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Cosmetic Genital Surgery

This section covers the elective / aesthetic end of the genital-surgery spectrum, sharply distinct from reconstructive operations for trauma, oncologic resection, lichen sclerosus, FGM/C, or congenital anomaly (those live at 04e Genital Reconstruction) and from gender-affirming pathway surgery (which lives at 04k Gender-Affirming Surgery). The atlas splits the operative decision space into the two patient cohorts that drive technique selection — male cosmetic (augmentation phalloplasty, girth enhancement, suspensory-ligament division, suprapubic lipectomy, Penuma, scrotal aesthetic procedures) and female cosmetic (FGCS) (labiaplasty, clitoral hoodoplasty, labia majora augmentation, monsplasty, surgical vaginoplasty / energy-based devices, hymenoplasty, regenerative / fat-grafting techniques). Each sub-page hosts its own Decision Framework + Treatment Database. For the clinical-conditions framework on small penis syndrome (SPS) / penile dysmorphic disorder (PDD) see Small Penis Syndrome.

Society positions and evidence-quality caveat. The SMSNA 2024 position statement notes that the overall quality of evidence for male cosmetic penile-enhancement procedures is low and most should be considered investigational. The ACOG 2020 Committee Opinion and the FIGO 2025 Statement assert that female genital cosmetic procedures are not medically indicated in patients without structural or functional abnormalities, and the FDA 2018 safety communication warned against use of energy-based devices for "vaginal rejuvenation" or cosmetic indications — no such device is FDA-cleared for these uses. Mandatory psychological screening for body dysmorphic disorder (BDD) and penile / genital dysmorphic disorder belongs at the front of every consultation.

  • Male Cosmetic Genital SurgeryMandatory BDD screening, objective measurement, PTT first-line, then HA / PLA / Penuma / SLD / suprapubic lipectomy. SMSNA 2024 evidence hierarchy. Explicit "do not use" carve-out for non-autologous injectables.
  • Female Cosmetic Genital Surgery (FGCS)ACOG / FIGO framing, BDD screening, labiaplasty (trim vs wedge vs de-epi per Zahedi 2023), clitoral hoodoplasty (Liu 2022 classification), labia majora / monsplasty, surgical vs energy-based vaginoplasty (Pereira 2024 negative-RCT data; ACOG colporrhaphy-rebranding warning).

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