Female genital cosmetic surgery covers procedures performed to correct or change the genital anatomy without a specific organic condition or disease. The increasing demands in the last decade led to the improvement of methods in cosmetic gynecology. This report aims to raise awareness about a rare hence severe complication of female cosmetic surgery. The case of an abdominal abscess caused by ileal perforation that occurred during abdominal liposuction for aesthetic surgery, and drained from the Douglas pouch to the vagina is presented. Intestinal perforation may rarely occur after abdominal liposuction in patients who have previously had an abdominal operation or have abdominal diastasis, as in our patient. In the advancing field of female genital cosmetic surgery, the application of liposuction for monsplasty or autologous fat grafting to the labia majora can present significant morbidity and mortality complications. Documenting these complications in the literature will disseminate knowledge. Awareness of risk factors and complications in the planning and application of operations can greatly support cosmetic gynecologists in improving patient safety.