Maggie McKay (Host): There's something new in the world
of gynecology, and it's one of the fastest growing fields in women's health.
It's called cosmetic gynecology. And today, we'll find out what it is, why it's
needed, what the benefits are and more with Dr. Marco Pelosi III, founder of
the International Society of Cosmetogynecology or ISCG and the Pelosi Medical
Center.

Host: This is Top Docs Podcast. I'm your host, Maggie
McKay. Thank you so much for being here today, Dr. Pelosi. Would you please
introduce yourself?

Marco Pelosi, III, MD: Sure. Maggie, thank you so much
for having me on. I am Marco Pelosi III. I am a gynecologist. I trained in
Manhattan in the mid-1990s. And in the late 1990s, we started getting into
cosmetic surgery. We started with gynecology procedures, expanded into body
contouring. But we're really well known for our focus on teaching in cosmetic
gynecology. So, we pretty much were the leaders in the field on the east coast.

Over time, as the internet started to evolve, the word started
to get out and people started to take a keen interest in this because it
addresses things that normally weren't being addressed in the field of
gynecology. They were lifestyle issues, sexual things that didn't quite meet
the level of a medical problem, but they were more or less just a lifestyle
issue. Lousy sex, didn't like the way the area looked in a bikini or naked. And
as women were finding out that these problems had solutions and that they could
actually do something about them rather than being just disappointed, it began
to take off and other gynecologists wanted to get in on the action. And through
my efforts, through our society's efforts and through the efforts of other
doctors in similar teaching venues with similar experiences, this whole thing
has spread worldwide so that now it's not uncommon to see it on television,
mentioned on social media. Even at party conversations, people are talking
about things like vaginal rejuvenation and everything along those lines.

Host: I can't imagine cocktail hour talking about that,
but maybe with doctors, right? First off, what is cosmetogynecology?

Marco Pelosi, III, MD: Well, cosmetpgynecology in basic
terms is just gynecologists doing cosmetic surgical procedures on women. And
since we're gynecologists, we have special expertise in the genital area, in
the vagina, the vulva, the labia, and the mons pubis. So, our version of
cosmetic gynecology might include liposuction and tummy tucks and boob jobs,
but it always includes a strong focus on the genital area. So when you come to see
a cosmetic gynecologist, you expect to see all of these procedures on the menu,
and maybe some of them also expanded into body contouring, BBLs and tummy tucks
and such. But the core of it, what distinguishes cosmetic gynecology from other
specialties that do gynecology is that focus on that female pelvic area.

Host: And you mentioned a little bit of why you created
the ISCG, but what is the ISCG, and a little more on why it was created?

Marco Pelosi, III, MD: We initially started doing these
procedures on our own. We got training from dermatologists and plastic surgeons
in the United States and South America because we took an interest in it. And
as we were going to gynecology meetings, we'd meet people who say, "Oh, I
have a friend here. I have a friend there. You should meet them and train with
them." So, we did. And as we started to go to more meetings and people
were asking us, "What are you doing these days?" We would say,
"Oh, we're doing this and we're also doing vaginoplasty. We're tightening
the vagina, we're doing the labia, we're doing liposuction."

So after a few years of this, we said, "You know what?
We're getting so many requests from people to learn what we're doing, that we
should start a teaching society." And the industry jumped on board with us
because they were trying to get gynecologists into cosmetic procedures in
general. And when they went to a gynecology meeting and dragged in a famous
plastic surgeon, the gynecologist couldn't relate to that plastic surgeon
because it wasn't a gynecologist or she wasn't a gynecologist. So once we
became involved with this, there was that connection. Then, the gynecologist
would say, "Oh, you're one of us and you're doing this, so it's feasible
to do this in a gynecologic practice. Tell us what it's like and show us how to
do it." So, that's how we got started.

And as time went on, obviously other specialists from other
specialties would ask us if we could train them in these procedures. And we
said, "Sure." So, that's how the society grew and we've been doing
this now since 2004, giving courses throughout the year in our home base in New
Jersey, as well as our teaching facility down in Florida. We have a company we
work with down in Fort Lauderdale, where we teach people on cadavers, so they
can actually do the surgery from beginning to end all by themselves without any
fear of damaging anything and with close surveillance by myself and my team.

