Prominence of the mons pubis — the fatty mound overlying the pubic symphysis — is caused by genetics, significant weight loss including after GLP-1 or bariatric surgery, hormonal fat redistribution, or prior abdominoplasty that did not address the upper pelvic frame. The degree of subcutaneous fat volume and skin laxity present determines the appropriate intervention. In Charlotte, NC, Dr. Kevin Stepp, MD, FACOG, URPS, evaluates each patient individually across a spectrum of options — from non-surgical radiofrequency fat reduction to surgical monsplasty — selecting the approach the anatomy indicates.
What Determines the Treatment
The mons pubis forms the upper aesthetic frame of the pelvic anatomy. When prominent, it can create visible bulk in fitted clothing and cause friction during activity. The correct intervention depends on two variables: how much of the problem is fat volume, and how much is skin laxity. Mild-to-moderate fat excess without significant laxity may be appropriate for non-surgical fat reduction. When fat volume is substantial, or when skin laxity is a co-existing problem, surgical monsplasty — combining liposuction with skin excision and fascial anchoring — is the indicated treatment.
Patient Concerns
Patients may seek treatment because of visible prominence in fitted clothing, friction during activity, or dissatisfaction with the contour.
The Technique
Skin excision removes redundant tissue; fascial anchoring lifts and secures the result to prevent recurrence. When significant volume reduction is indicated, liposuction is incorporated into the coordinated surgical plan.
Treatment Pathway One
Non-Surgical Mons Fat Reduction
For patients whose mons pubis prominence is driven primarily by subcutaneous fat — without significant skin laxity — non-surgical radiofrequency fat reduction with Aviva may be the appropriate first intervention. Aviva is not a substitute for liposuction when fat volume is substantial; it is a clinically appropriate alternative for the right candidate.
Aviva uses Radiofrequency Assisted Lipocoagulation (RFAL) — the same technology platform as BodyTite and FaceTite, adapted for intimate anatomy. A 0.6mm cannula is inserted through a pinpoint access site, delivering bipolar RF energy internally and externally simultaneously. The energy reduces treated adipocytes and causes measurable tissue contraction, without surgical incisions, sutures, or general anesthesia.
Performed under local anesthesia in the office. Tissue contraction is measurable immediately; final results are apparent at three to six months. Volume reduction in the treated compartment can be long-lasting. The procedure is appropriate when the degree of fat excess is mild-to-moderate — sufficient to cause visible prominence, but not at a volume that exceeds what RFAL can predictably address.
Appropriate for: Patients with mild-to-moderate mons fat excess and adequate skin elasticity who prefer a non-surgical approach or are not candidates for operative liposuction. Not appropriate when skin laxity is a co-existing problem or when fat volume exceeds the correction threshold of RFAL — in those cases, surgical monsplasty may be indicated.
When Liposuction Is Required Instead
When the volume of subcutaneous mons fat is substantial, Aviva may not provide enough reduction. Liposuction can remove a larger volume of fat. Dr. Stepp considers fat volume, skin quality, laxity, goals, and treatment preferences during consultation. When significant liposuction is planned, skin excision and fascial anchoring may also be used to address laxity.
Treatment Pathway Two
Surgical Monsplasty
Surgical monsplasty may be appropriate when fat volume is substantial or when skin laxity is present with fat excess.
Monsplasty addresses skin laxity through excision and fascial anchoring, lifting redundant tissue and securing it to the abdominal fascia. The plan also accounts for the lower boundary of the dissection, where the mons transitions to the clitoral hood. Liposuction can be added when significant volume reduction is needed.
Performed under IV sedation or general anesthesia. Return to desk work within 3–5 days; compression garment worn 4–6 weeks; exercise restriction for 4 weeks; final results visible at 3–4 months. When the surgical plan includes significant liposuction or abdominoplasty, the approach is planned collaboratively from the initial consultation — both specialties informing the design of a single coordinated surgery.
