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A Quick Conversation With the Guy Who Pioneered Anal Botox

Anal Botox allowed Tom to enjoy having sex again.

“It sounds crazy,” he told Queerty back in July. “People laugh and ask, ‘Does your butthole look younger now?’ It probably does! But seriously, I identify with my sexuality very strongly, and I couldn’t receive anal sex for seven years. That was a big issue for me.”

For his rejuvenated sphincter, Tom has Manhattan surgeon Evan Goldstein to thank.

In 2010, Goldstein founded Bespoke Surgical, a concierge-style medical service that addresses the unique health needs of the gay community — e.g., his pioneering practice of making buttholes beautiful and more sexually compatible using Botox injections. “I was in a unique position to recognize the issues gay men were facing with regard to this area of their bodies,” he tells me.

While Goldstein says he’s seen a steady increase in women seeking anal rejuvenation procedures as anal sex gains in popularity — a 2015 study found 1 in 3 straight women in the U.S. had tried it — most of Goldstein’s clients are still gay men between the ages of 20 and 65, who, for whatever reason, are struggling to take it up the ass. Some are lifelong tops who are bending over for the first time because erectile dysfunction has robbed them of their ability to fuck someone else. Some have new boyfriends who are much larger than their exes. Others want to start fisting.

“I have clients who come from all over the world — Abu Dhabi, Europe, Asia,” he says. “Because no one is tending to our community and providing a safe haven, a taboo-free environment where they can be honest about what pleases them and what’s going on.”

To better understand how a shot of botulism to the ass enhances that pleasure, I recently talked to Goldstein, whose anal Botox business is booming enough that his profits have climbed 20 percent year-over-year and allowed him to open a second clinic in Beverly Hills.

Anal Botox is an aesthetic treatment — kind of.

It’s not like Scrotox, Goldstein clarifies, which guys use in search of smoother scrotums and lower-hanging balls. “I don’t inject it to get rid of the wrinkles — most people like a pucker in their asshole. The aesthetic issues I deal with are skin tags, hemorrhoids or excess skin on one side. More commonly, though, the person is struggling to receive anal sex.”

There are two limiting factors when it comes to bottoming.

The first: Stretchability of the anal skin. The second: Elasticity of the anal muscles. “Some people can relax their muscles, but the skin is so taut they tear easily,” Goldstein explains. “I’ll inject the Botox where the skin is too taut. If it’s a muscular issue, I’ll inject the muscle.”

The internal sphincter muscle, to be specific.

Your asshole is comprised of three separate muscles, Goldstein explains. Two of them — the external sphincter and superficial sphincter — can be controlled. The internal sphincter cannot. Botox, however, allows it to relax. “You’re not shitting on the street,” Goldstein reassures, “but when you’re ready to engage, that relaxation allows for enjoyment and less pain.”

The procedure typically takes 5 to 10 minutes and costs between $5,000 and $50,000 depending on the extent of the work being done.

Under local anesthetic and light sedation, Goldstein isolates the internal sphincter and injects four rounds of Botox at four locations around the anus (12 o’clock, 3 o’clock, 6 o’clock and 9 o’clock). Most procedures are covered by insurance, he explains, because he’s treating physiological issues. “I take Medicaid and all the other different insurances,” he says. “For me, it’s about helping the community.”

If necessary, while the patient is sedated, anal sex is simulated in the operating room with a butt plug.

While the patient is sleeping, Goldstein uses a medical device to stimulate intercourse, identifying problematic locations and injecting accordingly. He’s also able to tell if the problem is psychosomatic. “If I’m able to stretch the skin and muscle to a considerable extent while the patient sleeps, I know the challenge is to make the physical and mental connect so the patient can learn to relax.”

Additional injections typically aren’t necessary.

Most people only need one series of injections, Goldstein says, because when the Botox starts to work, he has them begin to use butt plugs, dilators and dildos on their own. “Usually three to six months later, they’re bottoming and learning the correct way to engage and don’t necessarily need to Botox again,” he says.

That said…

Some people remain super tight, Goldstein says, and others like to push the limits — bigger cocks, fists, forearms and so on. “Those are the people who are going to return for Botox injections more often.”

Either way, recovery is swift.

Botox injections typically take three to five days to begin working, Goldstein explains. He does, however, preach caution in the early going. “I tell people, ‘When you feel like you have to fart, go do it in the bathroom — just to be safe.”