Abstract
BACKGROUND: Esthetic gynecology addresses the growing demand for treatments covering functional and esthetic concerns of the external genitalia, significantly impacting women's confidence and sexual relationships. While hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) have shown promise in vaginal rejuvenation, data on hybrid filler applications remain limited. OBJECTIVE: This narrative review examines the anatomical, structural, and psychological aspects of labia majora rejuvenation, outlining available treatment options and presenting the authors' experience with a novel HA/CaHA hybrid filler. METHODS: This paper combined a narrative literature review using online databases PubMed and Google Scholar, between 2015 and 2024, with the keywords: "labia majora," "rejuvenation," "aesthetic treatments," and "fillers" with a case series of two patients treated with a hybrid CaHA/HA (Radiesse and Belotero Balance Merz Pharmaceuticals GmbH) filler for labia majora volume loss and laxity. RESULTS: Sixty-day follow-up evaluations by four experienced physicians revealed substantial improvements in labia majora esthetics. A marked improvement in skin coloration was observed in both patients, with skin appearing more even and less hyperpigmented. Both patients showed noticeable volume restoration, resulting in a fuller appearance of the labia majora. Overall aesthetic improvement was evident, as confirmed by the patients' perception. Patient-reported genital appearance satisfaction, as measured by the GAS score, improved by a mean of 41% (pretreatment mean: 28/33; posttreatment mean: 15/33). CONCLUSION: These two case reports and a narrative literature review suggest that a combined HA/CaHA filler may be a safe and effective treatment for labia majora rejuvenation.