When Labiaplasty is Not Enough: Rejuvenation of the Labia Majora Using Hybrid Calcium Hydroxylapatite With Hyaluronic Acid Filler for Increased Satisfaction and Uniform Results.

Abstract

Dermal fillers hyaluronic acid (HA) blended with calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) for facial indications is increasingly being adapted for body applications, offering both volumizing and regenerative benefits to the skin. In its hyperdilute form, CaHA functions as a regenerative biostimulator, effectively inducing the synthesis of key extracellular matrix components, whereas HA provides immediate volumization. Vaginal rejuvenation, with or without surgery, is also gaining attention with reports of off-label use of fillers for labia majora augmentation; however, analyses of hybrid approaches remain limited. This report outlines a technique utilized in 2 patients in which, following labia minora reduction, the labia majora were volumized using a combination of fillers with the aim of improving both skin quality and enhanced volumetric support. Patients who had previously undergone labiaplasty 6 months prior, presenting with mild-to-moderate laxity of the labia majora, received a single treatment of combined CaHA-CMC and HA injected into the subdermal plane. Outcomes were evaluated after 3 and 20 months for skin texture, firmness, adverse effects, and patient satisfaction levels. Posttreatment, improvements to skin quality, flaccidity, volumization, and dermal integrity were observed for both patients. High patient satisfaction was similarly reported, along with no adverse effects nor prolonged downtime typically associated with more invasive surgical alternatives, such as fat grafting. The treatment presented here offers a promising solution for postlabiaplasty patients seeking further labia majora rejuvenation, offering preliminary evidence of the safety and efficacy of hybrid fillers for addressing laxity. Level of Evidence: 4 (Therapeutic).