Host: And what's the appeal of cosmetic gynecology to
women and to physicians?

Marco Pelosi, III, MD: Well, to women, it solves
lifestyle issues that normal gynecology doesn't, and it allows them to fix a
problem that they may have been having for years. As time has gone on, for
whatever reason, it's become a trend to look good naked down there. It was never
a big deal. When I was growing up. And when I was training in the '90s, there
wasn't that much of a focus on the genital area. It was just something that
just-- I guess, you know, shaving became big and once shaving became big,
people were looking at the area and saying, "Oh, you know, I can see this,
and now I have an opinion about it. And if I don't like the way it looks,
"Well, I found on social media..." because that wasn't around either,
you know, "that I can talk to other people who have had procedures done
and I can form an opinion as to whether I want something done or not, and even
see before and afters." Whereas before, the only way to see these things
would be to go to an actual cosmetic gynecologist, if you could even find one.

Host: Exactly. And what's the appeal to physicians?

Marco Pelosi, III, MD: Well, for physicians, it is a
direct business with the patient. Rather than going through insurance companies
and providers and just looking for a provider on your list, is basically just a
number connecting to a number, the patient has a number, the physician has a
number, problem has a number. You know, none of these things are direct
patient-to-doctor interactions. There's always a third party involved. It's
more direct patient care, which is sort of what patients want for these
intimate issues. They don't want to be dealing with just some random
"provider." They want to talk to a specialist who's going to take the
time to listen to their concerns, take the time to examine them, take the time
to really get into a detailed discussion that you really can't do in a
conventional medical setting where it's more of you're on the clock for x
number of minutes before you have to move on to the next patient.

Host: Dr. Pelosi, are there any controversies around
cosmetic gynecology?

Marco Pelosi, III, MD: Oh, there's always controversies,
especially since it's a relatively new field. The conventional gynecologists
like to complain that there's no randomized studies for whatever they do. If
you want to open your car door, if there's not a randomized study that says you
should use your left hand or your right hand, they complain about that. So when
it comes to cosmetic procedures, they just don't get cosmetics. The academic
gynecologic societies have never been in the aesthetic field. So when they look
at something, they look at it as if it doesn't have a medical disease, if it's
not cancer, you shouldn't touch it.

But in the field of aesthetics, as you know, everything that we
work on is normal, whether it's a nose, whether it's boobs, whether it's a
tummy, or whether it's the vaginal area. It's normal, but it's not in that part
of the normal range that the patient is looking for. Patient with a big nose,
that's a normal nose. They just don't want it that big. They want it a little
smaller. Patient with a flat chest, that's normal. They just want it a little
bigger. So, bigger and smaller issues also apply in the genital areas.
Looseness and tightness issues also apply in the genital areas. So, it might be
normal for the vagina to be a little loose, but maybe the patient doesn't like
it in the degree of looseness that it is and wants it a little bit tighter.
They have issues with all of that stuff and they just don't get aesthetics,
that it's a patient request for something that's normal to be adjusted to
another spot of the normal range. I call that the ideal range. You know, you
are in a certain range, but you want to be in the ideal range. You don't like
how long your hair is. That's not a medical problem. But if you cut the hair to
a certain length, some people are happy, some people want it a different way.

Host: Right. And what types of procedures fall within
the scope of cosmetogynecology?

Marco Pelosi, III, MD: Well, let's go from top to
bottom. The top would be the mons area, the pubic area. The area where you see
a C-section, that area is called the Mons, and it's a fat pad. And if that fat
pad is a little full, it bulges a little too much in the bikini, it drives some
women crazy because they think they look like a guy, so they want it flattened
down. It can be flatter and it can be saggy. And then when it's saggy, it does
the same thing, it just doesn't look right in tight clothing And they say,
"I want this not to be so saggy." So, they want to have a mons lift.
If it's too full, they want to have a mons liposuction.

