Signature Intimate Restoration Program™

Labia Majora Restoration
& Augmentation

Two distinct problems. A precise spectrum of solutions — from volume restoration to skin tightening to surgical reduction.

At Advanced Pelvic Surgery and Urogynecology of Charlotte in Charlotte, NC, Dr. Kevin Stepp, MD, FACOG, URPS evaluates labia majora concerns across two anatomically distinct categories: volume deficiency and structural laxity. The correct treatment depends on which problem — or what combination of problems — is actually present.

Subspecialty Assessment.
Not a Protocol Menu.

Dr. Kevin Stepp, MD, FACOG, URPS is one of fewer than 10 surgeons in the United States with dual-fellowship training in both Urogynecology and Minimally Invasive Gynecologic Surgery, both completed at Cleveland Clinic — a depth of pelvic anatomical training that is directly relevant to procedures in this region. He has performed more than 3,000 pelvic reconstructive procedures.

Patients who have seen other providers often arrive with a procedure already suggested before their anatomy was fully assessed. The evaluation at Advanced Pelvic Surgery and Urogynecology of Charlotte begins with the anatomy. The treatment follows from that.

That foundation — deep operative experience in pelvic anatomy — is what makes an accurate diagnosis possible before a single treatment is recommended.

Volume Deficiency

Age-related fat atrophy, hormonal changes, and rapid weight loss — including GLP-1–mediated adipose reduction — progressively deflate the labia majora. The outer envelope flattens and becomes lax, exposing the inner anatomy to friction and reducing natural cushioning. The tissue is otherwise structurally sound; it simply lacks volume.

Structural Laxity & Redundancy

Skin laxity is a different mechanical problem. The dermis and subcutaneous architecture have lost elasticity — through collagen fragmentation, childbirth-related distension, or significant weight fluctuation — leaving excess, redundant skin that no longer recoils. Adding volume to a lax envelope will not resolve laxity. These two conditions require categorically different interventions.

Woman walking comfortably outdoors after labia majora restoration — Charlotte NC

Physical comfort and freedom of movement are measurable outcomes of structural vulvar restoration — not abstract benefits.

The GLP-1 Factor

Women who have experienced meaningful weight loss on semaglutide or tirzepatide (Ozempic, Wegovy, Mounjaro) are presenting in increasing numbers with a combination of adipose deflation and dermal laxity that can occur simultaneously — informally termed “Ozempic Vulva.” The appropriate treatment pathway depends on which component predominates. In many cases, both must be addressed, and sequencing matters.

Treatment Pathway One

Labia Majora Augmentation

Restoring lost volume when the skin envelope is adequate but the underlying fat compartment has atrophied.

Autologous Fat Grafting

Fat is harvested from a donor site — typically the inner thigh or abdomen — processed, and injected precisely into the deflated compartment. Because the graft is your own living tissue, integration is biologically familiar. Approximately 60–80% of transferred fat may survive long term; the remainder is reabsorbed over the first three months. This is a primary treatment option for volume loss in patients with adequate donor fat.

Adipose Allograft — alloClae™

For lean patients who lack sufficient donor fat, or those who prefer to avoid a harvest site entirely, alloClae™ provides an acellular adipose matrix derived from processed donor tissue. No incision or harvest site is required, and recovery expectations are reviewed during consultation.

Because alloClae is performed in the office under local anesthesia while you are fully awake, you participate directly in the outcome. Volume is placed incrementally — you evaluate the result in real time, direct the placement, and confirm the amount before the procedure is complete. This level of intraoperative feedback is not possible under general anesthesia.

A higher percentage of the fat matrix persists compared to traditional autologous grafting, which means the result you see during the procedure more accurately reflects the final outcome. Less reabsorption, more predictability.

Treatment Pathway Two

Labia Majora Skin Tightening

When laxity — not volume loss — is the primary driver, the treatment objective is collagen remodeling and dermal contraction. Dr. Stepp uses the empowerRF platform by InMode, which delivers a graduated spectrum of tissue response: from gentle surface-level remodeling to deep subdermal lipocoagulation. The correct point on that spectrum is determined by the degree of laxity, skin quality, and patient goals.

