Labiaplasty or labial reduction has become an increasingly common procedure over the last several years.  Patients often inquire whether labiaplasty under local anesthetic may be an option.  It is certainly an option to have labiaplasty performed under local anesthetic.  This is in fact the most common type of anesthetic used for labiaplasty within my practice.

When labiaplasty is performed under local anesthetic, patients are instructed to apply a topical anesthetic (Emla cream) to the region approximately one hour in advance.  This partially numbs the sensation as the local anesthetic is injected.  A series of small needles are injected at the beginning of the procedure, which takes approximately 10-20 seconds.  After the freezing is infiltrated, you are left to relax for approximately ten minutes as the freezing takes effect.  You should not experience any discomfort during the actual procedure.

Labiaplasty may be routinely performed under conscious sedation or general anesthetic in other practices.  During conscious sedation, medications are administered systemically to alter your level of consciousness during the minor procedure.  Intubation is not required and you still protect and maintain your own airway.  During general anesthetic, more medication is administered and you become increasingly sedated to the point that intubation is required.  You are completely asleep for the procedure while a breathing machine controls your airway.

Labiaplasty under local anesthetic may provide several advantages over these other types of anesthetic:

– Less post-operative nausea

Labiaplasty under local anesthetic reduces the risk of post-operative nausea, which is a fairly common side effect following conscious sedation and general anesthetic.  If nausea is experienced following labiaplasty under local anesthetic, it is most commonly related to the prescription pain medication.  It is recommended to take this medication with food and to take Gravol as needed.  It is also encouraged to wean from prescription pain medication as soon as possible following labiaplasty.  Most patients no longer require any prescription pain medication after 1-2 days post-operatively.  At that point, Tylenol plain or extra-strength may be substituted and then discontinued when able.

– No need for a companion on the day of surgery

Although you may still prefer to have a relative or close friend accompany you on the day of your minor procedure, it is not required for patients undergoing labiaplasty under local anesthetic.  It is recommended to go directly home following surgery to begin applying cold compresses.  You may drive yourself home afterwards if preferred or travel on your own by taxi since no systemic medications are administered.

– Labiaplasty under local anesthetic provides excellent pain control for several hours post-operatively

The local anesthetic lasts for several hours following labiaplasty.  I recommend for patients to take Tylenol #3 upon arrival at home following labiaplasty.  This provides a bridge as the local anesthetic wears off.  The cold compresses also reduce localized discomfort following labiaplasty and should be applied as frequently as possible over the first 48 hours post-operatively.

– Patient remains awake and alert during the procedure

For many patients it may less stressful having labiaplasty performed under local anesthetic.  You remain awake and alert during the procedure, which also provides additional time to review the post-operative wound care instructions and activity modifications in great detail.

– Lower risk of airway complications for labiaplasty under local anesthetic

There is risk of airway compromise when labiaplasty is performed under conscious sedation.  Labiaplasty has become one of the most commonly performed procedures in my practice as a female plastic surgeon.  Almost all labiaplasties have been performed and very well-tolerated under local anesthetic.  If following our discussion a patient wishes to have either conscious sedation or general anesthetic, a board-certified anesthesiologist is present to administer these medications and to closely monitor you during surgery.  In these cases, I think it is the safest option to perform your surgery alone and have an airway expert present to manage either the conscious sedation or general anesthetic.  It is important to ask regarding this point when undergoing elective cosmetic surgery in an out-of-hospital setting.

Please contact us if you have more questions regarding labiaplasty.

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