And as you work your way down from there, you get to the vulva,
the labia majora, same thing. They can be too saggy, they want them not to be
saggy. They can be too flat, they want them to be a little fuller. We get a lot
of people, we call them fit and 40. So, they're in their 40s and they're in the
gym all the time. So, they have a sixpack, they're ripped, you know, they have
all the muscle definition. But when you get to that level of leanness in your
40s, your face gets ripped too. I said, "Nobody wants a sixpack on their
face. There's just too many lines. And the same thing happens in the vaginal
area. Nobody wants this thing looking deflated. Because when it deflates, it
wrinkles. Nobody likes wrinkles, they want smoothness. So, we plump them up to
eliminate the wrinkles. That's called the labia majora fat transfer. They also
call it labia majora puffing. And that's a very popular term for it on the
internet and all over social media. So, we get requests all the time from all
over the place for people that want puffing and that's exactly what they're
looking for.

Some people have lost a ton of weight and when you lose a ton
of weight down there, everything's sags. So, we actually have to do a nip and a
tuck and cut some of that skin away and tighten it up because that's the only
way to get it to do that when you have that situation. Some people have long
labia minora, so the inner lips are a little too long, which it is normal, but
it can be painful if it gets dragged around when you're riding a bike, having
sex, wearing tight clothing, or you're involved with other sports where they're
getting tugged on and abraded all the time. And it's a problem that doesn't go
away because they don't get shorter on their own. They just keep getting tugged
and tugged and tugged. The more they get tugged, they get even longer. So, we
do labia minora reductions, which are called labiaplasties.

In the vaginal opening, the vaginal canal can be open at the
opening, that's called the introitus. The outer opening is called the introitus
and tightening that by itself is called an introitoplasty or a perineoplasty
because the tightening is done at the bottom half of that, and the bottom half
is called the perineum. So, tightening that up is called the perineoplasty. The
inner canal is the true vagina. So when you ask a gynecologist, "What's
the vagina?" They just say it's just the inside part. And tightening that
is called a vaginoplasty. But it's almost always done with the tightening of
the opening because nobody wants to be loose at the opening and tight on the
inside. They want to be tight on the outside and tight on the inside when they
seek out these procedures. That kind of situation arises mostly from childbirth,
not always, but mostly. So if you push a baby out, that big head coming through
does a lot of damage to the ligaments and to the muscle attachments. So much
that, even if the baby is small, even if the muscles are in good shape, they're
just so stretched out and dislocated that not even the world's most intense
Kegel exercises will fix it. So, that's where we come in with our surgical
tightening procedures.

Other things you can do in there, the skin of the vagina can
dry out in the menopause because the hormone levels change. So on the
non-surgical side, there's a whole host of procedures, non-surgical,
energy-based devices like lasers, radiofrequency, ultrasonic heat to tighten
the vaginal skin and to rejuvenate the ability of that skin to stay moist and
elastic. So, there's a whole field of nonsurgical treatments for that. There's
also treatments to increase the sensitivity of the clitoral area. They have the
G-shot. They have the O-shot. They have all kinds of combinations of
G-shots-O-shots, O-shots-G-shots. And combine that with the lasers, combine it
with the nonsurgical, even with the surgical. So, there's a whole spectrum of
procedures, surgical and nonsurgical. And those are the highlights of cosmetic
gynecology.

Host: I was going to say who knew it covered so much
ground? My goodness. So, you did touch on it a little bit, but just in a
nutshell, tell me a little bit more about the International Society of
Cosmetogynecology. What types of doctors do you train and what types of
training do you offer?

Marco Pelosi, III, MD: Well, we started out initially,
believe it or not, even though we're cosmetic gynecology, and I just told you
about all that vaginal stuff that we do, we originally started training people
in liposuction, because it was one of the procedures that's easy to get into.
It's not technically challenging. It's more of an art. Think of it as like
learning to drive a car and then learning to drive that car on all terrains in
different areas. Once you're good at the basic mechanics of liposuction on easy
parts of the body to work on, you can work all over the body with a little bit
more experience.

