Hyaluronic Acid Injection for Labia Majora Hypotrophy:Evaluation of its Efficacy and Safety
- Admin
- Jun 9
- 7 min read
As aesthetic and regenerative gynecology continue to evolve, physicians are seeing a rise in patients seeking non-surgical options for intimate concerns, particularly those related to the labia majora. Over time, factors such as aging, hormonal changes, significant weight loss, or even genetics can contribute to hypotrophy or atrophy of the labia majora. Patients may present with deflation, skin laxity, or protrusion of the labia minora, which not only causes physical discomfort but can also impact body image, self-esteem, and sexual confidence.
While surgery has historically been the mainstay of treatment, it comes with risks, bleeding, scarring, nerve sensitivity changes, and downtime. In this context, Dr. Fabien Boucher and colleagues conducted a prospective, multicenter clinical study to evaluate the safety and efficacy of HA filler, a cross-linked hyaluronic acid (HA) filler, specifically formulated for volume restoration of the labia majora. The study offers compelling evidence supporting the use of HA fillers as a safe, well-tolerated, and effective solution for intimate rejuvenation.
Patient Selection and Injection Technique: Clinical Workflow
A total of 73 adult women were enrolled in the study. Participants were either self-reporting dissatisfaction with their labia majora appearance or were clinically diagnosed with volume loss by a physician. Many had protrusion of the labia minora due to surrounding fat depletion, which can create both aesthetic and mechanical discomfort. Patients with a history of autoimmune disease, hypersensitivity to HA, or genital infections were excluded.
The injection technique was carefully standardized. Up to 2 mL of HA filler was injected per labium using a linear retrotracing technique via an 18-gauge blunt-tip cannula. The cannula could be inserted from either an anterior or posterior approach based on injector preference and anatomy.
This figure outlines the two potential cannula entry points, anterior and posterior, along the longitudinal axis of the labia majora, offering flexibility while ensuring even filler distribution. A touch-up session was permitted at week 4, allowing up to 1 mL additional filler per labium, typically used to correct minor asymmetries or undercorrection after the initial treatment. This technique prioritizes patient comfort, minimal trauma, and natural tissue integration, making it well suited for outpatient settings and practitioners trained in vulvovaginal anatomy.
Key Takeaways:
Ideal for patients with age-related or post-weight loss labial volume loss.
Use a linear retrotracing technique with an 18G cannula for even filler spread.
Touch-up session after 4 weeks improves symmetry and refines the result.
Subcutaneous fat plane is optimal for safety, comfort, and durability.
Aesthetic Outcomes and Clinical Durability
The primary outcome measure for aesthetic improvement was the Global Aesthetic Improvement Scale (GAIS), which includes both physician-assessed and patient self-assessed ratings of improvement.
By week 12, 97% of patients described their results as “improved,” “much improved,” or “very much improved.” Notably, this improvement was maintained throughout the 52-week follow-up, showing the durability of cross-linked HA in this tissue zone, even in an area subject to movement, friction, and hormonal changes.
These graphs chart the evolution of GAIS scores over time. One curve tracks patient-reported satisfaction, while the other reflects the clinician’s objective aesthetic assessment. The consistency between the two indicates not only clinical success but strong alignment with patient expectations.
Peak results were observed around week 24, with a gradual but mild decline thereafter—consistent with HA biodegradation kinetics. Importantly, over 90% of participants still rated their improvement as positive at week 52, demonstrating both longevity and satisfaction beyond the initial post-treatment period.
Key Takeaways:
GAIS improvement peaked at 3–6 months and remained above 90% at 12 months.
Cross-linked HA offers longer durability in labial tissue than in facial zones.
Touch-up treatment supports symmetry and extended effect longevity.
Impact on Sexual Function: A Critical Yet Under-Explored Outcome
A key strength of the study by Dr. Boucher’s team is its inclusion of the Female Sexual Function Index (FSFI) to evaluate the broader impact of labia majora volume restoration, not just on appearance but on quality of sexual life.
The FSFI measures six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Many women entered the study with scores indicating clinical sexual dysfunction. Following HA treatment, the mean FSFI score increased significantly across all domains, with the most dramatic improvements noted in sexual satisfaction, arousal, and desire.
