There’s a buttload of money in anal rejuvenation.

Just ask Dr. Evan Goldstein, a Manhattan surgeon who has pioneered the practice of making buttholes beautiful and more sexually compatible through Botox, tightening and loosening procedures.

“It’s kind of crazy. I did not think I would be playing with ass all day, that is for sure,” Dr. Goldstein told Moneyish. As a gay man, Goldstein, who began his medical career as a cardiothoracic surgeon, wondered how he could help his community. He noticed that most doctors performing anal surgery were treating hemorrhoids or cancer but “were not looking at the anus as cosmetic or sexually functional,” he said.

So he opened his Bespoke Surgical practice on East 12th Street in 2010, where he offers medical services to treat hemorrhoids, skin tags and fissures, as well as cosmetic procedures like Botox, dilating and tightening services, that run from $5,000 to $25,000 depending on the severity of the case.

“Sometimes people come with really bad booties,” said Dr. Goldstein.

And he’s not the only surgeon specializing in these niche procedures: Dr. Norman M. Rowe, who practices in New York and New Jersey, uses noninvasive radiofrequency energy to heat and tighten anal tissues, and Los Angeles-based Dr. Zuri A. Murrell offers anal rejuvenation and bleaching services and treats hemorrhoids, skin tags and polyps. Many of these cosmetic issues stem from something medical, which means that patients may find insurance covers their procedures.

That was the case for Joseph, 45, who asked to speak to Moneyish under an alias. Joseph got a hemorrhoid he’d suffered for five years treated in February. “It was unquestionably a medical issue. I wasn’t going in and saying, ‘Hey, tighten things up and make them look pretty,’” he said -- but noted, “that was definitely an added benefit. I love it. Everything looks normal again.”

Best of all, the procedure has also rejuvenated his love life. “I had sex with my husband, and it’s like, ‘Wow - I’m 20 years younger!’” he said. “This is not a stretched-out ass. It’s back to how it was when he met me 13 years ago.”

Still, the recovery process is painful. There are “one to two days of really not liking me, especially when it’s time to go to the bathroom,” said Dr. Goldstein, noting his patients take pain medication, numbing lotions and suppositories so they can do their business. You can expect a good two weeks of bathroom discomfort. And forget about sex - bottoming at least - for three months.

The number of men having plastic surgery continues to rise, according to the American Society of Plastic Surgeons, which reported that 1.3 million total cosmetic procedures were performed on men last year, up 3% from the year before. And while they didn’t record anal rejuvenation procedures in particular, profits for Dr. Goldstein’s business have climbed 20% year over year, and he's opened a second clinic in Beverly Hills. And John Treadwell, a patient concierge at the Dupage Dermatology and Laser Center in Illinois, told Moneyish that, in the last 30 days alone, he's already had more than 42 requests for anal rejuvenation using the DiVa laser.

Dr. Evan Goldstein, a pioneer in the anal rejuvenation field working out of NYC and LA. (Bespoke Surgical)

They’re not only treating gay men, although both Goldstein and Treadwell said they make up most of their business. “I get a lot of women now, too, as anal sex has become more accepted,” said Goldstein. A 2015 study found 1 in 3 straight women in the U.S. has tried it, and 13% have done it within the past year.

For Rob, 44, from Brooklyn, who lost his husband to lung cancer two years ago, anal rejuvenation and hemorrhoid removal helped him get back into the dating game.

“Hemorrhoids are embarrassing. They’re not something that you want to spring on somebody. So you either have to explain ahead of time, or freak your partner out in the moment,” he told Moneyish. Rob says he’d recommends the procedure to others too: “It is so worth it, just for the peace of mind, if nothing else,” he said.

Sometimes doctors tidy up the botched work that other physicians leave behind. Tom, a 48-year-old in Manhattan, had serious scarring from another procedure that narrowed the opening to his anus.

“It was horrific, like Freddie Krueger performed it,” he said. “Normal daily activity [using the bathroom] was difficult, and sex was out of the question.”

So he began getting that taken care of in 2012, and has had about $70,000 worth of surgery over five procedures to clear the scar tissue, loosen the opening and make everything down there look good again. He also got Botox injections to release the muscles around his anus so that he can enjoy bottom sex once more.

“It sounds crazy. People laugh, and they ask, ‘Does your butthole look younger now?’” he said. “It probably does! But seriously, I identify with my sexuality very strongly, and I couldn’t receive anal sex for seven years. That was a big issue for me.”

So the butt Botox, years of surgery and $70K tab were worth it when he was finally able to have bottom sex again recently.

“How does it feel? Whoo-hoo! Yes! It was a victory,” he said. “And the guy was like, ‘Wow, you have a beautiful butthole,’ which just made me feel so good. This is all I wanted, from the beginning - for this tiny little thing to look beautiful.”