So, we started training people, mostly gynecologists, in
liposuction. From there, we started training them in the cosmetic vaginal
procedures. But initially, we were just going to gynecology meetings along with
the industry people. So, we were pretty much just recruiting gynecologists. We
weren't advertising to anyone else and we weren't really looking for anyone
else because there were plenty of gynecologists. And we said, "You know
what? There's just not enough room in this facility to train more than the
people that are coming in just as gynecologists." And back then, you
advertise in the journals because there was no internet. So, our first couple
of years it was 90% gynecologists and a couple of tag-alongs, like general
surgeons and family practice that happened to know gynecologists, and they
would come together because they were friends.

And then, it really took off in all specialties because we
started advertising on the internet when the internet became a thing. And
remember that the iPhone didn't come out until 2007. YouTube had just come out
in 2006. Facebook and all that stuff was all brand new and nobody had a good
phone until you had to replace your phone. So, I think until about 2008, you
could advertise your guts out on the internet, but nobody would find you. So as
that started to become a thing, and as younger doctors started to get to the
age where they were looking for postgraduate training, those people were mostly
phone savvy and internet savvy. Then, people started to find us-- because
Google didn't exist either-- so once Google came out, they started to find us
on Google. So we started advertising all over the place. And now, we draw from
everywhere. We train people in New Jersey. We treat them train them in
liposuction, tummy tucks and cosmetic breast surgery. And down in Florida, we
train them on cosmetic vaginal procedures.

Liposuction and body contouring procedures are big procedures,
so you can get a lot of people around the table, you can get them involved,
they can see everything that's going on, whereas a vagina is a small area. And
if you get more than yourself and another person, so the trainer and the
student, you really can't fit anybody in there. So when you try to do a
training course where you have a trainer and more than one person between the
patient's knees, there's just no room. So if you have a whole crowd, they're
really spectators. And that's not really conducive to good training.

So, we were for years trying to find a place where we could do
cadaver training in a good environment and in a high quality. And we found this
company down in Florida that we've been working with for regular gynecology for
years. They do medical instruments and they do cadaver training. So, we did a
one-off course just to see if it would be any good. And it was fantastic
because we said we're only going to have two trainees on each cadaver because
that's all you can fit between the knees. And luckily, we got a cadaver and
they give you cadavers the thighs. So, you can fit maybe a third person. But we
said, "No, we don't want that. We want two people maximum on a cadaver,
and we're going to go through every single operation in cosmetic gynecology."
So, what we did initially is we got cadavers of our own and we did the
surgeries, and we filmed them step by step by step by step. So now, we had a
training video. So, we would set up a training video in the cadaver lab on this
massive TV screen, like a jumbotron, and we would break it down into step one,
step two, step three. So, we play them, step one two or three times. And then,
we said, "All right, guys. Each of you pair up into teams and go on your
cadavers and do what you just saw." And then, we do like musical chairs.
We tell people in the other stations to go to the other cadaver, take a look at
what the other people did, and it's going to be a slightly different anatomy
and it's going to be slightly different work, so you get to see a little bit of
variety. We found that that was the best way to train people because they
really got their hands on.

Once you're holding and touching and doing, you get that
mind-hand coordination, the muscle memory, the mind-body connection, you really
learn. Sort of like learning golf. I could talk golf and I can watch golf, but
that's not going to make me a better golfer until I actually get those sticks
and swing them because then I get the feel. I could say, "Oh, this is what
you mean. Oh, I see why it looks easy, but it's not easy." And they really
focus and drill down to the essential elements, which is different for every
person.

Host: Right. And I hear you have the 2024 World Congress
coming up in March for ISCG. What's that all about and how do doctors sign up?

Marco Pelosi, III, MD: We have a website. Our main
website is iscgmedia.com. And on there, we have pages devoted to the World
Congress. We have pages devoted to all of our training programs. We have a
blog, all kinds of stuff. And we usually start advertising these things in
September for the meetings, which we usually have in March. And this year's
meeting is, I believe, March 9, 10, 11. It's Thursday, Friday, Saturday in Fort
Lauderdale. And what we do is we have the first day and the third day devoted
almost exclusively to cosmetic gynecology topics where we're focusing on the
vagina, the vulva, and all of the genital region. We also include some cosmetic
urology lectures because it's just equal time for the guys because, you know,
we're fixing women, so we want both sides to get a little bit of attention. And
a lot of cosmetic urologists are also interested in the cosmetic gynecology and
vice versa. And then in the middle day, we have a full day devoted to body
contouring and business because this is the stuff that most cosmetic
gynecologists don't see in meetings that are exclusively devoted to the vaginal
area. And this also allows body contouring specialists like plastics and
cosmetic surgeons who don't do a lot in the genital area to learn from each
other. So, everybody gets a taste of something they don't normally do. And it's
a great synergy there. It really exposes docs to different techniques,
different technologies, and different specialties. And they also make a lot of
very, very fruitful networking connections.

