Tales From the Tail — New Innovations in Aesthetic Treatments for Your Booty

Dr. Evan Goldstein
6 min readOct 6, 2021

Client’s Tale.

Who the fuck wants to fuck a scarred asshole? Some may find it hot, others may not even notice (“a hole is a hole”), and others, like myself, may be turned off by one.

Let’s start from the top — the top of my bottom. I had prolapsing hemorrhoids a few years back, primarily on the right side of my hole. It would pop in and out and sometimes I would actually have to manually reduce it. It wasn’t pretty and also not truly functional, especially for all the sex that I wanted to have. It would become swollen, even just from douching, and then the friction of sex would make it more engorged, causing it to protrude and bleed. A fucking bloody mess would ensue and no one wants that during a first-time hook-up.

Finally, I had had enough and went to my local proctologist. I had it surgically removed and that part actually went off without a hitch. The first few days of my recovery sucked, but on the hole, I was quick to bounce back. However, unfortunately, I had significant scarring from the incision. This didn’t come as a total surprise since I was told this is common, but what I didn’t expect was that it would go all the way out into the beginnings of my butt cheeks. The scar was quite thick and pink in color. I used some over-the-counter scar treatments and definitely saw some improvement, but I was still quite self-conscious of the way it looked.

Fast forward, I moved to NYC and found Bespoke Surgical. My exam with Dr. Goldstein was thorough — he wanted to make sure there were no other issues going on. During my appointment, we spoke of the scar and what could be done to aid its improvement. One suggestion was bleaching and/or microneedling or a combination of both. The last resort would be a surgical scar revision.

What I especially loved about his practice is that everything is now in-house — from clinical to surgical to aesthetics (they even have a pelvic floor therapist). After Dr. Goldstein, I saw Chris Bustamante, their Aesthetic NP, for a free consultation. This led to our sessions of microneedling which — fuck — has made such a huge difference in my hypertrophic scarring. Yes, there’s mild pain, but it’s similar to when I got my tattoos (in other words — it’s tolerable).

It was well worth it because I am finally back on the scene and super happy. It was a totally different experience going to a one-stop shop that just gets it. No judgement — just a safe space where I felt completely comfortable sharing my concerns and desires. It completely took the tension out of the situation. And thank god for these services. Feeling whole again takes on a hole new meaning for me.

My Discussion.

Anal injuries and surgical treatments can both cause local scarring. The key to creating a clean surgical scar line is knowing where to make the incisions and how to strategically close them (or leave them open, depending on the location). Due to the amazing healing capacity and the normal skin lines in the region, when performed correctly, most people do not even know they had any surgery in the area. That’s because this part of the body is similar to the face — there are so many blood vessels that allow healing to happen quite nicely. It makes my life that much easier.

We also use Botox to aid the pressures and can place it right into the scar lines to improve the aesthetics, as well as Vitamin E oils and/or Strataderm Scar Therapy Gel to help prevent scar development. Silicones have been a game changer for dealing with preventing and reducing scarring. It’s important to find one that provides the support without over-moisturizing the area (read: swamp ass).

During post-surgery consultations, we will conduct a full evaluation to make sure everything is healing well. It’s important to note that no matter what, some people will end up with hypertrophic scarring and/or some scarring with a pinkish hue. That’s where our Aesthetic Nurse Practitioner, Chris, and his wonderful world of aesthetics come in.

My goal was always to build a practice that would cover your ass from inside, out. With this approach, we can micromanage the healing and augment where we need to. Anal bleaching and microneedling are game changers for the anal community. What are they, you may ask? Let’s get into some FAQ’s:

What is microneedling and how can it make you more confident about your hole?

Microneedling utilizes a medical-grade tip containing dozens of needles that are glided along the skin at a precise depth to create controlled micro-injuries that both promote collagen induction and help to remodel existing collagen. Traditionally, in aesthetic medicine, microneedling is used to soften fine lines and scars, and can help with pigmentation issues to create a luminous glow. But here at Bespoke Surgical, our patients often receive microneedling after healing from surgical procedures to treat their scar lines. While most of the scarring is minimal and heals quite well a few months after surgery, we do have many patients that want things to look more perfected. This is where microneedling comes into play. We can microneedle their holes to smooth out the texture of the surgical scar to both soften and flatten it. In combination with anal bleaching, we’re able to color correct the area to create an even, flat, and flush hole that is bedroom ready.

What’s the process like for microneedling your hole?

For those familiar with the sensation of getting a tattoo, microneedling can feel quite similar, but not as intense. The treatment always begins with Lidocaine, a topical numbing cream. We numb the area for at least 15 minutes and then proceed to thoroughly disinfect and prep the area for the microneedling procedure. We only use medical-grade disposable tips and attach them to a professional device that allows the tips to make clean, vertical micro-injuries. Other forms of microneedling, such as rollers, put the patient at risk for scarring, infection, and post-inflammatory hyperpigmentation and are not recommended. We use a hyaluronic acid serum to allow the medical-grade tip to flow along the skin without tugging, which helps to to avoid excessive abrasion. Multiple sessions are required, but patients can expect to see improvement with each treatment.

What should I expect after the treatment?

Patients should expect mild bleeding, as the multi-needle tip is repeatedly glided along and stamped into the skin to create precise, clean micro-injuries. Over the following week, patients may experience peeling at the treated site. This is a normal aspect of the healing process. Over the following weeks, post-treatment patients will notice an improvement in the appearance of scar texture, pigment, and overall appearance. It will likely take multiple sessions, spaced four to six weeks apart, for optimal results.

At Bespoke Surgical, do you only microneedle the hole?

No, we go beyond surgical scar treatment with our microneedling service. Microneedling is a great treatment for virtually anywhere on the body. We often use it on the butt cheeks, in combination with medical grade chemical peels, to improve texture, discoloration, and scarring. We’ve realized that people are looking beyond the skin on the face when it comes to having an even complexion. We will work with you to build a customized plan that can deliver results and boost your confidence.

How much does microneedling cost and can insurance be used to cover the cost for scar revision?

Microneedling starts at $250 per session, but your exact quote will be determined at your free consultation. We take into account the amount of time that needs to be allotted for your treatment sessions. Unfortunately, insurance does not cover the costs for aesthetic procedures.

If you’re interested in booking a consultation or have any questions, please visit our website for more information.

Don’t forget to stay in touch on Instagram: me and Bespoke Surgical.