Appropriate for: Significant mons fat excess — particularly with co-existing skin laxity — that exceeds what non-surgical RFAL can predictably correct. Dr. Stepp provides a direct, anatomy-based assessment of which pathway is appropriate.
Subspecialty Expertise
Why Pelvic Anatomy Matters
The lower mons transitions directly into the clitoral hood and labia majora, so lifting one area can affect the others. Dr. Kevin Stepp, MD, FACOG, URPS, is double board-certified in Urogynecology and Reconstructive Pelvic Surgery and in OB/GYN, with dual-fellowship training completed at Cleveland Clinic.
When a plan includes significant liposuction or abdominoplasty, Dr. Stepp and board-certified plastic surgeon Dr. Joel Beck can coordinate the operation from the initial consultation.
Dr. Beck: Volume Reduction
When significant liposuction is part of the plan, Dr. Joel Beck, FACS, performs that component using AYON. He also performs abdominoplasty when it is included in the coordinated surgical plan.
Dr. Stepp: The Intimate Transition
Dr. Stepp manages skin excision, fascial anchoring, and the lower boundary where the mons transitions to the clitoral hood, with attention to vulvar tension and nearby structures.
The Process
Your consultation identifies how much of the prominence comes from fat volume and how much comes from skin laxity. The surgical plan may include liposuction, skin excision, fascial anchoring, or a combination, with attention to the transition into the clitoral hood.
Frequently Asked Questions
Common Patient Questions
What is monsplasty and who needs it?
Monsplasty is surgical reduction and contouring of the mons pubis through skin excision and fascial anchoring. It may be appropriate when skin laxity is present or when prominence exceeds what nonsurgical treatment is likely to address. Patients with mild-to-moderate fat excess and adequate skin elasticity may be candidates for Aviva RFAL instead.
Can Aviva be used for non-surgical mons pubis fat reduction?
Yes. Aviva RFAL (Radiofrequency Assisted Lipocoagulation) uses a 0.6 mm cannula to deliver bipolar radiofrequency energy through a small access point. It may be an option for patients with mild-to-moderate fat excess and adequate skin elasticity. Substantial fat volume or accompanying skin laxity may require surgical monsplasty instead.
What is the difference between monsplasty and liposuction of the mons?
Isolated liposuction addresses fat volume but does not remove excess skin or provide a structural lift. Monsplasty addresses skin laxity through excision and fascial anchoring. The treatment plan depends on the relative amounts of fat and loose skin and whether adjacent intimate anatomy also needs attention.
How long does recovery from monsplasty take?
Most patients return to desk work within 3–5 days after monsplasty. Compression garments are generally worn for 4–6 weeks. Exercise and strenuous activity are restricted for 4 weeks. Final results are typically assessed at 3–4 months.
Can monsplasty be combined with other procedures?
Yes. Monsplasty is frequently combined with labiaplasty, vaginoplasty, significant liposuction of the mons, or abdominoplasty as part of a comprehensive pelvic and intimate restoration plan. Because Advanced Pelvic Surgery and Urogynecology of Charlotte includes both a board-certified Urogynecologist and a board-certified Plastic Surgeon within the same practice, cases that involve significant liposuction or abdominoplasty are planned collaboratively from the initial consultation — not referred out after the decision has already been made.
How much does monsplasty cost in Charlotte, NC?
The cost of monsplasty at Advanced Pelvic Surgery and Urogynecology of Charlotte depends on whether it is performed alone or as part of a combined procedure. The practice operates as a cash-pay concierge model with transparent pricing. A fee estimate is provided during your consultation. To schedule, call (980) 771-0726.
Where is Dr. Kevin Stepp's office located, and how do I schedule a monsplasty consultation?
Dr. Kevin Stepp performs monsplasty at Advanced Pelvic Surgery and Urogynecology of Charlotte, located at 11210 Golf Links Dr North, #100, Charlotte, NC 28277. To schedule a consultation, call (980) 771-0726.
