Cosmetic gyn continues to grow during the recession

Though the recession has blunted overall demand for cosmetic surgeries, one subcategory appears to be entering a growth phase, at least judging from the fifth annual Congress on Aesthetic Vaginal Surgery, held late last year in a luxury resort outside Tucson. There, about 60 doctors, most of them OB-GYNs, converged to discuss the expanding field of “cosmetic-gyn”—elective surgeries for women seeking to “rejuvenate” and/or “beautify” their vaginas. Attendance at the conference has been increasing by about 20 percent each year—one doctor there explained that his services are in such demand, he has multiple operating rooms so he can move quickly from one surgery to the next—and last year a competing conference was held at the Venetian in Las Vegas.

The affable organizer of the Tucson event, Dr. Red Alinsod, was an early entrant into cosmetic-gyn, and is recognized for inventing the procedure in which the labia minora are completely amputated to create a “smooth” genital look known in the field as “the Barbie.” Though he began his career by winning a prestigious fellowship in gynecology-oncology at Yale in 1990, Alinsod now spends his days making genitalia “look pretty” for the wealthy patients who flock to his Southern California practice from all over the world. He is also an evangelist for the field, spreading its lucrative gospel to fellow doctors tired of toiling in the time-intensive and high-liability fields of traditional obstetrics and gynecology.

Interest in cosmetic-gyn has been explained by such cultural shifts as the trickle-up effect of porn aesthetics and, relatedly, the popularity of the “Brazilian” wax, which leaves the genital area bare and thus subject to closer scrutiny. But the breakthrough moment for the field, cited by several presenters at the conference, was the appearance on the reality-TV plastic-surgery show Dr. 90210 of David Matlock, an OB-GYN turned full-time cosmetic-gyn specialist.

Cosmetic-gyn is part of a broader trend in medicine, away from the traditional model of insurer-reimbursed, professionally sanctioned procedures and toward a simple fee-for-service model. The surgeries themselves are controversial: in 2007, the American Congress of Obstetricians and Gynecologists issued an opinion advising against vaginal cosmetic procedures, and one committee member scathingly declared, “The absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable.” The American Board of Obstetrics and Gynecology, meanwhile, refuses to recognize cosmetic-gyn as a legitimate subspecialty.

As a practical matter, this rejection by medical gatekeepers means that, for now at least, cosmetic-gyn has virtually no oversight and no credentialing requirements. At the conference, doctors were encouraged to view themselves as entrepreneurs marketing their services to consumers, with all that entails: sessions covered everything from search engine optimization for doctors’ Web sites to “The Blue Plate Special,” a urogynecologist’s advice on how to persuade a patient to add cosmetic-gyn to an incontinence surgery. The Web site of one ahead-of-the-curve doctor featured not only a $500 coupon but also “Patriot Program” discounts for federal employees and military personnel. One conference presenter summed up the new dynamic: “Retail plus medicine equals ‘retailicine.’”

But for all the talk at the conference about “giving patients what they want,” it was clear that patients aren’t the only—or necessarily the primary—driving force behind the cosmetic-gyn boom. Many of the conference’s OB-GYNs groused that even after they’ve amassed hundreds of thousands of dollars in medical-training debt, their insurance reimbursements are lousy. One doctor said he receives just $1,700 in fees for prenatal care and delivery, and a mere $800 for a hysterectomy. By contrast, a labiaplasty can be done in just a few hours, in-office, for a fee upwards of $5,000 and no “income socialism” to spread the proceeds among hospitals, insurers, and group-practice partners. Underscoring just what this can mean, one conference presenter left his computer’s wallpaper—rotating images of him with his red Porsche 911—up in the background during his PowerPoint lecture. The message was tough to miss: practice cosmetic-gyn, and you too can live the life of a plastic surgeon.

Some doctors at the conference expected, after merely watching videos of the procedures, to return home and begin performing the surgeries immediately, without any further training. But Alinsod and other presenters insisted that the skills necessary to perform these operations can be achieved only through mentored training. Perhaps in recognition of some doctors’ inexperience, one presentation tutored how to avoid malpractice suits and another, on labiaplasty disasters, offered tips on the secondary market of “revision surgery.” Alinsod himself described a trompe l’oeil procedure he had come up with to create the appearance of resurrected labia in the event that a simple trimming job accidentally became a Barbie.

