get your body and harness the environment. So now we can control and just allow your body to do its thing. And if we can affect the body that way, then it's amazing what it can do. So just allow your body. The worst thing you can do is walk into surgery highly stressed. In fact, I've said no to a lot of patients when I want to have surgery in between this and that. And I'm trying to do so many things. I want to have surgery like your body doesn't have enough energy to do all those things. And you're a big proponent of the thyroid and adrenal. Like I'm a big proponent of the adrenals. The adrenals can only do so much. So if you're already stressed out and work and life and then you want to push it a little bit more, having a major surgery, you're just not going to give yourself a chance in order to heal well and then, and then it takes time away. Instead of, you know, two, three weeks to heal, you take six weeks to heal and then it just causes more problems than harm. But then good.

Oh yeah. And you have to remember too that surgery is a stressor on the body. Even if it's chosen. So that stressor if piled on top of you not taking care of your own shit. Like if you're not dealing with trauma and the stress of your running yourself.