Butthole Beautification Surgeries Are Quickly Becoming a Way of Life

Like the nose job and boob job before them, anal rejuvenation procedures — from bleaching to Botox to outright reconstruction — have gone mainstream

Back in 2006, porn star Tabitha Stevens checked into L.A.’s Pink Cheeks salon for a little televised anal bleaching. Broadcast on E!, the camera soon switched to Stevens, who was laying face-down in a blue surgical gown with her ass in the air. “You’ve got a tail on you,” the beauty therapist joked. “Put a saddle on you, and we could ride you around the parking lot!” Stevens didn’t know it at the time, but her on-screen bleaching became a landmark moment for butthole beauty treatments. It didn’t take long for interest to spill over into surgeries, either — from tightening operations to sphincter repair, there truly is something for everyone.

Evan Goldstein, a gay sexual health specialist and founder of Bespoke Surgical, started performing these types of anal procedures around 10 years ago, learning techniques from plastic surgeons as he went along. “Anal lips and mouth lips are very, very similar, so you talk to people, and it starts to bud into a speciality,” Goldstein explains in his thick New York accent.

Before long, he had stopped performing other surgeries altogether to focus solely on the anus. Fast-forward to 2020 and he offers everything from anal botox, which relaxes the muscles and is a common cure for anal fissures, to anal reconstruction surgeries, which range from scar revisions to symmetrical surgical alignments. In an average week, he estimates that he performs 15 surgeries and sees 75 clients. (Statistics are hard to track down, but it seems like cisgender, gay men are the primary demographic writ large.)

A common myth is that these treatments are solely cosmetic. But this wasn’t the case for Dolf Dietrich, a gay porn star now known for having “one of the prettiest assholes in the industry,” as well as his campaigns to end HIV stigma and his role as an ambassador for Pineapple Support, a nonprofit offering mental health services to sex workers. Back in 2008, Dietrich was working as an art director for a New York magazine — a job that came with comprehensive health insurance. He decided to put it to good use: First, he had an operation to restructure his chest (Dietrich was born with pectus excavatum, which forms a concave chest); then he decided to tackle a series of skin tags around his anus.

“I always thought they were unattractive, and I’d [find it] embarrassing when I’d have sex with somebody and they’d go down on me,” he tells me. “But they also caused hemorrhoids on occasion, which were obviously very uncomfortable. So I went to one of the best proctologists on the Lower East Side.” He laughs as he remembers the consultation. “I asked him if he could spruce it up during the procedure, and he looked at me like I was crazy,” he tells me, before breaking into a hilarious impression of his proctologist’s response. “‘It’s an asshole, why would you want it spruced up?!’” Dietrich wasn’t in porn at the time, but his instincts paid off. “I haven’t had hemorrhoids since, and it turned out pretty magnificent!” he raves. 

Other patients haven’t been so lucky. “A lot of people come to me for their second or third opinions, because they’ve had surgery for a functional issue with another surgeon who hasn’t taken the aesthetic component into consideration,” Goldstein says. “Yes, they may have their functional issue taken care of, but they don’t want to look at it! They don’t feel sexy or want to engage. So it’s a combination of asking how we fix things so people can shit and have sex, but also to make it pretty and to make it what people want aesthetically.” (Insurance usually covers costs — although not always; Goldstein says ballpark prices range from $8,000 to $25,000 “depending on the extent needed.”)

More and more women are starting to seek out such procedures, too. Colorectal surgeon Zuri Murrell runs a clinic in L.A., and over the last few years, he’s seen the number of cis female patients rise steadily. In fact, he estimates that 50 percent of his patients are now cis women between the ages of 25 and 50.

Specifically, they’re in search of his patented Anal Rejuvenation, which is basically the deluxe, all-inclusive option of the butthole surgery world. “It’s designed to restore the skin surrounding the anus, and to enhance the overall experience,” he tells me, explaining that it’s done “in conjunction with, or after correction of, underlying anal/rectal dysfunction or pathology.” 

In other words, it’s a legit medical procedure rather than a cosmetic trend. 

He argues that women are “paying closer attention to their perineum,” and attributes this new fascination to the rise of treatments like bikini waxing and laser hair removal. Goldstein also specifies that women often come to him for surgical treatment post-pregnancy. “Because the vagina is so close to the ass, they don’t feel sexy any more [after childbirth], or it gets irritated,” he explains.

In terms of going mainstream, ever since Kourtney Kardashian talked butthole bleaching on an episode of Kourtney and Khloe Take Miami, the media has certainly been fascinated with anal beauty treatments. YouTubers film reviews of bleaching creams, tabloid reporters bleach so you don’t have to, and in the gay market, companies market “pink booty” cream through Instagram sponsorship deals with jacked-up, cake-heavy influencers. The official line is that these creams are designed to even out skin tone, but given the colorist connotations of vaginal bleaching, it’s worth being critical of how Eurocentric beauty standards have shaped our notions of the “perfect butthole,” especially when some of these bleaching products can cost $599 a pop.

Color aside, Goldstein says there are some key checkmarks for the perfect butthole. “The most in-demand look is no extra skin folds, and a really tight pucker,” he says. “But you have to be careful about how tight you go, because if you go too tight, you’re not able to have sex.” However, he’s quick to stress that perfection is subjective. “Some people love all that extra skin! They love ‘blooming’; people love to bite it and play with it,” he says. (Per Urban Dictionary, “a ‘blooming asshole’ is when the inner lining of the rectum protrudes from the anus in a flower-like formation.”) Not to mention, Goldstein adds, “What looks good for me doesn’t necessarily mean it looks good for the client, so it’s about taking all of that into account.” 

All of this, of course, may seem trivial, but Dietrich points out that it’s interwoven with much bigger issues like mental health, body image and depression (especially in the gay community). “Because I show off my asshole online, I get so many messages from gay guys who are self-conscious about theirs,” he tells me.  

And so, after hitting 100,000 followers on Twitter, he felt a responsibility to use his platform to share his story. As for specific butthole questions, however, “there isn’t really an answer I can give,” he explains, “because I only know what I experienced, so I just offer my story and advise them to see a proctologist if they have good health insurance.”

Plus, he notes, he’s more the exception than the rule. “There are going to be HD close-ups of my asshole,” he laughs. “So I want it to look its best!”