Vaginal replacement surgeries often require donor materials such as skin grafts, myocutaneous flaps, or bowel, each with significant disadvantages. We describe our technique using autologous buccal mucosa grafting for partial or complete neovagina creation.Our indications for buccal mucosa vaginoplasty have included primary repair of congenital defects such as vaginal agenesis (Mayer-Rokitansky syndrome), cloacal abnormalities, and intersex disorders as well as secondary repair of postsurgical vaginal defects like vaginal stenosis after vaginoplasty or pelvic extenteration. This video demonstrates our surgical technique in a Mayer-Rokitansky syndrome patient.A transverse incision is made over the mucosal prominence at the level of the expected location of the hymen. Blunt dissection and electrocautery are used to dissect between the urethra and anorectum to depth 8 cm and width 3 fingerbreadths. Bilateral buccal mucosa is harvested, prepared on the bench and sewn end to end. The graft mid-portion is secured with interrupted 4-0 chromic to the apex of the previously dissected vaginal vault. The meshed graft is then stretched and tacked into position with interrupted 4-0 chromic sutures to achieve 360 degree coverage of the entire neovaginal area. A spongy vaginal mold is left in-situ for 5-7 days.Buccal mucosa generates a moist, hairless, nonkeratinized neovaginal mucosa with excellent color and texture matching the genital/vaginal skin. It leaves no visible surgical scars, avoids abdominal bowel surgery and has no excess mucous production. It is an ideal replacement material for primary or secondary vaginoplasty with excellent early results.