Morpheus8V — RF Microneedling

Mild to Moderate Laxity • Series of 3 • Annual Maintenance

Morpheus8V delivers fractional radiofrequency energy through microneedles to depths of up to 3mm in vulvar tissue. The controlled thermal injury stimulates neocollagenesis and elastin remodeling — tightening the dermis from within, without removing tissue. Performed in-office with topical anesthesia, no incisions, minimal downtime.

A standard protocol is three sessions spaced four to six weeks apart. Results mature over three to six months following the final treatment. Because the mechanism is biological remodeling rather than tissue elimination, results are not permanent; annual maintenance is standard to sustain the outcome.

Appropriate for: Mild-to-moderate labial laxity, skin crepiness, or early dermal quality changes. Not a substitute for surgical correction when laxity is significant.

Aviva — RFAL Lipocoagulation

Moderate to Significant Laxity • Single Treatment • Long-Lasting Reduction

Aviva uses Radiofrequency Assisted Lipocoagulation (RFAL) — the same technology platform as FaceTite and BodyTite, adapted for intimate anatomy. A 0.6mm cannula is inserted through a pinpoint access site, delivering bipolar RF energy internally and externally simultaneously. The dual-electrode energy delivery causes tissue contraction and reduces treated adipocytes.

Performed under local anesthesia in the office. No surgical incisions, no sutures, and a small access point. Tissue contraction is measurable immediately; final results are apparent at three to six months. Volume reduction in the treated compartment can be long-lasting. Clinical series document 30–50% reduction in labial hypertrophy with retraction of the clitoral hood and perineal structures in many patients.

Appropriate for: Moderate-to-significant laxity or hypertrophy where meaningful anatomical reduction is the goal but surgical excision is not preferred. Represents a minimally invasive alternative to surgical labia majora reduction for appropriate candidates.

Combined Protocol — Morpheus8V + Aviva

For presentations that include both dermal surface laxity and deeper tissue bulk, combining Morpheus8V and Aviva may provide a broader remodeling response than either alone. Aviva provides the deeper lipocoagulation and structural contraction; Morpheus8V refines dermal quality and surface texture. Sequencing is determined at consultation based on individual anatomy and goals.

Treatment Pathway Three

Surgical Labia Majora Reduction

When the degree of laxity or tissue redundancy exceeds what energy-based treatment can reliably correct, surgical excision is the appropriate intervention for predictable correction of significant tissue excess.

The procedure involves precise elliptical excision of redundant skin and soft tissue, with the resulting scar placed within the natural anatomical groove between the labia minora and majora — a location that is functionally concealed. Typically performed under local anesthesia with optional oral sedation; no surgical center or general anesthesia required. Recovery is predictable: sedentary activity resumes within days; physical activity at three weeks; full activity at six weeks.

Surgical reduction can be combined with augmentation in selected cases — for example, a patient with both excess skin and a deflated upper pole — though anatomical feasibility and sequencing are assessed individually.

Appropriate for: Significant, functionally or aesthetically limiting labia majora redundancy that exceeds the correction threshold of energy-based treatment. Dr. Stepp provides a direct, evidence-based assessment of whether surgery is indicated for your anatomy.

Regenerative Adjuncts

Tissue Quality Enhancement

Regenerative protocols — including exosomes, PRP/PDGF, and CO₂ transdermal therapy — can be applied as adjuncts to any of the above pathways to optimize tissue quality, support healing, and enhance the biologic environment. These are not standalone treatments for laxity or volume loss; they amplify primary interventions. Each modality is addressed in full on its dedicated page.

Exosome Therapy → PRP / PDGF → VliftCO₂ Therapy →
Dr. Kevin Stepp MD FACOG URPS — labia majora restoration Charlotte NC

Consultation & Discretion

The right treatment begins with an accurate anatomical diagnosis. Dr. Kevin Stepp, MD, FACOG, URPS evaluates each patient individually — determining whether volume loss, laxity, or a combination is the operative problem, and recommending only what the anatomy indicates. Consultations at Advanced Pelvic Surgery and Urogynecology of Charlotte are private and unhurried. Located at 11210 Golf Links Dr North, #100, Charlotte, NC 28277. Contact us at (980) 771-0726.

