With the new millennium, the increase in internet use and the rapid spre-ad of social and digital media have caused significant changes in societies. The desire of women to feel better, the increasing popularity of general anti-aging treatments, especially the visual comparison races in social media, development of energy-based new technologies, and the incredible increase in social aware-ness are just a few of the factors that accelerate the popularity of female genital operations. The aesthetic operations of the genital area include a range of sur-gical and non-surgical procedures with a high level of patient satisfaction for cosmetic, reconstructive, and regenerative purposes, providing excellent results when done with the right technique and personalized methods. However, when these procedures are done without sufficient knowledge and experience, they can lead to irreversible results in terms of both aesthetic and functional aspects as well as serious legal problems. For this reason, training is essential before starting practice. However, this field is not included in the residency training programs of most universities today. Some associations, organizations, or indi-viduals working with special status are trying to fill this gap. ISAGSS (Interna-tional Society of Aesthetic Genital Surgery & Sexology), which I established in 2017 and still continues to provide hands-on training under my leadership in different parts of the world, uniquely combines aesthetic genital surgery with sexual well-being. Another important issue is that scientific evidence-based data on genital aest-hetic procedures are still insufficient. For this reason, energy-based technologies used in applications and treatments become the target of organizations such as WHO, FDA, and ACOG from time to time. I hope that as the evidence-based data on genital aesthetic operations increase, this field will soon reach a much stron-ger position in the scientific arena. For the physician who intends to work in the field of genital aesthetics, it is essential to have the ability to empathize with his/her patient, not to compro-mise on ethical principles, and to draw his/her own boundaries with the motto “first, do no harm”. The operation demands and expectations of the patients can be quite different from each other. There is no one-size-fits-all in cosmetic sur-geries. The technique to be used in the operation in line with the experience of the physician should be applied according to the patient’s wishes and the con-dition of the tissue.

As stated in the ACOG declaration published in 2020, some sexual dysfunctions can also be corrected by functional genital surgeries. However, for this, the physician must have sufficient training in the fields of sexual dysfunction and psychiatric disorders, and when necessary, should not hesitate to ask for consultation from different disciplines. The book “Female Aesthetic and Functional Genital Surgery” is blended with nearly 20 years of knowledge and experience in the field of genital area aesthetics, techniques from the most up-to-date literature, and a multidisciplinary perspective. The work, which is the product of the coronavirus pandemic period in 2020, consists of 22 separate sections, and the images in its content were selected from more than 20,000 photographs from over a 20-year period in this field. Procedures not yet included in the literature, e.g., labia minora asymmetry classification, Barbie vaginal aesthetics with Eserdag concept, neolabiaplasty (re-labium reconstruction), inverted-U hoodoplasty, hat trimming in hoodoplasty, “Juicy Vagina Syndrome”, rooster comb appearance in perineum, painful hymen as a cause of superficial dyspareunia, square mattress suturing in labiaplasty, office labiaplasty, majoraplasty with adipose tissue reduction, and teardrop incision in majoraplasty, as well as procedures of mine such as the Inverted-Y plasty procedure in clitoral hoodoplasty operations and primary repair of hymen with Vestibulo-Introital Tightening Technique (VITT) in the literature are also discussed in detail. The book includes from basic to advanced methods of aesthetic, reconstructive and regenerative surgeries and non-surgical applications related to female genital organs, and has been enriched with the consent forms and genital aesthetic examination in the last part. Before you start reading, I recommend that you test yourself with the aesthetic genital surgery MCQ in the last part, or at least take a look. After you finish reading the book, you can return to the exam questions. My aim is that the physicians who have devoted themselves to this field and whose number is increasing rapidly every year can gain knowledge from the most basic level to advanced techniques in this happy journey. I hope that this work, in which I generously share all the methods I apply to my patients, will be beneficial for the global medical community.

Süleyman Eserdağ, MD
Gynecologist,
Fellow of European Committee of Sexual Medicine (FECSM),
President and Founder of the International Society of Aesthetic Genital Surgery & Sexology (ISAGSS)

I devote this book to;
My life teacher, my dear mother Alime Eserdağ (1941-2018),
Altruistic, modest, and unique my dear father Ünal Eserdağ,
My biggest supporter in my academic life, and my love Dr. Şenay Eserdağ, My life energy sources, my dear sons Can Batu and Batuhan…

