Anal Botox

Treat anal fissures and other conditions with anal botox at Bespoke Surgical

What is anal botox?

Botox, also called botulism toxin, serves our community in many ways. Most people assume botox can only be applied to the face (for wrinkles) or underarms (to curb sweating), but there are also successful applications and treatments for the anus.

Anal botox allows relaxation of the muscle in the region and overlying skin it’s applied to in order to accomplish the relaxation that is necessary to achieve a desired goal. One may or may not need several anal botox sessions to achieve complete success. Once the relaxation is achieved, with constant engagement and/or anal dilation, the control is usually there to stay, allowing for continued success.

Anal botox can also be used for purely cosmetic reasons, where it can assist with anal skin de-wrinkling, depending on one’s aesthetic desires.

What conditions is anal botox used to treat?

Anal fissure Botox is a game changer for treatment of anal fissures, which are small cuts or tears in the lining of the anus, specifically as it relates to the bottoming community, and is used quite regularly.

  • Dosage – The appropriate dosage utilized is 100 units. We inject 20 units into each quadrant of the internal sphincter, rendering it temporarily paralyzed for 3-5 months, for a total of 80 units, and then the residual 20 units directly into the fissure lines. This can be titrated to the desired effect, depending on the elasticity needed for full healing.
  • Acute Anal Fissure – If done when one initially develops the tear (all the while properly using creams and suppositories), it can assist in complete healing.
  • Chronic Anal Fissure – Most clients, unfortunately, have chronic scar tissue in the region that continuously tears during both defecation and anal intercourse.
  • Symptoms – People get pain and bleeding on and off with bouts of improvement, yet when stressing the region, recurrence occurs. With this scenario, not only do we use Botox to assist healing, but also we need to remove the chronic scar tissue (a fissurectomy) to create a healthy environment for all to heal.
  • Phantom Fissures – Many people do not specifically have fissures on initial examination, but rather develop them post-intercourse. We term these “phantom fissures”. One may go to a physician, who is not versed in appropriate bottoming management, and be given the usual medical creams that may only temporarily treat the issue. Once you begin engagement, it occurs again. This needs to be dealt with in the operating room, dilating the anal canal and creating these fissures, which then allows local treatment and the anal Botox. Healing occurs and then one can achieve their desired outcomes. Botox can also treat anal spasms (proctalgia fugax), which can be acute and quite painful.
  • Desires – Lastly, we use anal fissure Botox a lot in people who just can’t accommodate their desired girth. When attempting to achieve full acceptance, tearing occurs in both the skin and muscle lines. Using Botox in these regions allows for the relaxation that is needed to accomplish the tasks required.


Being part of the community at Bespoke Surgical, we are able to provide the most effective and efficient surgical care to keep form, function, and aesthetics as our top priority, and anal fissure Botox injections are an enormous part of our success.

Anal botox at Bespoke Surgical

In our practice, anal botox is used both preventatively or as treatment to assist in all that Bespoke Surgical is passionate about: better, safer, and enhanced bottoming. Contact us today to learn more.

Ready to become a client?

Schedule An Appointment
Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein is the founder and President of Bespoke Surgical, a surgical practice for modern males based in New York and Los Angeles. He received his medical doctorate from the University of Medicine and Dentistry School of Osteopathic Medicine in 2002. Receiving the highest osteopathic education was pivotal in shaping his holistic whole-life approach towards his practice of private surgical care.

Learn More about DR. EVAN GOLDSTEIN, D.O.