Care after removal, implantation, frenuloplasty

Why is surgery performed - plastic surgery of the foreskin frenulum?

The frenulum of the penis is a fold of skin running from the glans to the foreskin. Sometimes, due to congenital characteristics or injury, its length is insufficient, which causes pain and tissue tears during sexual intercourse. The situation can be corrected with the help of frenulotomy - dissection of the frenulum of the penis followed by plastic surgery.

The short frenulum becomes tense during intimacy, causing pain and discomfort. Due to painful sensations, a man is unable to have sexual intercourse. If the operation is not performed on time, the patient will develop a psychological failure complex linking intimacy and pain. It will be difficult to get rid of the problem.

A tight frenulum pulls the head of the penis down during an erection. The penis becomes curved, making intimacy impossible.

The frenulum may break during intercourse. The rupture is accompanied by severe pain and bleeding. Sometimes during contact the tissues do not tear completely, but are constantly torn a little. This leads to the formation of cracks and scarring.

The frenulum is a sensitive area containing a large number of nerve endings. Therefore, its stretching during intimacy causes additional stimulation, reducing the duration of sexual intercourse. The result is premature ejaculation. This significantly reduces the sexual satisfaction of both partners and can cause psychological complexes in a man.

Therefore, in order to prevent the occurrence of psychological and medical problems, if
the frenulum of the penis
is short it is necessary to undergo
plastic surgery
. After the operation, the patient will be able to lead a full intimate life without pain and discomfort.

Indications and contraindications for frenuloplasty

Indications for frenulotomy may include:

• Curvature of the erect organ. During an erection, the head bends downwards.
• Difficulty retracting the skin fold, an unpleasant feeling of tightness.
• Painful frictions.
• Microtears of the frenulum, which are accompanied by bleeding.
• Phimosis, paraphimosis.
• Early ejaculation in men can also be associated with a short frenulum.

60% of men with the problem of early ejaculation note excessive tension on the frenulum during sex. Frenuloplasty solves this problem.

The manipulation is not classified as complex, but requires sophistication and skill from the surgeon - many receptors are concentrated in this area.

Contraindications

• Inflammatory and infectious processes of the genitourinary area. The operation cannot be performed due to the risk of spreading inflammation and infection.
• Rash in the intimate area. Plastic surgery is performed after the condition of the skin has normalized.
• Fever, poor health, colds and other infections.
• Reduced blood clotting - surgery is not performed due to the high risk of bleeding.

In emergency cases, for example, in case of rupture of the short frenulum of the penis, accompanied by bleeding, plastic surgery is performed even if there are contraindications. In this case, the possibility of intervention is decided specifically for each man.

Possible complications after surgery

Foreskin frenuloplasty is a simple procedure. Reviews from men after surgery indicate the absence of complications. However, if during the manipulation the doctor made a mistake or the man did not follow the recommendations after the intervention, then negative consequences develop:

1. infection resulting in an inflammatory process;
2. seam divergence;
3. intense bleeding from the wound;
4. allergy to anesthesia medications.
5. pronounced pain in the penis area;
6. bleeding at the suture site;
7. severe swelling of the shaft of the penis;
8. postoperative scarring;
9. unsatisfactory appearance;
10. penetration of infection into the reproductive organ.

In most cases, complications are not dangerous and are treated on an outpatient basis.

Contact with water should be avoided for a week after frenulotomy. To do this, you can put a condom on the penis while swimming. Having sex is allowed only after complete healing, when a pink scar forms at the site of the wound. Sexual intercourse should be carried out carefully during the first month, it is recommended to use a lubricant.

Preparation for plastic surgery

A medical examination is carried out, during which the degree of shortening of the frenulum of the penis and existing scar changes are revealed. The genitals are examined for the presence of rashes and skin changes, which are a contraindication to plastic surgery.

During the preoperative consultation, you should inform the urologist about the medications you are taking. Some medications have a negative effect on blood clotting and may be incompatible with anesthesia drugs. In this case, the medications are canceled or replaced with others.

The patient undergoes tests:

• General – blood and urine.
• Analysis for sexually transmitted infections, which are a contraindication to plastic surgery.
• Blood test for coagulogram - clotting time and bleeding duration. If there is increased bleeding, surgery is contraindicated. Sometimes it can be done after preliminary normalization of blood counts.
• Blood for the group and Rh factor is donated in case of unexpected blood loss, which is eliminated by the introduction of donor blood. If a man has documentary evidence of his group and rhesus, the study is not carried out.

