Purpose: The purpose of this study is to report technical refinements with gluteoplasty, donor site morbidities, and functional outcomes. Background: For patients with severe fecal incontinence, who have failed medical therapy, surgical reconstruction of the anal sphincter, via functional gluteoplasty, may provide symptomatic relief and improve quality of life. However, donor site morbidity may be significant, and long-term results are unknown. Methods: We performed a retrospective analysis of 24 consecutive patients undergoing gluteoplasty for fecal incontinence. During the study period, our operative technique evolved and now includes several useful operative details. Results: From October 1996 to October 2003, 24 patients underwent functional unilateral gluteoplasty for reconstruction of the anal sphincter. Etiology of incontinence was as follows: obstetrical injury, irritable bowel syndrome, previous rectal surgery, Crohn’s disease, impalement, rectocele, and idiopathic. Gluteoplasty was successful in restoring continence in 18 patients(75%), was partially successful in 4 patients(16.7%), and was not successful in 2 patients(8.3%). Donor site morbidity observed in 15 patients(62.5%). Conclusions: Unilateral functional gluteoplasty, for reconstruction of the anal sphincter, was successful or partially successful in restoring fecal continence in the vast majority of carefully selected patients(22/24, 91.7%). Refinements in surgical technique may reduce morbidity while further optimizing outcome.