Hello there. When you get a fourth degree tear, it means that the tissue has torn all the way through to the rectal mucosa. Later this can cause sagging, fecal incontinence and general discomfort. The kind of surgery you would need to fix the damage depends on your symptoms and the persisting defect. If you are having problems after your fourth degree, the proper surgery to fix this would be to do a sphincter repair and a rebuilding of the perineal body. As far as if it is safe to get a vaginal rejuvenation after having a fourth degree, you must wait at least three months after the injury to make sure the area is healed. The forma V technique for vaginal rejuvenation is a very safe radiofrequency technique that increases muscle tightness, tightens skin, resets the pelvic angle, increases lubrication, bulks the vaginal tissue and increases sexual pleasure.