Patients who are planning to undergo surgery under general anesthesia are prescribed an ECG and a consultation with an anesthesiologist - a doctor who will deal with pain management.

If necessary, other research methods and additional consultations with doctors may be prescribed.

One day before surgery, you should refrain from sexual activity, physical activity, and drinking drinks containing caffeine. You should not drink alcohol, as they are incompatible with pain medications and can cause bleeding. During the period of preparation for surgery, you should not take medications not recommended by your doctor.

Before plastic surgery of the frenulum of the foreskin of the penis, performed under general anesthesia, you should not eat for 8 hours. You can drink still water and unsweetened tea.

Pubic and groin hair is removed. Carrying out basic hygiene procedures is mandatory. Before the operation, you need to remove removable dentures, contact lenses, hearing aids, and empty your bladder.

Is special training required?

The procedure does not require special preparation. Immediately before surgery, it is necessary to perform thorough oral hygiene. You also need to feed the child - hunger negatively affects blood clotting. In addition, it will be difficult to eat for several hours after the operation.

Since plastic surgery of the upper lip frenulum is performed mainly on young children, first of all, psychological preparation is necessary. Parents should reassure the child, assure him that the procedure is painless, this will help significantly speed up and simplify the doctor’s work.

How is frenuloplasty performed?

The operation is performed under general or local anesthesia. The method of pain relief is selected depending on the complexity of the intervention, the wishes of the patient and his individual sensitivity to pain. The task of the doctors at the University Clinic is to make plastic surgery as painless as possible. Therefore, an anesthesiologist is located next to the man, who, if necessary, will intensify anesthesia, eliminating any pain that may arise.

The operation is performed using surgical instruments, laser and radio wave method. The use of radio waves and laser methods significantly reduces the risk of bleeding and shortens the recovery period after plastic surgery.

Immediately after processing the surgical field, the doctor cuts the frenulum of the penis using a surgical instrument, laser or radio knife. Scar tissue is excised.

There are several methods of plastic surgery:

• Longitudinal-transverse
  - the frenulum is cut transversely, the edges of the cut are moved up and down, and then stitched together, forming a longitudinal seam.
• V-shaped
  . An incision is made in the form of a Latin letter V, with the wide part facing towards the head. The edges of the incision are pulled up and down, and then stitched in the shape of the letter Y. In this case, the frenulum becomes longer.
• Z-shaped
  . A longitudinal incision is made in the shape of the letter Z, the edges of the teeth are spread apart so that the frenulum lengthens by about 1 -1.5 cm. Then a suture is applied in the form of a “snake”. The method is well suited for the surgical treatment of premature ejaculation. The presence of a Z-shaped seam protects the tissues from excessive tension and reduces their sensitivity, helping to prolong sexual intercourse.

The operation lasts approximately 15-20 minutes. Then a bandage is applied to the wound. The man leaves the clinic immediately after the plastic surgery is completed or after some time.

Due to the effects of anesthesia, on the day of surgery it is undesirable to drive or do other work that requires concentration and quick reaction.

Implantation: rules of care after surgery

Dental implantation is another type of surgical intervention, after which careful care of teeth and gums is required. Even if the most modern medical equipment was used during the operation and the implants consist of the latest materials, the patient needs to know a number of standard recommendations.

Care immediately after dental implantation

After the operation, begin applying ice to the cheek on which the intervention took place. This can be done several times with a break of twenty minutes. It is enough to hold the ice on your cheek for seven to ten minutes.

After the dental implantation procedure, you can wipe the wounded area with a cotton swab soaked in water and salt. You can add just a little iodine to the water. If you are bleeding heavily, apply a sterile gauze pad to the wound for twenty minutes. Remember that bleeding after implantation, as well as after tooth extraction, is normal if it does not last too long.

If you experience pain, you can use painkillers prescribed by your doctor, but not earlier than an hour and a half after the operation.

Care for several days after implantation

When you brush your teeth, in the first few days try not to touch the sore spot with the bristles. To treat the implant, use water with a little salt dissolved in it. In food, exclude the consumption of hard fruits, tea, coffee, carbonated sweet and mineral waters, alcoholic beverages, and hot food. This ban lasts two to three days, the ban on eating hot food lasts for a day.