So, one of the unique features that we have in the meeting is I
get the leaders in cosmetic social media. So, I get Dr. Miami, Real Dr.
Feelgood, I also get Dr. Ho-def. These guys each are like number one, number
two, and number three in the world on Instagram, TikTok, all over the place. We
have Dr. Miami do a live broadcast from there, just does like a little video
with one of his social media people, and they blast it out on the internet
instantly and you see all the views explode. And nobody does that in a medical
conference because it's just not medical, it's more of entertainment. But this
is how people get patients. And when we actually show them in action, they go
nuts. And it's very, very interesting to see that even though it's entertaining,
there's a lot of science behind it, there's a lot of strategy behind it, and
there's a lot of nuance to it. And people gain so much from this that they
really appreciate it because you can't get it anywhere else. And we jammed that
into that second day where we have the body contouring and business aspects of
aesthetics because getting patients for aesthetics is all about getting
attention. Because you're not a guy on a list from an insurance company, you're
not a woman on a list from an insurance company, you're a personality putting
out work and you want to attract people. And that's all about getting
attention. So when you have the people that are the best at it teach you their
tips and tricks, it's really valuable information. So, that's one of the keys that
makes this meeting so valuable.

And we keep it small. We cap it at about 250 people because we
want to get people that are super motivated to attend. We don't want somebody
that's just going to go home and just say, "Yeah, it was nice" and
not do anything about it. We want people that are going to like explode and
burst into flames in excitement that they're getting the juicy information that
they can't get anywhere else. I invite anyone who's interested in this to come
on down. It's a good old time. Florida in March, it's great weather, no
hurricanes and it's awesome. We love it down there.

Host: It is beautiful, that's for sure. So Dr. Pelosi,
is there anything else you'd like to add in closing that we didn't cover?

Marco Pelosi, III, MD: Well, I think we hit all of the
highlights. I think that if there are gynecologists out there who are not sure
whether they should get into aesthetics or not, they should at least drop by to
our basic liposuction course. It's not intimidating. It gets your feet wet in
the most popular aesthetic surgical procedure on the planet. And it's the type
of procedure that is well suited to the office setting. So, you can come over,
you can see what we do. We could talk about cosmetic gynecology, and then, if
you really wanted to get down and dirty with the labiaplasty and all that
stuff, you could visit us down in Florida. We give our cadaver course down in
Florida, right before the World Congress, and we also give it throughout the
year two or three times. Our next one is going to be October 13-14, which is a
good time of the year to be down in Florida also. It's not really hurricane
season and it's still nice, it's still warm down there. So if you catch us in
October, you can get tanned. If you catch us in March, you can get tan. But
more importantly, you're going to get some top-notch training to get you
focused and get you on track to really turn your practice around. If you think
that regular medicine is kind of boring and it's really putting in a lot of
hours and not getting a lot out of, this is going to make your head spin, it's
going to change your life and you're really going to be so grateful that you
got into it when you did.

Host: So again, if anyone would like to find out more,
you can go to iscg media.com. Dr. Pelosi, thank you so much for telling us
about this option in women's health. I had no idea there were so many things
that it encompassed. We appreciate you being here and sharing your expertise.

Marco Pelosi, III, MD: Maggie, it's been a pleasure. And
I hope you come down to Florida and see what we're doing during the annual
meeting.

Host: Again, that's Dr. Marco Pelosi III. And if you
found this podcast helpful, please share it on your social channels and check
out our entire podcast library for topics of interest to you. This is Top Docs
Podcast. I'm Maggie McKay. Thank you for listening.