Vulvar lichen sclerosus in Paris

The exact cause of lichen sclerosus is not yet known.
However, we do know that this condition is not associated with infections, nor is it a result of treatments or procedures you may have undergone.
It is also not a disease that can be transmitted from one person to another.
Women with low estrogen levels—hormones produced by the ovaries—are at higher risk.
Sometimes, a person with lichen sclerosus may also have another autoimmune disease, such as hypothyroidism, vitamin B12 deficiency anemia, alopecia, or vitiligo. It is important to note that one condition is not the cause of the other.

Women of all ages can develop the condition, but it is most commonly seen before puberty or after menopause.

The treatment for vulvovaginal lichen sclerosus aims to alleviate symptoms, prevent complications (such as infections or cancers), and improve the patient’s quality of life.
It primarily involves the topical application of corticosteroid creams, which have anti-inflammatory and immunomodulatory effects. These creams must be used regularly and long-term, under medical supervision.
Other treatments, such as emollients, antihistamines, hormones, or surgery, may be offered depending on the severity and progression of the condition.
While the disease cannot be cured, its effects can be reduced and managed.

Advancements in research have demonstrated the regenerative properties of stem cells found in and around fat cells, which correspond to stromal vascular tissue.
Autologous Fat Transfer (the Patient’s Own Fat)
Autologous fat transfer is based on the principle of performing a true autograft of fat cells by reinjecting fat harvested from the patient.
The regenerative properties of stem cells present in fatty tissues, combined with the ability to further refine the fat to obtain nanofat (or stromal vascular tissue, a liquid fat emulsion), explain the improvements observed in the quality of tissues where the stem cells are reinjected. This process enhances the flexibility and texture of the treated area.
The purpose of this nanograft is to restore tissue trophicity and improve tissue quality.
It is a specific method following a precise protocol to achieve effective and lasting results.
In the Context of Lichen Sclerosus
The goal is to stop the progression of the disease, regenerate tissues, and improve tissue quality.
This is achieved by regenerating the tissues affected by the autoimmune effects of lichen sclerosus.
It is important to note that other autoimmune conditions, such as scleroderma, Raynaud’s syndrome, Sjögren’s syndrome, scars, or the aftereffects of treatments like radiotherapy or chemotherapy—such as vulvovaginal atrophy or discomfort linked to genitourinary syndrome of menopause—can also benefit from the regenerative potential of stem cells.
However, it is essential to understand that this is a genuine surgical procedure that must be performed by a qualified and competent Plastic Surgeon, ensuring a truly sterile surgical environment.

If left untreated, chronic inflammation caused by lichen sclerosus can lead to changes in the anatomy of the vulva, such as:
• Fusion of the labia minora with the labia majora
• Skin covering or burying the clitoris
• Pain at the vaginal opening due to a reduced orifice
These anatomical changes can:
• Make sexual intercourse difficult and painful
• Cause difficulties in emptying the bladder in more severe cases
• Lead to a loss of self-confidence and a feeling of reduced femininity.

Without treatment, women with lichen sclerosus have a higher risk of developing vulvar cancer.
This occurs in 1 in 20 women who are either untreated or do not respond to treatment.

If symptoms do not improve, if you need to apply creams more frequently to get relief, or if unpleasant sensations persist, you should consult your doctor to evaluate your treatment plan.
Your doctor should monitor the condition of your vulva at least once a year.
If you experience unusual symptoms such as bleeding, bumps, or persistent lesions, these should be examined by your doctor.

An initial consultation will be required to examine you, determine the indication, and propose a treatment strategy.
A thorough clinical and photographic assessment will help establish a treatment plan.
Preoperative blood tests will be prescribed, and a pre-anesthesia consultation will be arranged.
A second consultation with Dr. Guzman will address any questions, organize the procedure, and provide you with care instructions and prescriptions to ensure the surgery and recovery process go smoothly.

For your comfort, this type of procedure is best performed under short-duration general anesthesia or local anesthesia enhanced with sedatives administered intravenously, or through hypnosis.

This procedure is typically performed on an outpatient basis, unless contraindicated.

The technique is tailored to each patient to achieve the best possible results.
The areas for fat harvesting are identified during the consultation. Dr. Guzman selects donor areas based on your anatomy and the amount of fat required, which typically does not exceed 200 cc.
The fat is gently harvested via closed-circuit liposuction through a small incision, using an atraumatic technique with a specialized cannula.
The harvested fat is then prepared, washed, and filtered using fine strainers to obtain high-quality stem cells and remove non-transplantable elements.
The transfer of the obtained cells is performed using micro-punctures. With fine cannulas, Dr. Guzman injects the cells at different depths and directions to maximize the contact surface between the implanted cells and the recipient tissues, improving the survival rate of the stem cells.
The successful integration of the grafted stem cells depends on proper technique and the vascularization of the recipient tissues, which ensures effective graft uptake. The cells remain alive within the treated area. This technique is definitive, as once the cells are integrated into the tissues, they will remain viable for as long as the surrounding tissues stay healthy.

Recovery is usually straightforward. At the donor site, pain is minimal due to the atraumatic technique, though some bruising may occur. Swelling or slight edema may be present for 48 hours following the procedure and typically resolves within 1 to 2 weeks.
In the vulvar area, minor bruising and slight swelling may occur during the first two weeks. A lubricating, healing gel will be prescribed to assist during the cellular integration process.

Since this procedure involves cellular regeneration, it takes at least three months to notice improvements in tissue trophicity, suppleness, and mucosal quality.
Over time, the results may change due to the natural aging of tissues or the progression of the condition.
A complementary treatment (a minor touch-up) may be needed from the 6th month post-operation to refine the results.
This technique offers significant benefits to patients, effectively halting the progression of the disease.

Recovery is usually straightforward. At the donor site, pain is minimal due to the atraumatic technique, though some bruising may occur. Swelling or slight edema may be present for 48 hours following the procedure and typically resolves within 1 to 2 weeks.
In the vulvar area, minor bruising and slight swelling may occur during the first two weeks. A lubricating, healing gel will be prescribed to assist during the cellular integration process.

Since this procedure involves cellular regeneration, it takes at least three months to notice improvements in tissue trophicity, suppleness, and mucosal quality.
Over time, the results may change due to the natural aging of tissues or the progression of the condition.
A complementary treatment (a minor touch-up) may be needed from the 6th month post-operation to refine the results.
This technique offers significant benefits to patients, effectively halting the progression of the disease.

Since it is a surgical procedure, autologous stem cell transfer is a true surgical intervention. This means it is subject to the inherent unpredictability of living tissues, whose reactions can never be entirely foreseen.

Regarding Anesthesia

During your pre-anesthesia consultation, your anesthesiologist will inform you of the risks associated with any procedure performed under general anesthesia or monitored sedation.
The anesthesiology team at the clinics where Dr. Guzman operates is highly qualified and works in a surgical environment. This ensures that the risks associated with surgical procedures are statistically very low.

Regarding the Surgical Procedure

Dr. Guzman is trained and highly skilled in this type of intervention. True complications are rare when the surgical indication is carefully chosen, the procedure is performed with precision, and the appropriate surgical tools are used. This includes specialized filters and atraumatic cannulas designed to preserve the tissues, blood vessels, and nerves in both the donor and recipient areas.
As with any surgical procedure, even seemingly simple ones, there is always a small element of risk. However, Dr. Guzman possesses the necessary training and expertise to minimize the likelihood of complications and effectively address them should they arise.