What is the difference between recto lie repair and vaginal tightening done by a plastic surgeon?

I am planning on having surgery to tighten my vagina. Two years ago I was told I had a small rectocile. Will this interfere with me having the surgery or will the surgery help with this issue any? I was wanting to have the surgery performed by a plastic surgeon opposed to a gynecologist because I figured i would be able to request smaller and tighter results.

Doctor Answers 5

Rectocele should be repaired by a gynecologist

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Thank you for sharing. In your particular issue when there is pelvic floor prolapse such as a rectocele, I would highly encourage you to have the procedure performed by a trained cosmetic gynecologist, who can address both the vaginal tightening and repair the rectocele at the same time.Best of luck!

Plastic Surgeon or (uro)gynecologist for your vaginal remodeling/reconstruction?

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Hello friend from Orange County...
I will not re-invent the wheel that has been so correctly constructed by my colleagues, Drs. Miklos, Pelosi and Aguirre.  I agree with them entirely! For you to achieve both repair of your rectocoele, pelvic floor remodeling, and vaginal tightening, your VERY best bet is a cosmetic gynecologist or urogynecologist who additionally is expert in "vaginoplasty" and "perineoplasty. Whom to see? The docs mentioned above are all solid! Up in Northern CA, I have performed hundreds of vaginal floor reconstructions over the years, > 125 specifically for vaginal tightening. Dr. Red Alinsod in your area (he's in Laguna Beach) is also fine. Both he and I perform many of our surgeries in our offices under local anesthesia... You have many excellent choices, but USUALLY a "plastic surgeon" is trained only to "pretty-up" the opening, not to work deep within the vaginal canal to reconstruct the pelvic floor... (there ARE exceptions...)
** The weblink below is a cute blog referencing vaginal tightening. Check out all the "Genital Plastic/ Cosmetic Surgery blogs; several relate to your situation...
Michael P Goodman, MD
Davis, CA, USA

Rejuvenation vs reconstruction

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Great question!!   This is the on going problem for most women seeking just too tighten their vaginas. I have been performing reconstructive vaginal surgery for 25 years and rejuvenation surgery for 16 years.   Reconstruction and rejuvenation are very similar but it is the art of the surgery which define rejuvenation.  Rejuvenation and reconstruction defined below: So lets first define reconstruction --- this is what urogynecologist, gynecologists and pelvic floor reconstructive surgeons do.  We treat vaginal prolapse.  Vaginal prolapse means a lack of support of the vagina and the vagina supports the bladder, rectum, urethra.  The uterus can also prolapse as the ligaments which supportive uterus often break and results in uterine prolapse Define rejuvenation - it means to make new again.   Well actually reconstruction means - to make new again too.  The difference in reconstruction is the surgeon is just putting it anatomically back to where it belongs.  Sort of like making a suit with all the basics.  Where as a rejuvenation specialist is not as worried about putting it back to where it belongs but instead they focus on making things tighter for intercourse.  They are often done through the exact same size incision at the same spot of the vagina. So a reconstructive surgeon can make you a suit which has two sleeves, a pocket in the front, a neck hole/yoke and shoulders and a it comes just below the buttocks. This is great for women who have advanced prolapse and doesn't care about tightening.   A rejuvenation specialist can give you a tube top which is tight around the torso but you don't have any armholes/sleeves or a pocket.  This is great for someone who has mild prolapse and just wants to be tighter during sex.  If you have advanced prolapse or prolapse which is moderate or severe and are sexually active you want to ATTEMPT to have it all.  You want a tailored made suit which has the sleeves, pockets and looks good and feels good when you go out.   If your uterus is falling down or you have had a hysterectomy  and the vaginal apex or vault is falling down, you really need to have this area suspended first and then the surgeon can advance to the tightening aspect at the same surgery.  The surgeons with the most experience in reconstruction are urogynecologists.  The problem with most urogynecologists is they do NOT believe in vaginal tightening as they have yet to learn how to think outside of the box. Most urogynecologist have 2-3-4 years of extra training.  A good urogynecologist can treat uterine prolapse and cysotcele with laparoscopy and should have performed 100s if not 1000's of procedures. To get the right surgeon to tighten the vaigna is not based upon a plastic surgeons skill but instead a surgeon who is trained in both reconstruction ( usually a gyn, urogynecologist) and rejuvenation (which was developed here in the USA by a gynecologist)        You need to find a surgeon with experience, expertise and a proven track record of results.   Go to their website looks before and after pictures read their reviews.  Understand their complication rate especially for the reconstructive aspect as this is the most invasive of procedures. DOES YOUR SURGEON SPECIALIZE IN BOTH??>==   The average plastic surgeon does NOT tighten the vagina this is not their specialty nor do they understand vaginal anatomy.   A gynecologist unless they were specifically trained in rejuvenation do not tighten vaginas either.   Choose a surgeon who has trained in BOTH and who has the reputation, experience, expertise and results you are hoping to achieve.   Do not choose a surgeon based on location or board certification as neither guarantees expertise in vaginal rejuvenation.  Best of luck in your endeavors!
John R  Miklos MD
Urogynecology & Cosmetic Vaginal Surgery
Atlanta ~ Beverly Hills ~ Dubai

