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Labioplasty If you are considering surgery we want you to be thoroughly informed about this procedure. Reading this information is the first step. However, a personal consultation with your surgeon is the best way to obtain any additional information you need. What is labioplasty? Cosmetic surgery of the genital area and more specifically of the labia is also called labioplasty. Is labioplasty for me? Women are often concerned about the appearance of their genital area. This may be a concern purely for aesthetic reasons or more functional reasons. The inner labia may actually protrude so far out of the outer labia that it produces functional problems. It may cause chaffing on underwear; it may cause folds which become irritated and painful. Large labia may also be visible through underwear or swimming costumes, causing embarrassment. Initial and subsequent Consultations During the initial consultation, you may be asked about your concerns and what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can be realistically achieved. You will be asked about your medical history including previous operations, past and present medical conditions and current medications. In order to provide you with the best information and safest options, it is important that you give your surgeon complete information. The medical conditions that may increase risks of surgery include high blood pressure, thyroid problems, diabetes and bleeding problems. Physical examination will be performed, usually with a nurse present. The labial anatomy and the extent of the problem will be assessed and a plan for a possible corrective procedure will be formulated by your surgeon. Preoperative photographs may be taken during your initial consultation or a subsequent visit with your consent. Your surgeon will discuss with you the details of the operation and the possible risks and complications associated with the procedure. Preparation for surgery The goal of your plastic surgeon and the staff is to make your surgical experience as easy and comfortable for you as possible. Smokers must stop smoking 3 weeks before surgery. Aspirin and some anti-inflammatory drugs used for the treatment of arthritis can cause increased bleeding, so you should avoid taking these medications for 2 weeks before surgery. It is helpful to have the genital area shaven or waxed several days prior to surgery as you will find it easier to look after the stitches after surgery. Apart from a normal diet and hygiene, no special preparation is necessary. Labioplasty is usually performed in a hospital or a day surgery under general anaesthetic or intravenous sedation. The operation is performed on a day surgery basis, meaning you can leave after the operation is finished and you have recovered sufficiently form the anaesthetic. If this is the case, make certain you have someone drive you home after surgery and to stay with you at least the first night following surgery. The day of surgery You will be admitted to the hospital or day surgery by the admissions staff. This requires about 15 minutes of paperwork after which you will be seen by the anaesthetist. This is the doctor responsible for putting you to sleep and keeping you safe during the operation. The anaesthetist will ask you again about your previous medical history to ensure that giving you anaesthetic is in fact safe. During the anaesthetic, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. Your surgeon will mark your skin before the operation and if you have not already done so, you will need to sign the consent form for your operation. You will also have the last opportunity to ask any last minute questions you may have. You will then be moved to the operating theatre. There, you will be placed on the operating table. The anaesthetist and his assistant will prepare you for the anaesthetic and put you to sleep. You will also be given antibiotics intravenously to minimise the chance of infection. Your operation The operation will take anywhere between 60 and 90 minutes, depending on the type and extent of the operation. The incisions will be places according to the preoperative plan formulated by your surgeon. The stitches used in the operation are dissolving, so that looking after the operation will be easier. Once the operation itself is finished, antibiotic ointment is applied to the sutures. After surgery When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. You will feel drowsy for several hours after the procedure and you will remember very little of this time. Generally, you will be ready to leave the day surgery about 3-4 hours after the operation is finished. Because the area is infiltrated with long-lasting local anaesthetic, you will have little or no pain when you wake up. As the anaesthetic wars off, some discomfort will return. This can generally be well controlled by taking oral medications such as Panadeine Forte. Resting also helps decrease the discomfort. The pain will settle over several days to a point where you will be taking only Panadol by 4th day or so. Straining, bending and lifting must be avoided, since these activities might cause increased swelling or even bleeding. Although you will find that mobilisation is a little slow at first, you should expect to be walking normally within five days after surgery. It is important that you keep the area clean. Showering 2-3 times per day is a good idea, letting the water run over the area, then patting it dry rather than rubbing. The antibiotic ointment is to be applied to the suture lines 3-4 times a day to minimise the chance of infection. How will i look and feel? You will notice swelling and bruising, which is to be expected. The bruising and much of the swelling will disappear over a period of 2 weeks. However, it may be several months before all swelling subsides and you see the final result of your labioplasty. Incisions will initially be red or pink in colour. They will gradually begin to fade till they are skin coloured or lighter after 12-18 months. Some numbness around the suture line may persist for months after surgery. When can i resume my normal activities? You may be able to return to light work anywhere from one to two days to a week after surgery. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported to your doctor. You should avoid sexual activity for a minimum of two weeks. Results of your surgery Because of individual factors, not everyone will achieve the same results from labioplasty. Your plastic surgeon selects the surgical technique that he feels will obtain the best outcome for you. Incision lines will fade over time but will be permanently present. It is important to realise that the amount of time it takes for recovery varies greatly among individuals and also depends on the extent of the operation. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your surgery. Risks and possible complications of surgery Fortunately, significant complications from labioplasty surgery are infrequent. Every year, many operations are performed with no major problems and good results. However, everyone considering surgery should be aware of both the benefits and risks. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon. • Bleeding may occur. At worst, this will require return to the operating theatre to evacuate the blood clot and to stop the bleeding. • There will be bruising after surgery. This usually settles after approximately 2 weeks • Because labioplasty involves incisions in an area which is very rich in nerve endings, a risk exists of painful scars. The pain from surgery may interfere with normal function and may result in painful sexual intercourse. • Wound infection may complicate the operation in approximately 5% of operations. The infection is usually treated with antibiotics, oral or intravenous, depending on its severity. • Dehiscience or reopening of the wound may occur in about 1-5 percent of operations. This usually happens as a result of infection and is managed by treating the infection. • Collection of blood or fluid under the operated skin. This usually happens within the first 24 hours after surgery. Rarely, it may require return to the operating theatre. More commonly, fluid collects under the skin without any obvious ill effects. Removal of this serum is a painless process but may require several visits to the plastic surgeon’s office. • Labioplasty results in scars. They run on the ridge or around the labia. Healing is intrinsically unpredictable and different in different people. Wide, lumpy or irregular scars may occur due after surgery. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. • Clots in leg veins may cause leg swelling. The clots may travel to the lungs causing severe breathing difficulty and, rarely, death. With adequate precautions, which are routinely taken, including medications, compression stockings and early mobilisation, these complications are uncommon. You can help to minimise certain risks by following the advice and instructions of your plastic surgeon, both before and after your surgery. Maintaining a relationship with your plastic surgeon Should there be any questions regarding labioplasty, be sure they are answered in advance. Well meaning friends are not a good source of information. Find out everything before proceeding with the operation - a well informed patient is a happy one. After surgery, you will return to your plastic surgeon’s office for follow-up care at prescribed intervals, at which time your progress can be evaluated. Post-operative photographs will form a part of the evaluation of your result. Once the immediate postoperative follow-up is complete, many surgeons encourage their patients to come back for periodic check-ups to observe and discuss the long-term results of surgery. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.