NEW LEVEL

THERE ARE TWO IMPORTANT CONCEPTS ABOUT WOUND SURFACES IN THE ORAL CAVITY:

1. Healing and contraction of any open wound in the oral cavity occurs towards its center (hence the need to keep it as open as possible).

2. Two moist surfaces in the mouth that are in direct contact with each other re-grow well.

I believe stretching is necessary after a frenulum trimming procedure to achieve optimal results. The exercises do NOT require the use of force and do not take much time. It is necessary that the movements be fast and precise. Using an LED headlamp will help you achieve the best results.

To relieve pain, you can use Tylenol, Ibuprofen (if baby is 6 months or older), Arnica, Rescue Remedy (Ed. - Dr. Gaeri's recommendation), or other medications. I also recommend purchasing a soothing teething gel (without benzocaine or lidocaine, which are numbing ingredients), such as Hyland's Teething Gel or Orajel Naturals (not regular Orajel). These gels should be used during stretching exercises, and they will also help relieve pain immediately after completing the warm-up.

The main danger of cutting the frenulum is that wounds in the mouth heal very quickly. This can cause premature fusion, whether of the tongue or lip, resulting in new limitation of mobility and persistence or return of symptoms. The exercises shown below are best done with your baby lying on your lap (or on the bed) with his feet pointing away from you.

PRINCIPLES OF PERFORMING STRETCHING EXERCISES: WATCH THE VIDEO https://vimeo.com/86784777

STRETCHING

SIGNIFICANT DISCHARGE OR BLEEDING AFTER THE FRENALE CUT PROCEDURE IS CONSIDERED NORMAL, ESPECIALLY IN THE FIRST FEW DAYS. BLEEDING IS REDUCED TO A MINIMUM BECAUSE THE PROCEDURE IS CARRIED OUT WITH A LASER. BEFORE STARTING THE EXERCISES, WASH YOUR HANDS CAREFULLY (GLOVES ARE NOT NEEDED). APPLY A SMALL AMOUNT OF SOOTHING GEL ON YOUR FINGER BEFORE STARTING TO WARM UP. I RECOMMEND DOING THE EXERCISES 4 TIMES A DAY FOR THE FIRST 3 WEEKS AND THEN DURING THE 4TH WEEK, QUICKLY REDUCING THE NUMBER OF EXERCISE REPEATS FROM 4 TO 3, 2, 1 REPS PER DAY BY THE END OF THE 4TH WEEK.

Scheme by Dr. Sherwin Yazdi. The wounds are usually diamond shaped. It has 3 dimensions - height, width and depth. This is especially important for the sublingual wound, since it is much deeper than the wound under the lip. Working along these 3 dimensions is the key to successful healing.

The upper lip stretches more easily than the tongue. If you need to stretch your lip and tongue, I recommend starting with lip exercises. As a rule, children do not like this warm-up and may cry. This way, lip exercises allow for easier access under the tongue when the baby starts to cry. For the upper lip, simply place your finger under the lip and push it as high as possible (until you feel resistance). Then gently move your finger from side to side for a few seconds. Remember, the main purpose of this procedure is to use your finger to separate the moist opposing surfaces, the lip and gum, so that they cannot stick to each other.

The next area of ​​stretching work is the tongue . Place both index fingers in your mouth (insert one first and move it toward your cheek to stretch your mouth, making room for the second index finger). Then use both index fingers to place them under your tongue and lift it towards your upper palate. You need to perform three separate stretching movements with your tongue:

1. With your fingers under your tongue, try to lift your tongue as high as possible (towards the upper palate). Hold it in this position for 1-2 seconds, then relax your fingers and repeat these steps again. The goal of the exercise is to fully open the diamond so that it is almost in the same plane (remember, the central horizontal fold line of the diamond is the place where fusion will first begin).

2. Lift and hold your tongue with one finger, place the other finger horizontally in the middle of the diamond and roll it like a roller from front to back, try to stretch the diamond as high as possible. Make sure that your finger movements when stretching this area are performed within the diamond. After this, repeat the movement on either side of the diamond (outside the diamond) to relax the muscles in the rest of the hyoid space.

WATCH THE VIDEO https://vimeo.com/98709935

SUCKING EXERCISES

It is very important to let your baby understand that not all manipulations that you perform with his mouth are associated with pain.

The following simple exercises can help you cope with uncoordinated muscle work during sucking or weak sucking movements. Their implementation helps to improve the quality of sucking:

1. Slowly move your finger along the lower gum from side to side, with your baby's tongue following your finger. These actions help strengthen the lateral muscles of the tongue.

