Would local anesthetic provide enough pain control during labia majora reduction surgery or do you suggest general anesthesic?

Doctor Answers 7

Anesthesia for labiaplasty

Labiaplasty, which most commonly involves surgical reduction of the labia minora (inner/thinner lips) but not infrequently trimming or tucking of the labia majora (outer/thicker lips), has become a relatively common procedure over the last ten and even more so last five years.  Most commonly it is done under light sedation (aka twighlight sleep) with local anesthesia, in which case the patient should feel no pain during the operation.  Whether the surgery is done using a laser, scalpel, or scissors does not really matter but what does matter is "symmetry".  Symmetry is the most important aspect to the final aesthetic result.  Most women, just like yourself, prefer to have as much of the darker pigmented edges removed as possible.  Also, it's not how much tissue is removed but how much is left remaining because a certain amount is necessary to maintain proper form and function - typically ~10 mm or so of the dry part of the labia.  To achieve these three most important elements, I have found that the "Trim Method" satisfies best.  It is extremely important to consult with a board certified plastic surgeon that specializes in this operation (does at least 1 - 2 per week).  It may cost you a bit more but it is this type of result you will want to live with for the rest of your life.  Typical (all inclusive) fee at my office/surgery center is $4500.

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 101 reviews

Labiaplasty Surgery and Local Anesthetic

Hello and thank you for your question. Here is what I usually tell patients at my office about the general surgical procedure:Surgery is the most common treatment and this problem can usually be corrected in under one hour with a local anaesthetic. Many women feel more comfortable and relaxed with a quick twilight or general anaesthetic. Each procedure is customized to the physical findings as well as the desired goals of the patient. Some procedures may include treatment of the clitoris or clitoral hood to further enhance this region.  The “trim procedure” is a straight incision along the edge of the labia to reduce excess tissue.  A “wedge” is the removal of a triangular shaped part of the labia with the remaining parts placed together to look completely normal. So, YES... you should be able to have everything completed under local anesthetic, but it would be best to confirm that in consultation with your own board certified plastic surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Local anesthesia is painless if your surgeon knows how to use it, if not opt for sedation

Surgeons inexperienced with local anesthesia will give you a million excuses not to use it. If you want to have surgery with such a surgeon, don't opt for local anesthesia because they lack confidence that they can provide a pain-free experience and you'll be taking a gamble. Although I always give patients the option to opt for sedation, they rarely take it. Local in expert hands is a painless experience.

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Would local anesthetic provide enough pain control during labia majora reduction surgery or do you suggest general anesthesic?

Thank you for your question and for doing your research.  Labia majora reduction surgery can be performed under a myriad of anesthetic techniques - local alone, local with oral sedation, local with IV sedation, or general anesthesia and the decision on which method to pursue largely rests with the patient and their desired level of awareness.  Talk to your surgeon about your concerns, they are in the best position to help you make the appropriate decision to maximize your comfort.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 reviews

Would local anesthetic provide enough pain control during labia majora reduction surgery or do you suggest general anesthesic?

This procedure can be done under local anesthesia only. If this is the case, you will feel the needle and then also the medication (it burns as it's being injected). It will take a few different sticks of the needle to block this area adequately. Once the medication is working, you will then only feel pressure, but not pain. I personally prefer to do these procedures with IV sedation with an anesthesiologist. This way you feel NO discomfort. Every once in a while I get a patient who is scared of the anesthesia or cannot afford it and are desperate to get the price lower.

Depends if you have a nice doctor

It depends if you have a nice doctor. I do labiaplasty surgery MOST commonly under IV sedation with an anesthesiologist. That's because I'm nice and don't like to hurt people. Doctors who ONLY do labiaplasty under local anesthesia are doing it for the money so they don't have to pay another doctor. #truth (do hashtags work on here?)That said, I've done about 4 or 5 labiaplasty surgeries under straight local anesthesia and another dozen or so under local with oral sedation (like Valium). ALL of those patients had a great experience with very little pain. I use a topical numbing cream first and then use a Botox needle, very tiny, to numb up the area. It works great, but I take my time injecting and don't harpoon the tissues. Most patients say that they have one little pinch or that they felt nothing at all!

Local vs GA

Dear Ms Bigkitty
First and foremost I would be more worried about the ability of your surgeon to perform labia majora reduction. Have you seen before and after photos of his majora work?  Are the scars hidden or at least cosmetic in appearance as the follow the natural lines of your body's contour?  Is your surgeon experienced in this procedure? Have they written papers, book chapters or presented lectures on this topic?  Does your potential surgeon know what they are doing?  Do you see before and after photos on his/her website dedicated to majora reduction.
I have been performing labia majora reduction for 15 years and I can tell you that few surgeons are skilled in this technique.  I personally will tell you it is not the pain relief is a problem by using local!!!! It is the very fact that the surgeon will overly distort the anatomy by injecting with local ( so it can be done but you will not always get the BEST cosmetic results). When one injects with local it makes it swell and then when you cut it is difficult to tell how much relaxation you are removing and you have a much more difficult time determining where the incision line will end up. Many patients will end up with an obtrusive, bold and unpleasant scar in the middle of their majora..................this is not plastic surgery !!!  Unless you don't care about the scar and final results as some patients don't care what it looks like as they just want the size reduced.
Please do your research well prior to committing to a surgery.................often the results are not fixable.Please see the first paper in the world written on the simultaneous labia minora and majora reduction and note the photos before and after results.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.