Cosmetic perineoplasty is a surgical procedure performed by a plastic surgeon or cosmetic gynecologist to tighten the perineal muscles, reconstruct the perineal body and excise the excess skin of the perineum overall producing a cosmetic and functional rejuvenation of the perineal region as well as a tightening of the vaginal introitus (vaginal opening).
The perineoplasty in one of the many medical and surgical treatments available falling into the category of designer vagina procedures.
Due to aging, pregnancy, childbirth, episiotomy, obesity or extreme weight loss, the perineal region may suffer some physical trauma and damage:
- muscles may stretch and lose elasticity or tear
- visible scars may be present in the perineal region or excess skin may be present
- internal scarring may cause the region to be tight, unable to stretch, with adhesions of different tissues stuck together, causing pain or other symptoms.
- the perineal body, which is a tendon in the central perineal region supporting the pelvic floor where all perineal muscles converge and attach, may suffer damage and need to be repaired.
Indications of cosmetic perineoplasty
A perineoplasty may be indicated when one or more of the following is present:
- Excess perineal skin
- Visible scarring
- Non-elastic hard scarring tissue on physical examination.
- Loose perineal muscle tone.
- Weak / loose vaginal opening
- Visible / exposed vaginal mucosa
Cosmetic Perineoplasty Procedure
The perineoplasty procedure may be performed with local anesthesia with or without a pudendal block and with or without sedation, or with epidural anesthesia, or with general anesthesia. It may be performed in an outpatient setting or require a 1-day in hospital stay, depending on the surgery. Surgery generally takes about 1 hour, or it may take longer if more than one procedure is performed at the same time. It can be performed with a traditional scalpel or with laser, electrocautery or radiofrequency cutting devices.
An incision is made in the midline of the perineal area or a U / V shaped incision may be made depending on the case; muscles are tightened, the perineal body and muscle tears may be repaired if needed; scar tissue is excised as well as excess skin. All internal tissues are sutured using absorbable stitches, while the skin may be sutured using non-resorbable sutures that will be removed 8-14 days after surgery. By tightening the perineal tissues, the vaginal opening will result tighter as well and the labia will be closer together.
After surgery you will be prescribed oral antibiotics and oral pain medication. The area should be kept clean and dry and tight garments should be avoided for the first week. 4-6 weeks after surgery you may be able to resume strenuous activities and sexual intercourse.
Contraindication to the perineoplasty
The consultation with the surgeon will make sure the surgery is right for you.
Patients for which the perineoplasty may not be indicated include:
- Patients looking to improve their own sexual gratification. A perineoplasty alone won’t help with that; by tightening the vaginal opening, the perineoplasty may improve male’s sexual satisfaction, but for a woman it is more indicated a vaginoplasty or a combination of vaginoplasty and perineoplasty known as colpoperineoplasty.
- Patients wanting to address vaginal canal laxity or sensation of internally wide vagina.
- Pregnant patients or willing to have children in the future.
- Patients with active infections
- Patients with unrealistic expectations
Risks and complications
Overcorrection may result in painful sexual intercourse or in perineal tears. This may be corrected with the use of special dilators over the course of several weeks.
Improper suturing may cause wound dehiscence, which is the reopening of the surgical wound; this is because the perineal muscles are very strong, and suturing must be done properly.
Other risks or complications resulting from the perineoplasty are scarring, healing problems, hematoma, infection, chronic pain, and failure to meet the expectations of the patient.
Price of the cosmetic perineoplasty
The costs vary depending on the chosen surgeon and clinic, on the surgical technique, and the country where you are undergoing surgery.
In the USA, the average price for a cosmetic perineoplasty is 5,500-7,500 USD.
In the UK, the average cost of the perineoplasty is 3,000-4,400 GBP (3,900-5,700 USD).
In Thailand, you can expect to pay 30,500-51,000 THB (975-1,600 USD) for the cosmetic perineoplasty.
- Vaginoplasty and Perineoplasty.
HJ Furnas, FL Canales – Plastic and Reconstructive Surgery Global Open Journal, Nov 2017
- Aesthetic Vaginal Plastic Surgery.
L Triana – Springer, 2020
- Female Cosmetic Genital Surgery – Concepts, Classification, and Techniques.
C Hamori – Thieme, 2017
- The Unfavorable Result in Plastic Surgery – Avoidance and Treatment, 4th Edition
MN Cohen, SR Thaller – Thieme, 2018