2. Offer to suck your finger and pull it towards you, as if trying to slowly pull it out, while the baby tries to pull it back deeper into the mouth. These actions strengthen the language as a whole.

3. Offer to suck your finger and apply gentle pressure to the roof of your mouth. Then turn your finger over, gently press on the tongue and stroke the middle of the tongue.

A FEW DAYS AFTER THE TRIMING PROCEDURE, THE WOUND(S) WILL LOOK WHITE AND/OR YELLOW, WHICH APPEARS VERY MUCH RESEMBLY TO SUPUPURING.

This is a completely normal inflammatory reaction. Don't let your regular pediatrician, lactation consultant, friends who think they are experts, or anyone else give you wrong advice. If you still think you have an infection, call our office.

1 week after the procedure

1 week after the procedure

10 days after the procedure

5 days after the procedure

AFTER THE PROCEDURE, IT IS VERY IMPORTANT TO CONTINUE TO WORK WITH YOUR BREASTFEEDING CONSULTANT TO ENSURE OPTIMUM RESULTS.

CALL OUR OFFICE IN CASE OF AN EMERGENCY:

Uncontrolled bleeding

Refusal to breastfeed or bottle feed

High temperature >38.6°C

With the official permission of the author, translated by Veronika Makarova , breastfeeding consultant, Moscow, https://milkmomstory.livejournal.com

If you are interested in this topic, we invite you to watch the webinar Short frenulum of the tongue and consultation on breastfeeding

Go to other interesting translations of articles by foreign experts

Possible complications

Plastic surgery of the frenulum is a simple operation, but still it does not exclude the occurrence of complications:

• Development of the inflammatory process. This complication is most likely, since the oral cavity is filled with various microorganisms and can cause infection. In this case, symptoms such as fever, local swelling, suppuration and pain are usually observed.
• Soreness. This consequence is normal. It is associated with soft tissue injury and can be aggravated by eating and drinking. In these situations, it is recommended to resort to the use of painkillers.
• Formation of a rough scar. This consequence of the operation is the result of refusal to perform tongue exercises.
• Increased body temperature. This symptom is a normal variant in children. If present, anti-inflammatory drugs may be prescribed. Body temperature should return to normal in 2-3 days. If this does not happen, then you should contact a specialist.
• Discomfortable sensations in the presence of stitches. Negative feelings usually disappear after a couple of days.
• Smacking in babies. The symptom is alarming, as it may indicate improper latching of the breast or nipple. Smacking that does not disappear after 3 days indicates a medical error.
• Seams coming apart. To avoid such a complication, it is necessary to ensure that the child does not fall or talk too much and actively. Also, you should not look into the child’s mouth, pulling the tongue too far. If the stitches come apart, you should immediately consult a doctor.
• Formation of white plaque on the wound surface. Do not be alarmed, plaque is not pus, but indicates epithelialization. But there should be no swelling, fever or other symptoms of poisoning. The plaque does not require cleansing; it will disappear on its own by the time it is completely healed.
• The tongue will remain numb and swollen for some time after the procedure. This is due to the fact that the effect of the anesthetic has not yet completely worn off. All these symptoms disappear within one day.

Parents of small children and adult patients should not worry about plastic surgery of the lingual frenulum. This procedure does not pose a health hazard and is very easy to tolerate. You can go to the World of Dentistry clinic with a “light” heart, since we employ qualified surgeons who know their business.

A practical way to choose a clinic

Such a delicate problem, requiring a delicate attitude and correct solution, requires contacting a specialist, the necessary qualifications and preferably in a comfortable environment without additional expenditure of free time. Such services can be obtained within a private specialized institution, but how to decide on its choice?

Our Help Desk for private clinics in Moscow “Your Doctor” has all the necessary information; by visiting the site you can not only determine the location of a particular center, but also see all the listed characteristics, as well as make an appointment with a specialist or arrange a home call from a urologist, without leaving the page.

Publication date: 2019-12-11

Useful information on problems associated with the frenulum of the penis:

• Calling a urologist to your home
• Balanitis
• Balanoposthitis
• Frenum plastic surgery
• Urethral swab
• Prostate massage
• Circumcision
• Tests for STIs
• Treatment of sexually transmitted diseases
• Ultrasound at home
• Frenum of the penis
• Pyelonephritis
• Ultrasound of the bladder
• Diagnosis of sexually transmitted infections
• How to prepare for an appointment with a urologist?
• How to get tested for urological diseases?
• What tests can be done by a urologist?
• What diseases does a urologist treat?
• What symptoms should you consult a urologist for?
• How to make an appointment with a urologist at the clinic?