You are totally confused about vaginal tightening, rectocele repair, plastic surgeons and gynecologists

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Here is your real answer on realself: if you have a loose vagina and also have a rectocele (a small hernia of the posterior vaginal wall), you need both fixed at the same time if you desire a tighter vagina. If you skip the rectocele repair, your vaginal tightening surgery (aka vaginoplasty) will fail quickly. Your confusion is probably this: if you ask most gynecologists to fix your rectocele repair, they will fix it without tightening your vagina simply because vaginal tightening is not required to fix a rectocele. Plastic surgeons are not trained in rectocele repairs and very few perform vaginoplasty because there is a very real risk of rectal injury with this procedure if the surgeon is not experienced in operating in this area. If you want a maximum achievable surgical vaginal tightening,  you need someone experienced in pelvic floor reconstruction (rectocele repair, enterocele repair, vault suspension, apical repairs, etc) AND vaginoplasty. That surgeon is usually a gynecologist or urogynecologist with specific experience and training in vaginoplasty.

Wow, sorry you and many other women are so confused!

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Thanks for your great question! First of all, I agree full heartedly with the responses from Dr. Miklos and Dr. Pelosi so I'll try not to repeat their major points. Sounds like your rectocele was correctly diagnosed by your gynecologist, but when it came time to counseling you may not have been advised properly. I've heard from hundreds of patients that their gynecologists tell them that their prolapse, rectocele in your case: "isn't that bad"..."you should wait till it's much worse"..."you should wait till you're older", etc.  And then, if patients ask their gynecologist if they can be tightened at the time of their repair they're told: "no, I don't do that"..."No, it will cause pain", etc.  Now, if they complain of their gaping vagina or large labia they're often told: "Don't worry about it...you're normal", or worse they're made to feel vain and/or crazy!  SO, no wonder women will then seek help from a plastic surgeon...mistakenly thinking that they will give them the results they're looking for.  Plastic surgeons are not trained to repair vaginal prolapse, in your case your rectocele. Having them do this is would be an injustice to you, your vagina and your sexual future since your risk of a rectal injury is much greater and they will primarily make the skin at the entrance look tighter, but your vagina won't be or feel any tighter. When the skin is jut approximated and the internal structures within the vagina aren't corrected your chances of pain with penetration is increased.  You should look for a reconstructive and cosmetic vaginal surgeon. This can only be a gynecologist or urogynecologist, not a plastic surgeon. Do your research, look for those with the experience, training, and reputation in providing excellent results. Look at their website, read their reviews/testimonials, and look at their photo gallery. Below is a link with more advice in choosing the best surgeon for you.  Best of luck!!

Oscar A. Aguirre, MD
Denver Urogynecologist
5.0 out of 5 stars 38 reviews

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