Why does volume loss occur?
Loss of fullness in the outer lips is most often seen as part of the picture of the genitourinary syndrome that appears with menopause. Tissue changes after childbirth, scars from an episiotomy (the cut made at delivery) and skin conditions such as lichen sclerosus can also affect the quality of the tissue in the area.
How is it carried out?
The main approach described in the sources is the use of the person's own fat tissue (autologous fat graft). The fat tissue is passed through filters of different fineness and obtained in three forms:
- Macrofat: the coarsest form, not used for injection.
- Microfat: suitable for giving volume — this is the form used in augmenting the outer lips.
- Nanofat: a fluid form that can be applied through a very fine needle. It contains no mature fat cells; on the other hand it is rich in stem cells and progenitor cells derived from fat tissue.
It has been shown that this process does not damage the cells in the tissue; cell viability and the number of stem cells are preserved. One study reported that more than 90% of the cells remained viable after mechanical processing.
Why is PRP added?
PRP (platelet-rich plasma) is the plasma fraction obtained from the person's own blood by separation through rapid spinning (centrifugation), in which the concentration of platelets is higher than in circulating blood.
Adding PRP to the fat tissue has been shown to preserve the structure of the fat cells better, to create a strong blood supply, and to create a favourable environment for the multiplication of stem cells derived from fat tissue. In recent years PRP has come to the fore as a support that improves the take of the fat graft.
Reported results
The published examples are limited in number:
- In a 67-year-old person with vaginal atrophy (thinning and dryness) and lichen sclerosus, autologous fat mixed with PRP was transferred to the outer lips. The lost fullness and firmness improved and the volume gained was maintained; improvement was also reported in the white patchy appearance of lichen sclerosus on the inner lips.
- In a 54-year-old person, microfat–PRP was applied to both outer lips and the result at 18 months was reported.
- In a person with problems following an episiotomy, fat augmentation together with injection of PRP and hyaluronic acid was reported to be effective.
It is stated that the fat tissue integrates naturally with the host tissue and that no notable side effect has been reported.
The limits of the evidence — what must be said plainly
The source text's own wording is this: the effectiveness of microfat and nanofat grafting in vulvovaginal rejuvenation has not previously been assessed. Further studies need to be carried out for the results to be confirmed, and the long-term effects need to be assessed further.
Most of the favourable results reported were obtained with subjective scoring scales based on people's own reports; the source accepts the subjectivity of these scales as a limitation.
What is proposed for objective measurement: measuring the elasticity and firmness of the outer lips with a device, and taking a tissue sample to demonstrate the change in the structure between the cells. These are not yet done routinely.
This does not mean the method "does not work"; it means it has not yet been measured in large comparative studies. This should be known when you decide.
With any surgical procedure, results vary from person to person. You are advised to discuss the procedure with your doctor in detail beforehand.
Frequently Asked Questions
Why does volume loss occur in the outer lips?
It is most often seen as part of the picture of the genitourinary syndrome that appears with menopause. Tissue changes after childbirth, episiotomy scars and skin conditions such as lichen sclerosus can also affect the quality of the tissue in the area.
What material is used?
The main approach described in the sources is the person's own fat tissue (autologous fat graft). The fat is passed through filters and turned into microfat and nanofat forms; microfat is the one suitable for giving volume. Nanofat contains no mature fat cells but is rich in stem cells.
Why is PRP added?
PRP is the plasma fraction obtained from the person's own blood with a high concentration of platelets (the cell fragments in blood that start clotting). When added to fat tissue it has been shown to preserve the structure of the fat cells better, to create a strong blood supply and to create a favourable environment for the multiplication of stem cells. Its purpose, in other words, is to improve the likelihood of the graft taking.
How long does the result last?
In one of the published examples the result at 18 months was reported in a 54-year-old person; in another, the volume gained was reported to have been maintained. But these are reports of a limited number of cases — that the long-term effects need to be assessed further is the source's own wording.
What is the level of evidence for this method?
It is necessary to be clear: the source text states that the effectiveness of microfat and nanofat grafting in this field has not previously been assessed, and that further studies are needed for the results to be confirmed. Most of the favourable results reported rest on subjective scoring scales, and the source accepts that subjectivity as a limitation. This does not mean the method does not work — it means it has not yet been measured in large comparative studies.
Are there side effects?
The source states that the fat tissue integrates naturally with the host tissue and that no notable side effect has been reported. Even so, this is a report resting on a limited number of cases; as with every interventional procedure, results may vary from person to person.
Sources
- Microfat and Nanofat Grafting in Genital Rejuvenation. In: Bader A (Ed.), Aesthetic Gynecology Rejuvenation. CRC Press, 2023, Chapter 12. Preparation of the fat graft, the contribution of PRP to graft take, the cases reported, and the limits of the evidence stated by the authors.
- Kim SH, Park ES, Kim TH — Rejuvenation using platelet-rich plasma and lipofilling for vaginal atrophy and lichen sclerosus. Journal of Menopausal Medicine 2017;23(1):63-68.
- Aguilar P, Hersant B, SidAhmed-Mezi M et al. — Vulvo-vaginal rejuvenation by lipofilling and injection of combined platelet-rich plasma and hyaluronic acid. SpringerPlus 2016;5(1):1184.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday