Cosmetic genital surgery is on the rise not only in the realm of plastic surgery but also in that of gynecology. Young women below the age of 20 (millennial adolescents) now inquire about procedures to improve the appearance of their genitalia during their annual gynecological visits. The American College of Obstetricians and Gynecologists (ACOG) recently released recommendations for their members to better field cosmetic questions by this subset of patients. These guidelines, albeit somewhat restrictive, acknowledge the field of aesthetic vaginal surgery as a distinct entity for gynecologists. As experts in the field of aesthetics, we should be at the forefront in developing recommendations for ourselves in regard to adolescents inquiring about labiaplasty.