Why is Local Anesthesia over General More Common for Labiaplasty? Is It a 'Shortcut' Per Se?

Hi,

I prefer to use local anesthesia for labiaplasty. It saves the patient around $1500 and is much safer when compared to a general anesthetic.When the procedure is complete the patient can get up and leave right away and expect to be completely pain free for several more hours. Even when the patient is put to sleep under a general (for instance when I am doing a combined procedure) I instill local anesthetics into the labia tissue to limit intra-operative bleeding and immediate post-op pain. Does the local cause swelling of the tissue? Yes? Does this prevent me from doing a good job? No. By carefully examining and marking the tissue prior to local instillation, I am able to effectively remove the excess tissue and close the incisions. I hope this helps.

All my best,

Daniel A. Medalie, MD

I find that if done correctly, local anesthesia provides excellent numbing and is tolerated by my patients extremely well.  Local anesthesia should not hinder an experienced surgeon's ability to achieve the patient's desired results of a labiaplasty.  Local anesthesia is more cost effective, and there are less risks associated with local anesthesia than there are with general.  Tissues do swell after we inject local anesthesia, however as an experienced Board Certified Plastic Surgeon, we understand how to make our initial marks and plan the surgery so that despite swelling immediately (from anesthesia), or later on during surgery (for any other reason) we can continue and complete the surgery with complete success.  Board Certified Plastic Surgeons are trained to create these types of flaps and move tissue around the entire body, so anyone that can't do this with a bit of swelling perhaps should gain a little more experience before attempting it with local anesthesia.  Best wishes.

Most labiaplasty experts will perform the procedure using either general or local anesthesia. Both are appropriate for labial contouring. Raffy Karamanoukian, Los Angeles

I perform labiaplasty with either local anesthesia or general anesthesia, depending on patient preference.  Because it is a small area, local anesthesia may be very effective.  For extensive procedures, I typically prefer general anesthesia.

   General anesthesia allows for the patient to be completely comfortable during the procedure.  I perform local with sedation upon patient request, but I prefer general for patient comfort.  Kenneth Hughes, MD Los Angeles, CA

The choice of local versus sedation or general anesthesia is determined by the surgeon and patient.  I perform the central wedge technique, often with extensive clitoral hood surgery.  This procedure can take up to two hours which can be difficult for patients with local anesthesia in stirrups, so I usually use general anesthesia or sedation.   Markings are always done prior to the injections since the injections can certainly cause swelling and deformities.  Occasionally, a patient can be very restless and uncomfortable while under local anesthesia, so an anesthesiologist is very helpful to give sedation or general anesthesia. 

Sincerely,

Dr. Gary Alter

 

I have been doing labiaplasty for many years, and the vast majority of my patients prefer local anesthesia. I have the privilege of operating in my own office-based nationally-accredited (AAAASF) surgical facility with full anesthesia capabilities, and a wonderful, talented, and experienced staff of operating room, recovery room, and anesthesia personnel, so I can offer my patients local anesthesia only, local anesthesia with IV sedation, or a full general anesthetic, according to their preferences, anxiety level, and pain threshold. (And cost-consciousness.)

Labiaplasty involves operating on one of those areas of the anatomy that is both perceived and actually is a sensitive area, so some patients will ask for and are willing to pay for a complete anesthetic. But most patients can be truthfully reassured that local anesthesia is both comfortable and complete for labiaplasty, and that careful measuring and marking (along with precise surgical technique) allows me to perform accurate and symmetrical incisions that lead to the degree of labia minora reduction the patient desires.

If there is any erring, it should be on the side of conservatism--you can always take a bit more, but it's impossible to "put back."

Using "improved accuracy" of excision as a reason for utilizing general anesthesia is likely both partly true, and partly surgeon preference, and could be a bit self-serving if the increased cost of utilizing general anesthesia is received by the doctor's own operating facility. It could also reflect a bit of inexperience or personal discomfort with this operation, and a desire to "work out the details" without the patient's awareness!

If the doctor's statement about "tissue swelling" under local anesthesia was true, then s/he must not utilize local anesthesia for blepharoplasty surgery, facelift surgery, or any of the myriad of cosmetic operations that rely on careful measurement, symmetrical incisions, and the beneficial effects of vasoconstrictive local anesthesia (even when the patient is asleep with general anesthesia). So, while true, the statement simply reflects that particular surgeon's preference for general anesthesia with a bit of "justification" thrown in for good measure. (And there's nothing wrong with general anesthesia, other than the infinitesimally-greater risk, the not-so-infinitesimally-greater cost, and a bit of recovery.)

Furthermore, there is an advantage of local anesthesia with adrenaline--more vasoconstriction, less bleeding, less bruising, better healing, and less scarring--which is why we utilize it for eyelids, facelifts, and other cosmetic procedures even when the patient is asleep! So you can see there is actually an advantage of using local anesthesia other than cost-savings.

Bottom line: I don't think I have any problem "artistically shaping" my patients' labia minora under local anesthesia, even while swollen. And in all the years I have been doing labiaplasty, I can recall only doing one revision (taking a bit more tissue per the patient's request). Local anesthesia labiaplasty has not been a problem for me or my patients (or maybe I'm just a better surgeon). See how "easy" it is to be self-serving in our pronouncements that patients take as "fact" when in fact they simply represent habit, preference, or training cloaked in statements designed to look like fact or "science!" Best wishes! Dr. Tholen

Thank you for your question. General anesthesia, although extremely safe now a days, has potential risks associated. On the other hand, local anesthesia is very well tolerated by most people and the risk of having any other medical issues is extremely rare. Therefore, if a procedure can be performed safely under local anesthesia why not! In my experience a labiaplasty is well tolerated under local anesthesia. Even the more extensive procedure using an extended wedge technique is well tolerated. Our patients receive oral sedation and topical anesthesia before getting into the operating room. Once in the OR, local anesthetics are injected into the mucosa of the inner lips. Most patients don't even feel this because the area is already numb from the topical anesthetic used before. I have to say that almost every single patient has a comment on how different the experience was compared to what they were expecting. They always say that the discomfort was close to none and that they were happy they did it under local.  

Labiaplasty can be safely performed under local, IV sedation or general anesthesia depending on the patient's preference, the surgeon's comfort and the cost considerations.  I prefer to perform labiaplasty under deep IV sedation.  This allows the patient to be completely comfortable before, during and after the surgery.  There is some added cost to performing labiaplasty this way, but the decrease in pain compared to local anesthesia only and the decrease in post-operative nausea and vomiting compared to general anesthesia outweigh the added cost in most cases.  However, if a patient really wants to do it under local only, we are not opposed.  The type of anesthesia should be discussed with your surgeon and find out his/her reasons for that type of anesthesia before deciding on what is best for you.

Dear nycgirl2011,  Labiaplasty can be performed under general or local anesthesia depending on the patient's and surgeon's preference.  When local anesthesia is used, the planned resection and incisions are marked before injecting the tissues to avoid the concerns you voiced.  The three biggest advantages for performing a labiaplasty under local anesthesia are: 1-the labia minora and adjacent tissues usually are relatively easy to numb with local. 2-There is a significant cost savings for the patient when compared to general anesthesia. 3-For many women, this is a very private procedure that if it can be performed in an office setting can allow them to drive themselves to and from the office.  The latter is dependent upon the patients not receiving any oral or IV medications for sedation but just using straight local anesthesia.