Votiva

Non-surgical vulvovaginal therapy has been one of the fastest growing areas in cosmetic surgery over the past 10 years. Votiva by InMode is a multi-technology workstation specifically designed to treat a full range of feminine concerns, reliably and effectively with minimal discomfort and less downtime.

Around half of all women will suffer symptoms of vaginal atrophy and ageing, which can include diminished sensation during intercourse, dryness, pain or discomfort, laxity, and urinary incontinence and urgency.

The topic of women’s sexual health and function is becoming more openly discussed and there is high demand for non-surgical low-risk/high-reward in-office procedures.

InMode’s Votiva is an advanced radiofrequency (RF) device harnessing three different technologies to address a broad range of vaginal changes derived from ageing and childbirth. It is the first of its kind to address both internal and external vaginal issues.

Votiva can improve urinary incontinence, dyspareunia, vaginal dryness, vaginal irritation, perineal scarring from childbirth, vaginal laxity, as well as pelvic floor dysfunction.

Patients report immediate changes, even after just one 30-minute treatment, however a series of three treatments based 4-6 weeks apart are usually recommended for optimal rejuvenation results. Because of its unique combination of technologies which can address both internal and external tissue, Votiva treatment can be customised for each patient’s concerns and goals.

The Votiva difference

Votiva’s bipolar RF energy works by gently heating the connective tissue of the vaginal wall to 40 to 43°C, thereby remodelling extracellular matrix configuration. Once optimal temperatures are reached, collagen contraction, neocollagenesis, vascularisation and growth factor infiltration promote durable vaginal wall changes with improvement in elasticity and moisture of the vaginal wall. By controlling temperature at this level, new cells generate rather than forming scar tissue.

Although numerous studies have demonstrated the therapeutic efficacy of energy-based devices in rejuvenation of the face and neck, their application in the vaginal canal is a fairly new concept. In a recent 2020 study published in PRS GlobalOpen*, 10 consecutive patients were treated with Votiva bipolar RF. The mean age was 44 and average number of pregnancies was two. Three patients were treated for aesthetic concerns, three for functional complaints, and four desired improvement in both.

The overall graded improvement in labia size/contour was +50%. Patient satisfaction scale data demonstrated 9.5/10, and all patients (10/10) stated that they would undergo treatment again. In all cases, tightening of the clitoral hood, introitus and forchett were observed, as well as improved distribution of dark pigmentation of the labia minora. All patients reported satisfaction with treatment outcome in regards to sexual function, lubrication and arousal.

There were no significant complications and no need for additional procedures. Average recovery time was 14 days. The authors concluded that treatment of labia hyperplasia and laxity with bipolar RF may potentially fill a treatment gap of women seeking aesthetic and functional improvements without surgical labiaplasty.

Another recent study** describes the use of the Votiva bipolar RF device for pelvic floor restoration (PFR) in 50 patients experiencing PFD symptoms after vaginal childbirth. A transcutaneous electromagnetic muscle and nerve stimulator (UROstym) commonly used in urogynecology was used to measure resting and maximal contraction of the pelvic floor pre- and post-RF treatments.

This study demonstrates the safety of using RF energy for PFR after vaginal delivery. The data found no adverse events in 50 consecutive patients. A significant correlation was found between treatment and maximal contraction of pelvic floor muscles using the UROstym device. Furthermore, the authors suggest a “tightening cascade” phenomenon, where the impact of one treatment was all that was needed to initiate patient improvement. Radiofrequency PFR may potentially fill a treatment gap of pelvic floor disorders, the authors suggest.

Technologies on the Votiva workstation

AVIVA

Aviva is a minimally invasive procedure for hemostasis and coagulation, delivering uniform energy to the entire soft tissue matrix of the vagina and offering a non-excisional alternative to labiaplasty. This innovative technology is designed with extensive safety features to reduce the risk of thermal injury to the soft tissue matrix, delivering uniform energy, temperature control and accuracy.

The Aviva procedure can be performed under local anaesthesia, in an office setting, in less than 20 minutes, without excising excess skin, offering a reliable and effective treatment to improve the function and appearance of the vulva.

FORMA V

FormaV provides uniform deep RF heating of the internal vaginal tissue and external vulvar laxity and/or labial hypertrophy. This advanced technology provides customised treatments for patients experiencing changes as a result of ageing, hormonal adjustments or physical trauma.

The precision of the FormaV applicator allows specific areas to be targeted, restoring their elasticity and firmness.

The therapeutic device delivers uniform volumetric deep heating with real-time control of temperature. It works to tighten the vaginal canal, increase lubrication, as well as well as rejuvenate the labia minora.

FormaV can also be an effective treatment for sexual dysfunction due to its tissue remodelling and increase in localised blood circulation. In addition, it can be used as an adjunct to Kegel exercises to help tighten the pelvic floor and increase muscle tone.

MORPHEUS8

Morpheus8 is the first and only full-body RF microneedling technology to morph and sculpt ageing skin. The triple action of fat coagulation, connective tissue contraction and bulk heating offers effective resurfacing of the external vulvar and labia tissues, textural and tightening improvement and correction of hyperpigmentation for overall genitalia aesthetics.

With proven technologies designed to treat a range of female intimate wellness issues, Votiva is an ideal addition for a growing segment of practices that are looking to diversify, reach new patients and adopt a holistic approach to women’s health and wellness concerns.

References
* Erez Dayan, MD, Henry Ramirez, MD, Spero Theodorou, MD. Radiofrequency Treatment of Labia Minora and Majora: A Minimally Invasive Approach to Vulva Restoration. Plast Reconstr Surg Glob Open 2020;8:e2418; doi: 10.1097/GOX.0000000000002418

** Erez Dayan, MD, Henry Ramirez, MD, Lacy Westfall, RN, Spero Theodorou, MD. Role of Radiofrequency (Votiva, InMode) in Pelvic Floor Restoration. Plast Reconstr Surg Glob Open 2019;7:e2203; doi: 10.1097/GOX.0000000000002203