Approximately 25 million people worldwide, including 1 million in the United States, identify as transgender. Gender affirmation surgery (GAS), including vaginoplasty, improves quality of life but carries a 20-70 % complication rate. Granulation tissue occurs in 26 % of cases, but treatment for severe cases remains unclear. We present one transfeminine individual with extensive neovaginal granulation tissue involving 70 % of the neovagina which was subsequently treated with laser destruction. This case illustrates a novel management strategy and underscores the need for standardized treatment approaches for severe granulation tissue following GAS.