Video story by surgeon S.K. Bakirkhanov about plastic surgery of the frenulum of the penis:

Sarvar Bakirkhanov, a specialist at the Mont Blanc clinic in the field of intimate plastic surgery, says:

— Frenumplasty is one of the most common procedures. It is performed under local anesthesia and lasts about ten minutes. The bridle is dissected transversely and sutured longitudinally. It is used for congenital short frenulum, when in a state of erection the penis seems to “bend” and there is a high risk of spontaneous rupture. The fact is that an artery passes through the frenulum and if damaged, there can be very severe bleeding. Another indication for cutting the frenulum is to combat accelerated ejaculation. A nerve passes through the frenulum; when the frenulum is tense like a string, its irritation accelerates ejaculation.

Coming out of anesthesia

Most types of oral surgery are performed using anesthesia. A person can “recover” from anesthesia for several hours after the operation. Then the patient experiences ailments such as fatigue, drowsiness, and poor concentration. There are several ways to get rid of side effects of anesthesia.

• The first way is to move as much as possible, but without excessive physical activity, which can cause bleeding.
• The second way is to drink plenty of fluids, but only a few hours after the operation. It is necessary to drink ordinary mineral and always still water.

Carrying out surgical operations in the oral cavity requires subsequent special care of teeth and gums. The postoperative period will become much shorter if the listed recommendations are followed. If you experience any serious complications, prolonged bleeding, or if you cannot “bring down” the increased temperature, then this is a reason to immediately contact your dentist. Only he can help you and provide additional recommendations.

Symptoms of incorrect placement of the frenulum of the tongue

With significant pathology of the frenulum, the following symptoms may be observed:

• It is impossible to stick the tongue out of the mouth due to the short length of the frenulum.
• When trying to stretch the tongue, it bends and takes an arched shape.
• When you try to reach the palate with your tongue, the tip of the organ expands, as there is a strong tension.
• When at rest, the tongue has the shape of a groove.

If you have such symptoms and discomfort, you should consult a specialist. Perhaps the doctor will conduct a more thorough diagnosis and make a diagnosis.

Operation methods

There are several ways to perform plastic surgery of the frenulum of the penis, which depend on the anatomical features of the structure of the structural tissue of the foreskin.

Among the main methods, there are two types of surgery:

• Frenulotomy.
  Lengthening the frenulum occurs by cutting in the transverse direction followed by longitudinal stitching, which allows you to naturally increase the length of the fabric up to 2 centimeters. With this method, the sensitivity of the genital organ is not affected.
• Frenulectomy
  . Complete removal of the frenulum, which is required for mechanical injuries of the foreskin and scarring of the tissue. The incision is made transversely around the circumference of the genital organ, followed by longitudinal stitching. The result is a scar that aligns with the natural suture at the bottom of the penis.

Quite often, both methods are implemented without the use of classical surgical instruments. Intervention in the tissue structure is carried out through laser exposure. The technology of the procedure fully complies with generally accepted rules, with the exception of the use of radiofrequency exposure instead of a scalpel; instead of stitching, the edges of the resulting wound are soldered.

The main advantage of using modern equipment is the minimal risk of bleeding during the process and natural disinfection of the wound through exposure to high temperatures.

Answers to frequently asked questions on the topic of the frenulum of the penis:

• Which doctor treats frenulum of the foreskin?
• Where to go with a problem on the frenulum of the foreskin?
• What tests should be taken if there are problems with the frenulum of the penis?
• Diagnosis of diseases of the frenulum of the penis
• Treatment of diseases of the frenulum of the penis
• Is it possible to remove the frenulum of the penis?
• Swollen frenulum of the penis
• Rash on the frenulum of the penis
• Herpes on the frenulum of the penis
• How does the foreskin affect sensitivity?
• How to stretch the foreskin?
• What is the foreskin for?
• Diagnosis of diseases of the foreskin?
• Why doesn't the foreskin open completely?
• What to do if the foreskin is swollen?
• Have plaque appeared under the foreskin?
• Do you perform foreskin plastic surgery at your clinic?