The FSFI score progression across timepoints, from baseline to week 52. By the end of the study, a majority of patients had scores above the threshold for sexual wellness, with sustained gains maintained after one year.
The implications are profound. This suggests that restoring labial structure doesn’t just enhance aesthetics, it can also normalize sexual sensation, alleviate psychological distress, and enhance lubrication, possibly due to improved vascularity and mucosal support.
Key Takeaways:
HA filler improves vaginal comfort, self-image, and intimacy confidence.
FSFI results support a functional benefit in addition to aesthetics.
Consider for patients reporting discomfort, avoidance of intimacy, or self-consciousness due to labial appearance.
Symptom Relief and Daily Comfort
Beyond sexuality, women also frequently report irritation, burning, or discomfort in the vulvar area, particularly when wearing tight clothing, exercising, or during intercourse. The study captured these symptoms using a numeric pain and discomfort rating scale, tracking changes over 52 weeks.
This graph illustrates the trajectory of symptom improvement, with noticeable reductions starting as early as week 4. These changes continued to improve steadily, reflecting tissue integration and hydration benefits of HA.
Moreover, women reported an increased ability to engage in physical activity and intimate contact without discomfort, which reinforces the dual benefit of this treatment: functional support and psychosocial comfort.
Key Takeaways:
Filler provided fast symptom relief, often within 1 month.
Particularly effective for athletic or active patients.
Also useful in early or postmenopausal women with vulvar sensitivity.
Patient Satisfaction and Visual Outcomes
High satisfaction scores further validated the clinical success of this treatment. Using a standardized Patient Satisfaction Questionnaire (PSQ), most participants responded positively to questions related to appearance, comfort, and overall confidence.
This figure presents patient-reported satisfaction metrics, including confidence in their intimate life, body image, and willingness to undergo treatment again. More than 80% of patients expressed that they were “a lot” or “totally” satisfied at multiple follow-up points.
These visual comparisons show before-and-after results, 12 weeks, and 52 weeks for three representative patients. Notable improvements include labial volume restoration, reduced sagging, and improved contour symmetry, reflecting the subtle yet natural enhancement that well-placed HA fillers can achieve.
Key Takeaways:
Over 80% of patients were satisfied at all timepoints.
Visual improvements were subtle, natural, and symmetrical.
High repeat interest makes this ideal for building long-term patient relationships.
Safety and Tolerability: A Low-Risk Profile with Minimal Downtime
One of the most important aspects of HA fillers is their reversible and biocompatible profile. In this study, injections were well tolerated, with low pain scores and minimal adverse events.
Most common side effects: bruising, swelling, temporary discomfort
Adverse events were mild to moderate and resolved within 8 days in nearly all cases.
No serious treatment-related complications occurred during the 52-week follow-up.
This data supports the use of HA filler as a safe, non-surgical alternative to labiaplasty or fat grafting, especially for women seeking aesthetic improvement without downtime.
Key Takeaways:
Use a blunt cannula to minimize vascular trauma and bruising.
Downtime is minimal, most patients resume normal activity within 1–2 days.
No delayed granulomas or allergic reactions reported across the 12-month follow-up.
Conclusion
The clinical evidence presented by Dr. Fabien Boucher and colleagues confirms that cross-linked hyaluronic acid (HA) fillers can safely and effectively restore volume, comfort, and sexual wellness in women experiencing labia majora hypotrophy or atrophy. For physicians and surgeons working in aesthetic gynecology, urogynaecology, or regenerative medicine, this study offers a clear protocol alongside a proven HA fillers has been shown to deliver high aesthetic satisfaction, significant improvements in sexual function, long-lasting volume restoration, and minimal recovery time with a strong safety profile. As the demand for non-invasive intimate rejuvenation continues to grow, HA fillers are poised to become a cornerstone in comprehensive vulvovaginal care.
Reference:
Boucher, F., Fatton, B., Deval, B., Hennebert, H., Debodinance, P., Boukerrou, M., Garbin, N., Panel, P., Fatton, M., & Rubod, C. (2025). Evaluation of the efficacy and safety of hyaluronic acid injection for volume restoration of the labia majora: A prospective multicenter study (ESOLANE). International Urogynecology Journal. Advance online publication. https://doi.org/10.1007/s00192-025-06094-1
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