For now, the cosmetic-gyn phenomenon seems confined largely to the coasts, and especially to body-conscious Southern California. But the feeling at the conference was that opportunity abounds. As one presenter noted, “The Midwest is a wide-open market!”

Marie Myung-Ok Lee is a novelist and a regular contributor to Slate. She teaches at Brown University can be reached on Twitter and Facebook, and will be appearing at the Yale Medical School for their Program for Humanities in Medicine on December 15, 2011. This article originally appeared in The Atlantic, and is reprinted with the author’s permission.

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  • Jennifer Gunter

    As a GYN who only cares for women with chronic vulvar disorders and pelvic pain (I am also board certified in pain medicine) I see no end of troubles from these procedures. Labial reduction can increase the risk of chronic vulvovaginal irritation as the labia are actually an important physical barrier for the more delicate vestibule and lower vaginal mucosa.  And don’t even get me started on the G-shot…collagen has NOTHING to do with orgasm.

    Charging $5000 for a labioplasty makes me want to vomit. I have fixed many botched procedures  in my time, but even if the procedure were indicated and done correctly (say for a women with severely asymmetrical labia post procegnancy or post significant weight loss), it is a 30 minute procedure.

    While I believe in the freedom of people to do what they want with their bodies, this trend of smaller labia (especially when combined with hair removal) makes the vulva look premenarchal. That is disturbing.  

    Reducing labia that are clealry redundant and causing symptoms is similar to a blepharoplasty for hooded eyelids causing symptoms. That isn’t a cosmetic procedure, it’s to improve function. However, to “cosmetically” reduce asymptomatic labia is akin to removing part of the eyelid. They both serve a function, to protect the more delicate tissue beneath. How many people would consider removing part ofthe eyelid so that it loses its function to be cosmetic?  

    • Anonymous

      Sadly, Asian people alter their eyelids for purely cosmetic reasons to look more western. Jennifer I agree with you that it is disturbing to have grown women’s genitals looking like premenarchal little girls. I get the hair removal thing, it’s a matter of personal preference (or are you trying to please the man in your life?) but vulvar amputation is ridiculous! Those silly women of Southern California need to get some backbone and self esteem.

  • Anonymous

    So how does this differ from female circumcision – which we all eschew?

  • Edward Pullen

    Men have been customers for this type of thing for much longer than women.  Why can’t we just be happy with our bodies.  None of these improve function, just appearance.  

  • Anonymous

    @mwilsoa-there is a big difference between a clitorectomy and decreasing the size of labia. and @Edward Pullen, how have men been customers of labia reductions?  Jennifer Gunter’s comments are on target for the most part-the idea of gyn cosmetic surgery is along similar lines of any other purely cosmetic surgery, either to have one feel better about themselves (for what ever reason) or to “satisfy” another’s desires.  There is a drive by our perceptions that what god gave ya aint good enough… 

    • Andrew Schiraldi

      Soon after my birth, a surgical procedure was performed on me that removed part of my penis.  This is what edward pullen was refering to.

  • Anonymous

    The “Barbie” and the “trickle up” effect of porn! How really sad that nobody can accept a natural woman’s body and instead we seek to amputate her labia!! Disturbing, what about your teenage daughter? Is this what you want for her – a porn defined bare (no hair), no labia vagina! Why not just suture it up?

  • ninguem

    Maybe some cosmetic urology. Do circumcisions with pinking shears.  Fancy Dan.

  • carolyn thomas

    Good grief. I had to go have a little lie-down after reading this….  “Retail plus medicine equals ‘retailicine.’”  Gag me. Dr. Red is the poster boy for docs who have taken that M.D. after their names and used it to go over to the dark side.  And why does that red Porsche screen saver seem so pathetically obscene to me in this story?

    However, it may be just the freak-show extreme of what’s widely happening already to non-red-Porsche-driving docs out there. My own family physician of 35+ years recently took one of those all-day Saturday classes in how to inject Botox and Juvederm into the willing faces of her patients. She now runs a clinic-within-a-clinic, two full-time medical aestheticians, a cash-only business complete with big ads on city buses, and ‘before-and-after’ testimonial ads from Allergan running on a continuous video loop for those of us patiently waiting who haven’t yet been convinced that we’re not good enough the way we are right now. She hasn’t quite hung up the sign warning her longterm general patients: “I Am No Longer Interested in Practicing Medicine” – but I’m expecting it soon.

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