Perineoplasty: how I restore the aesthetics and function of the perineum

Multidisciplinary partnership: aesthetics and function

One of the characteristics that distinguishes my approach to perineoplasty in Londrina is the partnership with Dr. Fabio Minotti, an experienced coloproctologist. This multidisciplinary collaboration is essential to provide a truly complete result.

My role: the external aesthetic reconstruction

As a plastic surgeon, my responsibility in perineoplasty involves:

• Removal of excess skin and scar tissue;
• Reconstruction of the perineal contour with a natural appearance;
• Correction of asymmetries and irregularities in the region;
• Aesthetic treatment of the posterior fourchette — the point where the labia meet at the bottom;
• Harmonization with other intimate surgeries when associated.

The role of Dr. Fabio Minotti: the internal functional reconstruction

Dr. Fabio Minotti is responsible for the functional part of perineoplasty, which includes:

• Reconstruction of the pelvic floor musculature — especially the levator ani and transverse perineal muscles;
• Reapproximating the muscle bundles that separated during childbirth;
• Correction of rectocele — herniation of the rectal wall towards the vagina;
• Reinforcement of the functional integrity of the perineum to support the pelvic organs.

By working together in the same surgical time, we ensure that both the appearance and functionality of the perineum are restored in an integrated manner. This team approach is a differentiator in our practice in Londrina and provides superior results compared to surgery performed by only one specialist.

The Perineoplasty Surgery

Perineoplasty is performed in a surgical center, with the patient in a gynecological position. The procedure involves two main stages, carried out together by myself and Dr. Fabio Minotti.

Functional Stage — Dr. Fabio Minotti

Dr. Minotti begins with the reconstruction of the deep musculature. The muscle bundles of the pelvic floor that have been separated or weakened — whether due to childbirth, episiotomy, or aging — are identified, dissected, and reapproximated with strong sutures. This restores the support of the pelvic organs and narrows the vaginal canal in its lower portion. When there is a rectocele, the posterior vaginal wall is reinforced.

Aesthetic Stage — Dr. Walter Zamarian Jr.

Next, I perform the external aesthetic reconstruction. I remove excess skin and scar tissue from the perineal area, shape the contour for a harmonious and natural appearance, and perform delicate sutures that are positioned in the natural folds of the area. When necessary, I also correct the vaginal introitus and address asymmetries of the surrounding tissues.

Duration

Perineoplasty lasts, on average, one to two hours, depending on the extent of the repair needed and associated surgeries. When combined with labiaplasty, labia majora reduction, or other intimate surgeries, the total surgical time may be slightly longer.

Techniques Used

The surgical approach is individualized. Depending on the degree of perineal compromise, I may use:

• Simple Perineoplasty: removal of excess skin and scar tissue with basic muscle reapproximation, indicated for mild cases;
• Perineoplasty with Deep Muscle Reconstruction: extensive repair of the pelvic floor musculature, indicated for more advanced degree lacerations;
• Perineoplasty with Rectocele Correction: when there is prolapse of the posterior vaginal wall, Dr. Minotti reinforces this wall in conjunction with the perineal repair.

Causes of Perineal Injury

To understand the importance of perineoplasty, it is essential to know the most common causes of injury to the perineum:

Vaginal Birth

Vaginal birth is the main cause of perineal injury. During the passage of the baby, the tissues of the perineum stretch to the maximum and may suffer lacerations of varying degrees. Perineal lacerations are classified into four degrees:

• Grade 1: superficial laceration, involving only the skin and mucosa;
• Grade 2: involving skin, mucosa, and superficial perineal musculature;
• Grade 3: extending to the anal sphincter;
• Grade 4: compromising the anal sphincter and rectal mucosa.

Episiotomy

Episiotomy is the intentional cut made in the perineum by the obstetrician during childbirth to facilitate the passage of the baby. Although it is done with the intention of preventing uncontrolled lacerations, often the healing is not satisfactory — especially when the suture is not performed in layers or when there is post-partum infection. Episiotomy scars can cause chronic pain, discomfort during sexual relations, and significant aesthetic alteration.

Aging and Laxity

As the years go by, even without a history of vaginal birth, the perineal tissues may lose firmness due to the effects of gravity, hormonal changes from menopause, and natural reduction of collagen. This progressive laxity can affect both the aesthetics and function of the area.

Perineoplasty and Other Intimate Surgeries

Perineoplasty is rarely an isolated surgery. In most cases, I combine perineal repair with other intimate surgeries to provide a harmonious and complete result. I specialize in various modalities of female intimate surgery and have the necessary experience to treat the entire genital area.

Labiaplasty

Labia minora reduction is one of the most frequent associations with perineoplasty. Many patients who have had vaginal births present both perineal laxity and excess labia minora. I perform labiaplasty using wedge or trimming techniques, depending on individual indications.

Vaginoplasty

Vaginoplasty aims to narrow the vaginal canal throughout its length, while perineoplasty focuses on the lower portion — the perineum itself. When combined, the result is a complete reconstruction of the vaginal and perineal areas.

Labia Majora Reduction

The laxity of the labia majora often accompanies perineal laxity, especially in patients who have had multiple births. The reduction of labia majora can be performed in the same surgical time as perineoplasty.