Schedule a Consultation

Frequently Asked Questions

Clinical Questions About Labia Majora Restoration & Tightening

What are the treatment options for labia majora laxity and volume loss?

Labia majora concerns fall into two anatomically distinct categories: volume deficiency and structural laxity. Volume loss is addressed with autologous fat grafting or alloClae adipose allograft. Laxity is addressed along a spectrum: Morpheus8V RF microneedling for mild-to-moderate laxity (series of 3, annual maintenance), Aviva RFAL lipocoagulation for moderate-to-significant laxity (single treatment, long-lasting reduction), or a combination of both. Surgical excision is the appropriate intervention when laxity exceeds what energy-based treatment can correct. Kevin Stepp, MD, FACOG, URPS performs all of these procedures at Advanced Pelvic Surgery and Urogynecology of Charlotte, 11210 Golf Links Dr North, #100, Charlotte, NC 28277. Call (980) 771-0726.

What is the difference between Morpheus8V and Aviva?

Morpheus8V uses fractional RF microneedling to stimulate collagen remodeling at the dermal level — a gentle, non-invasive approach requiring three sessions with annual maintenance. Aviva uses Radiofrequency Assisted Lipocoagulation (RFAL), delivering energy internally via a 0.6mm cannula to reduce targeted adipocytes and contract tissue in a single treatment. Aviva is appropriate for moderate-to-significant laxity; Morpheus8V is appropriate for mild-to-moderate presentations. The two can be combined when both surface laxity and deeper tissue bulk are present.

What is “Ozempic Vulva” and what treatments address it?

Ozempic Vulva describes the labial deflation and dermal laxity that many women experience following rapid weight loss on GLP-1 agonists like semaglutide or tirzepatide. The condition can involve pure volume loss, pure laxity, or both simultaneously. Volume loss is treated with fat grafting or alloClae. Laxity is treated with Morpheus8V, Aviva, or surgical reduction depending on severity. Kevin Stepp, MD, FACOG, URPS evaluates and treats this presentation at Advanced Pelvic Surgery and Urogynecology of Charlotte in Charlotte, NC.

What is the advantage of alloClae over autologous fat grafting?

AlloClae is performed in the office under local anesthesia while you are fully awake, allowing you to participate directly in the outcome. Volume is placed incrementally — you evaluate the result in real time, direct the placement, and confirm the amount before the procedure is complete. A higher percentage of the fat matrix may persist compared to traditional autologous grafting, so the result you see during the procedure may more closely reflect the final outcome. Autologous fat grafting remains the preferred choice for patients with adequate donor fat, achieving approximately 60–80% long-term graft survival. Kevin Stepp, MD, FACOG, URPS determines which option is appropriate at consultation.

When is surgical reduction recommended over Aviva?

Aviva is effective for moderate-to-significant laxity, with clinical series documenting 30–50% reduction in labial hypertrophy. However, when tissue redundancy exceeds what RFAL can predictably correct, surgical excision may provide more reliable correction. Surgical reduction is performed under local anesthesia in office with the scar placed in the natural anatomical groove. Kevin Stepp, MD, FACOG, URPS provides a direct, evidence-based assessment of which approach is indicated. Contact Advanced Pelvic Surgery and Urogynecology of Charlotte at 11210 Golf Links Dr North, #100, Charlotte, NC 28277, or call (980) 771-0726.

Where is labia majora restoration performed in Charlotte, NC?

All procedures — augmentation, Morpheus8V, Aviva, and surgical reduction — are performed by Kevin Stepp, MD, FACOG, URPS at Advanced Pelvic Surgery and Urogynecology of Charlotte, 11210 Golf Links Dr North, #100, Charlotte, NC 28277. The practice operates as an out-of-network concierge surgical model. Consultations are private and by appointment. Call (980) 771-0726.