The author was born in Bursa in 1969 and after completing his primary and secondary education in Manisa, he graduated from Izmir Science High School in 1986. After graduating from the Medical School of Dokuz Eylül University, he began residency program in Ankara Zekai Tahir Burak Women’s Health Educational and Research Hospital by passing the Medical Specialization Exam. He completed his residency education in 1997 and became a Gynecologist and Obstetrician. Later, he worked as a Gynecology and Obstetrics Specialist and also a Chief Physician at the Kazan State Hospital, which was his first place of appointment. In 2002, he was re-appointed to Zekai Tahir Burak Women’s Health Education and Research Hospital and worked in the perinatalogy, menopause, in vitro fertilization and infertility clinics of this hospital. In this period, he opened his first clinic named “HERA Clinic” in Ankara (Kavaklidere). In 2008, he resigned from the hospital due to adverse conditions and started working full time in his office. Dr. Eserdag, in 2014, passed the board exam organized by the European Society for Sexual Medicine (ESSM) and the European Federation of Sexology (EFS) to become Turkey’s one of first “Fellow of European Committee of Sexual Medicine”(FECSM) gynecologists. In 2015, he established the HERA Vaginismus Treatment, Education and Research Association, the first national non-governmental organization in the field of vaginismus. He trained physicians and health professionals within the scope of this association. Dr. Eserdag has received training from many leaders in the field during his vaginismus and genital aesthetics journey that started in the early 2000s. Prof Adam Ostrzenski (Florida/USA-2011), ECAMS (Athens/Greece-2015), and Dr. Red Alinsod (California/USA-2016) are some of the mentors and organizations that he received training from. Dr. Eserdag was accepted as a senior faculty member at ECAMS (European College of Aesthetic Medicine and Surgery) based in Ireland in 2015. Betwe-en 2015 and 2017, he gave hands-on genital aesthetics courses in Istanbul and Vienna. In 2017, he left this faculty and established an international association called ISAGSS (International Society of Aesthetic Genital Surgery and Sexology). In this association within the scope, Turkey, Northern Cyprus, India, Azerbaijan, Philippines and Indonesia in as many countries, has provided more than 600 different branches of one to one training physicians. In addition, he organized the International RAGSS (Reconstructive Aesthetic Genital Surgery and Sexology) congresses in Istanbul in 2018 and 2019. In 2020, he published the book Sexual Medicine and Genital Aesthetics, which he shared the editorship with two colleagues. This book is the first book published in Turkey in the field of sexual medicine and genital aesthetics. Inverted-Y Plasty procedure in clitoral hoodoplasty operations and Vestibu-lo-Introital Tightening Technique (VITT) in hymenoplasty surgeries applied by Dr Eserdag in cosmetic gynecology fields have entered the literature. Many national and international studies of him on vaginismus and dyspareunia have also been published in peer-reviewed journals. Dr Eserdag established clinics in İstanbul (Nisantasi) and İzmir (Alsancak) under the roof of ‘HERA Clinic’ in 2016 and İstanbul (Kadıköy) clinics in 2020. Now he’s the director of these four clinics and accepts the patients in his private clinic in Istanbul. At the same time, he continues giving lectures and trainings within the scope of the ISAGSS, and has been invited to many national and international congresses. He is married and father of two boys.

Asking new questions, new possibilities, looking at old problems from a new angle, requires creative imagination and marks a real breakthrough in science. Albert Einstein

It is an honor for me, to be able to write a few introductory words in this wonderful book. It is common for doctors to look in a book perhaps for the chapter that we are interested in consulting, because obviously we do not have time for more. However, this story may be very familiar to many readers. At the beginning of this millennium I remember how in my daily medical practice hundreds of women year after year complained of problems related to well-being and the quality of sexual life. Curiously, I felt limited by not being able to offer them any valid alternative that could at least alleviate them and thus obtain some benefit for them in this regard. Perhaps this was the trigger that made me twist the cour-se of my professional career as a gynecologist and I began my journey towards what we now know as “Functional and Aesthetic. Regenerative Gynecology”. Definitely the book that you are about to enjoy is in my opinion one of the most important written works of this new specialty in this century. It complies in each of its chapters with the proposed educational objectives. In a clear and complete way, it not only shows each of the procedures but also allows us the integration of concepts to be able to apply them all in our daily practice. When the term “Aesthetic Gynecology” was introduced in 1996 it only app-lied to surgical corrections in the genital area. As in all evolution in medicine, it began, with the passing of the years, to emerge innovators that contributed new techniques not only surgical but also (as in my personal case with the laser), minimally invasive and non-invasive procedures to be applied in the office. After 25 years of evolution, a large number of procedures have been developed with not only aesthetic but also regenerative and functional purposes in gynecology, which gave rise to this new specialty. Today we are living an unprecedented time, rather exceptional, that will go down in history and that will mark a before and after (due to a pandemic), where the demand for wellness procedures increased in an incredible way. The desire to be well, to improve the biological state prevailed over any other desire in the area of health. In the same way, the demand for procedures in Aesthetic, Regenerative and Functional Gynecology is growing almost exponentially. This means that gynecologists have to supply ourselves with information and we must incorporate new tools to be able to face this growing demand. In this sense, I want to emphasize that this work fills that empty space that we as women’s health professionals have. Regarding the author of this marvel of a book, I just have to say that beyond his vast experience in Aesthetic Gynecology, he is one of the few doctors (if not the only one) in the world who, from the humility that only great people have, has the immense generosity of transmitting absolutely all the information, and more as well. Has accumulated experiences, and more than a thousand proce-dures in the specialty, so as to be able to write and transmit all that world of knowledge that will enrich us for the benefit of our patients. I invite you then to walk the path of Regenerative and Functional Aesthetic Gynecology with the help of Dr Suleyman Eserdag who will show us how exciting and innovative this concept can mean for our clinical practice. Through each of its pages and each of its chapters, the reader will have a different and attractive feeling, which will go beyond the information they can find in it. I am referring to the passion and motivation that you will find between the lines. Finally, as a gynecologist dedicated one hundred percent to Regenerative and Functional Aesthetic Gynecology, I would like to convey a message to you and at the same time share a concern with the reader. My message is simple: aging and deterioration is a continuous process that can have consequences on the quality of life. The concern that I want to share with you is that we must be proactive, that is, take action before the symptoms of deterioration occur. For that we have today an innumerable amount of techniques that you will be able to discover in this beautiful written work. I invite you then to enjoy its pages.