Labia Majora Fat Grafting

In cases where the labia majora have lost volume — due to aging or weight loss — autologous fat grafting can restore fullness to this area, complementing the result of perineoplasty.

Pubic Liposuction

Excess fat in the mons pubis can be treated with liposuction during the same surgical time, providing an overall improvement in intimate aesthetics.

Mons Pubis Lift

For patients with significant laxity of the mons pubis — common after significant weight loss — lifting of this area can be associated with perineoplasty for a complete result.

Perineoplasty and quality of life

The impact of perineoplasty on the quality of life of patients is significant. Many women live for years with discomfort, dissatisfaction, and even shame caused by perineal injuries, unaware that treatment exists. Here are the main benefits reported by my patients:

Improvement in sexual life

The restoration of perineal anatomy and the tightening of the vaginal opening improve sensation during sexual intercourse, both for the woman and her partner. Patients who suffered from pain during intercourse due to episiotomy scars also report significant relief after surgery.

Improvement in self-esteem

Like other intimate surgeries, perineoplasty has a profound impact on a woman's self-confidence. Many patients report feeling comfortable with their own bodies again, resuming activities they avoided — such as wearing bikinis or tight clothing — and experiencing an overall improvement in emotional well-being.

Functional improvement

The strengthening of the pelvic floor muscles performed by Dr. Fabio Minotti improves the support of the pelvic organs, contributes to the prevention of prolapses, and can assist in cases of mild urinary incontinence associated with perineal looseness.

Frequently asked questions about perineoplasty

Is perineoplasty painful?

The surgery is performed under total intravenous general anesthesia or spinal anesthesia, so the patient feels nothing during the procedure. In the postoperative period, discomfort is moderate and well controlled with painkillers. Most of my patients report less pain than expected, comparing it to discomfort similar to postpartum, but lighter.

What is the difference between perineoplasty and vaginoplasty?

Perineoplasty focuses on repairing the perineum — the area between the vagina and the anus — while vaginoplasty aims to tighten the vaginal canal throughout its length. They are complementary surgeries and are often performed together. In my practice, I evaluate each case to determine if the patient needs one or both.

Why do two surgeons perform perineoplasty?

In my practice in Londrina, I work in partnership with Dr. Fabio Minotti because I believe that the best result comes from the combination of specialties. I, as a plastic surgeon, take care of the external aesthetic reconstruction — skin, contour, and appearance. Dr. Minotti, as a coloproctologist, takes care of the internal functional reconstruction — musculature and pelvic support. This division ensures excellence at each stage.

How long does the surgery last?

Perineoplasty lasts on average one to two hours. When combined with other intimate surgeries — such as labiaplasty or labia majora reduction — the total time may be longer, but everything is performed in the same surgical time so that the patient has a single recovery.

When can I return to work after perineoplasty?

For sedentary jobs, return is usually possible in 7 to 10 days, with the guidance not to sit for long periods in the first few days. For activities that require physical effort, I recommend waiting 4 to 6 weeks. Each case is monitored individually during follow-up consultations.

Does perineoplasty leave a visible scar?

Scars are located in the perineal area, a naturally hidden area. I position the incisions in the natural folds of the region, so that after complete healing — between six months and a year — the marks become practically imperceptible.

Do the stitches need to be removed?

No. I exclusively use absorbable sutures, which dissolve naturally in the weeks following surgery. This eliminates the need for a return visit to remove stitches and ensures more comfort.

Can I have a normal delivery after a perineoplasty?

Although it is technically possible, vaginal delivery after perineoplasty may compromise the surgical result, as the repaired tissues would be distended again. For this reason, I recommend that perineoplasty be performed preferably when the patient does not plan to have vaginal deliveries anymore. If pregnancy occurs after surgery, cesarean delivery is the most indicated route to preserve the result.

Is it possible to combine perineoplasty with other intimate surgeries?

Yes, and this is very common. In my practice, I combine perineoplasty with labiaplasty, labia majora reduction, pubic liposuction, and other surgeries as needed. The advantage of performing everything in the same surgical time is a single anesthesia, a single recovery, and a harmonious result of the whole.

Does perineoplasty resolve urinary incontinence?

Perineoplasty itself is not the surgery indicated for urinary incontinence. However, the strengthening of the pelvic floor musculature performed by Dr. Fabio Minotti can contribute to the improvement of mild urinary incontinence associated with perineal looseness. More severe cases of incontinence should be evaluated by a urogynecologist.

What is the ideal age for perineoplasty?

There is no ideal age. Perineoplasty is indicated when there is a functional or aesthetic complaint, regardless of age. I receive patients from 25 to 65 years old. The most important factor is not age, but the conclusion of reproductive planning — ideally, the patient should not plan for any more vaginal births after surgery.

What is the first consultation for perineoplasty like?

In the first consultation, I discuss in detail your complaints and expectations. I perform a complete physical examination of the intimate area, evaluating the perineum, pelvic floor muscles, vaginal opening, and all adjacent structures. I explain the procedure, the partnership with Dr. Fabio Minotti, postoperative care, and answer all your questions. The consultation lasts on average 30 to 40 minutes and is conducted with total respect and discretion.