Another option is a fat transfer, which is when a doctor extracts a patient’s fat from a transfer site (usually the stomach, butt, or thighs) using liposuction, purifies it, and then injects it into the outer labia. The procedure is more expensive (it starts at around $5,000) but lasts longer because the fat that survives the transfer will remain for up to 10 years. Dr. Milhouse hasn’t done a fat transfer to the labia majora, mostly because she thinks the results are less predictable. “With HA filler, what you see is what you’re going to get,” she says. “With fat transfer, it’s going to look super volumized at first, but maybe a third or more of that fat will not survive long-term.” (Doctors typically over-inject with fat transfers to account for the fat cells that don’t survive.) Plus, you don’t know exactly how or where the remaining fat will settle.

What are the risks of getting a labia puff?

Speaking of unpredictability, some women are even injecting themselves with filler for what might be called a DIY labia puff. I texted with one of these women, who asked to remain anonymous, and she told me she was a health care professional and did her own puff because her labia majora looked “deflated” and she couldn’t afford to have it done in an office.

To be clear, Allure does not recommend trying this at home: Experts emphasize the DIY route for any type of cosmetic injectable is extremely risky, not least because someone buying supplies online has no idea if the product they are using is legit or labeled correctly. On top of that, there are always risks to the genitalia whenever anyone, even a doctor, is performing a procedure. That’s why experts recommend getting it done by a board-certified plastic surgeon, gynecologist, or urologist. “Respectfully, dermatologists are great, but they don’t do surgery on this area of the body,” says Dr. Milhouse. There is a very low risk of hitting a blood vessel and causing tissue damage, which would then require surgery to the labia, a place derms don’t operate. “Worst-case scenario, if something goes wrong, you want to be in the hands of someone who knows this anatomy, has experience doing surgery on it, and can get you out of trouble.”

For puffs done with HA filler, Dr. Rajagopal says there’s little downtime and a low risk of side effects; a patient might experience swelling or some bruising in the first week after the procedure, but once tenderness goes away (usually within a week, but maybe up to two), they can resume sexual activity or even get waxed or get laser hair removal. Other complications such as infection or necrosis (when the filler blocks blood supply causing the tissue to die) are rare but always a possibility with on-label usages of filler. Renuva injections have similar side effects and risks to HA filler.

Fat transfer is a two-step surgical procedure, so it requires local anesthesia, which means it comes with additional risks, including anesthesia complications such as allergic reactions. There’s also the possibility of scarring, fluid build up, or a fat embolism, which is when fat is accidentally injected into the bloodstream, which can cause blockages or injury to your lungs. But all in all, it’s a minimally invasive surgery, and patients are back to normal within a week or two.

Why are labia puffs becoming more popular?

Experts think there’s one main reason people are putting filler down there: 84% of American women say they groom their pubic hair regularly and 62% say they’ve removed all of their public hair at some point, according to a 2016 survey of 3,316 people, so more women are able to see their labia clearly—and start judging them against the beauty standards of the day. “If we were all hairier, this would not be a thing,” says Dr. Milhouse. “In fact, this whole sector of cosmetic enhancements to the vulva, including labiaplasty, would probably not be as popular.”

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