Adrian Gaspar

The field of female cosmetic genital surgery and non-surgical genital treatments has had a long and controversial past. More recently it has found grudging acceptance in the fields of gynecology, urogynecology, urology, plastic and cosmetic surgery, and dermatology. We owe much of the progress to men and women who were willing to face the bows and arrows from their parent organizations and traditionally minded colleagues. These forerunners include Marco Pelosi II, Marco Pelosi III, David Matlock, Michael Goodman, Adrian Gaspar, Otto Placik, Troy Hailparn, Christi-ne Hamori, Heather Furnas, Sejal Desai, Charles Runels, Alexander Bader, Amr Seifeldin, Joao Brito Jaenisch, Clara Santos, Annebelle Ahererra, and Suleyman Eserdag. We owe much to these pioneers to ease the path for others interested in bravely moving forward and helping women worldwide. Pioneers get arrows, settlers get land. I heard about Suleyman Eserdag from my professional circles, an admittedly tight group of pelvic surgeons, almost a decade ago. His reputation in Turkey as a young and renown gynecologic surgeon was growing. I first met Suleyman at the International Society of Pelviperineology (ISPP) meeting in Istanbul in the summer of 2015 where I had the privilege of introducing ThermiVa radiofrequ-ency treatments to the edges of Europe. Legends of pelvic reconstructive surgery and founders of ISPP, Peter Petros and Bruce Farnsworth, wanted me to present my office labiaplasty and vaginoplasty techniques as well my extensive work in transvaginal prolapse repairs. I had the privilege of meeting outstanding Tur-kish surgeons and Suleyman stood out. Within a year (2016) he was in Laguna Beach, California, side by side with me as we dove into the brand-new world of non-surgical aesthetic gynecology using energy and biologics for the benefit of suffering women. 2015 was the birth year of the exponential growth of energy for gynecologic use with the advent of vaginal lasers and radiofrequency treatments. Adrian Gaspar from Argentina shepherded the tremendous growth and interest in vaginal lasers while I pursued radiofrequency indications. Because of Charles Runels primarily, it was also the birth year of PRP treatments getting worldwide notice. Charles had fought for many years before that to bring his message out but 2015 was the breakout year. He spoke at my very last Congress on Aesthetic Vulvovaginal Surgery (CAVS) meeting in Orlando, Florida, in September 2015 and the interest in his O-Shot procedure went ballistic. Suleyman was in the middle of all this outburst of creative energy and recognized that for this field to succeed surgical skill had to be at the forefront. So, we tackled labial and vaginal surgery with intensity in my office setting and planted the seed that would blossom into ISAGSS two years later. I shared all my trade secrets in No IV In-Office Awake Genital Surgery. I shared my skills in Hybrid/Barbie/Rim Labia Minoraplasty, Medial Curvilinear Labia Majoraplasty, Lateral and Vertical Clitoral Hood reduction, RF Feathering and Resurfacing of labial edges and anal skin tags, Perineoplasty, and full depth Vaginoplasty. I shared my secrets on my office set up and equipment, modifications of Pudendal and Levator Blocks, and use of Lone Star 3715 APS Retractor to allow safe and solo in-office surgeries. I made sure Suleyman would be an expert in ThermiVa and the O-Shot as we did case after case. I knew Suleyman would bring these life changing procedures to Europe and the world and help thousands or women in the future. I was very proud of my esteemed graduate and encouraged his professional development. Now, six years after we first met, Suleyman has brought together his experience and skills in his new book “Female Aesthetic and Functional Genital Surgery”. This textbook clearly shows his love and passion for this emerging field and will be a tremendous core source of knowledge. His personalized modifications and approach show a depth of experience from someone in the trenches, working daily to perfect his craft, and not from someone sitting inside an ivory tower having medical students and residents writing chapters from inexperience. I recommend this collection of written insight without reservation. It is the perfect partner for my own online and onsite training programs that have spanned several decades.

Dr. Red M. Alinsod
Alinsod Institute for Aesthetic Vulvovaginal Surgery South Coast Urogynecology
Laguna Beach, California

www.aiavs.com
www.urogyn.org