Note: Several times during this video, I misspoke and referred to the vulva as the “vagina”. Please pardon the error.
“I have been bothered by this for so long, and my mom has it and so does my grandmother. This has been a source of embarrassment, and I had no idea that there was a surgical treatment for it.” I hear it all the time. The mons pubis is a soft tissue mass that lies between the lower abdomen and the upper genital region. Both men and women have it. This shape of this region is defined by skin, fat, muscle, and bone. Also, there are erogenous, spongiform structures that can confer fullness to this region. The term monsplasty refers to any reshaping or modification of this region.
Patients who present to my practice often find me through YouTube. They are bothered by fullness in the lower abdomen, sometimes colloquially known as the “FUPA”, and may search for “FUPA reduction”, removal, or liposuction. For some reason, many of these patients find their way to YouTube videos that I produced. One of the most common procedures I perform is “monsplasty”, which is a catch-all term that refers to either liposuction, excision, skin tightening, or any combination of these procedures. The operation can often be performed in awake patients, which is very desirable, and can be combined with abdominoplasty, labiaplasty, and any other procedure.
When evaluating patients who are embarrassed by fullness above the vulva and below the abdomen, the so-called “FUPA”, I broadly divide the issue into two patient concern categories. The first is fullness of this region. This is often due to fat excess or a bony prominence. For example, it is visible in yoga clothes or a bathing suit. The second is “ptosis” or descent of the skin concealing the upper vagina; of course, both types may occur in a single patient. Depending on the extent of fullness and skin descent, I have a paradigm for treatment that I discuss with each patient.
This video is age-restricted and only available on YouTube. Watch on YouTube
Type I: Good skin elasticity, excess subcutaneous fat. Treat with liposuction alone, consider radiofrequency assisted lipolysis if greater than 150 cc of fat.
Type II: Moderate elasticity, excess subcutaneous fat. Treat with liposuction and radiofrequency assisted lipolysis. Consider skin excision if a C-section scar exists or greater than 150 cc of fat is present.
Type III: Poor skin elasticity, excess subcutaneous fat. Liposuction and skin excision may be warranted.
Type IV: Total concealment of the vaginal cleft. Liposuction, skin excision, and lower abdominoplasty is warranted.
The patient presented in today’s video has a type IV “deformity”. Although I used the word deformity, please note that fullness of the mons pubis is not a deformity and is considered desirable by many men. I would encourage all women not to consider this procedure unless they are personally bothered by this, or sufficiently insecure to validate the risks of surgery. To treat this patient, I agreed to perform wide awake surgery- and my intention was to excise excess skin and fat of the mons pubis and to unite the fascia of the mons pubis with the fascia of the lower abdomen. The patient featured in today’s video found me by watching YouTube and wants us to share her experience, as she feels that there is not enough about the patient experience presented on my channel.
Early before and after photos are shown, and I would like to take this opportunity to thank our patient for allowing us to show her journey to this procedure. I would also note the patient was comfortable throughout and has done very well in the recovery process.