Cleft-Lift FAQ

It is a procedure for pilonidal disease that removes all of the existing cysts, sinus tracts and open wounds, and flattens the gluteal cleft. By flattening the cleft, recurrence is minimized.

Compared to the standard wide excision, it is a much easier recovery. There is no wound packing and repeated office visits for wound care is not necessary. Most patients are fully healed and back to normal activity in six weeks.

When there are multiple operations for the same disease, that usually means that the best operation has not been well defined. Although the cleft-lift (and similar operations, like the Karydakis procedure) are the best, not all surgeons have been trained in the technique. Hopefully, as time goes by all surgeons will be performing this operation.

These procedures have a higher failure rate, but do not change the appearance of the cleft, and have smaller scars. Cosmetically they may be superior, and they are worth a try – as long as you understand they do not necessarily prevent pilonidal disease from coming back in the future.

The cleft lift is a modification of the Karydakis procedure. Dr Bascom described this modification in 1987, so this has been around for well over 30 years.

No, I do not agree. However, for some surgeons who are not properly trained in this operation, it may have a low success rate in their hands and they reserve it for the more difficult situations. In our clinic, the success rate is between 95-99% depending on the starting situation. So, we recommend it for any type of pilonidal problem.

When we perform a cleft-lift, there are certain subjective changes that we want to make to the anatomy. Because of our extensive experience with the procedure, we can tell when we have achieved a good result. If you are interested in the technical differences between successful and unsuccessful cleft-lift procedures, follow this link.

Most likely, yes. We have successfully performed the cleft-lift on patients who had previously had failed rhomboid flaps, Limberg Flaps, Karydakis Procedures, cleft-lifts, Z-Plastys, V-Y Plastys, and gluteal flaps. Actually, in those cases the cleft-lift may be the only viable solution.

No! As surgeons we do not like failure, and if when a surgeon sees a pilonidal patient, they anticipate failure – it is not going to be the kind of case they want to deal with. Because of the high success rate in our clinic, we are thrilled to see new patients, because we anticipate success, not failure.

No, this is not considered a cosmetic procedure, and is usually covered by insurance. It should not be confused with a “butt lift”, which is indeed cosmetic. We will work with your insurance company to get approval for surgery.

Yes. This link will take you to a page of post op examples. The cleft-lift does change the appearance of the buttocks, and does leave a scar that is several inches long. If you can’t accept this change, then you may want to look into the minimally invasive category of procedures – as long as you understand that the success rate is significantly less than with the cleft-lift operation

We take care of patients who live a long distance from Eau Claire, Wisconsin every week. We ask you to tell us the history behind your pilonidal problem, and send us photos as described on this web page. Once we have that information, we can let you know if a cleft-lift is a good option for you, and we can set up a time for you to travel here for surgery. Typically, we see you in the morning, and then perform surgery a few hours later. How long you need to stay in Eau Claire post op depends on many factors, but is usually between 3 and 7 days.

Pilonidal disease is notoriously difficult to treat, and many general and colo-rectal surgeons are performing outdated procedures, like wide excision. The problem with wide excision is that it has a long, difficult recovery; and the highest recurrence and failure rate. So, it is important to interrogate your surgeon more than usual regarding exactly what he/she plans to do, what their success rates have been, and why they are selecting their specific procedure. If they say that they only perform wide excision (cystectomy) with or without closure – I suggest you look elsewhere.

This is not a term with specific qualifications, but rather a description of someone who is well versed in the various operations for pilonidal disease, and has a large experience (and interest) in treating this problem. In this day and age, it usually means that they are skilled in flap procedures, specifically the cleft-lift. The Karydakis procedure is similar, and also gets very good results.

There are a handful of pilonidal surgeons who have taken an interest in this disease process, and usually an internet search will help you find them. Unfortunately, just because a surgeon indicates that he/she performs the cleft-lift procedure, does not necessarily mean that they are very experienced or competent in its execution. If done improperly, it can lead to many months of discouraging and expensive wound care.

Absolutely, yes. If a patient has had one or more failed operations, the more imperative it is that they find a specialist skilled in re-operative surgery for pilonidal disease. Every time an operation fails, it makes subsequent operations more difficult.

My recommendation is to become resigned to the fact that you are going to need to travel to get the care you need and deserve. Eighty percent of the patients we see in our clinic are from a good distance away – so we have a routine for dealing with long-distance patients. This includes pre-operative collection of all information, surgery and consultation on the same day, and digital post-op visits. How long patients need to stay here after surgery depends on the severity of the situation, and how far they have to travel, but it varies between 3-7 days.

In most situations, you can expect to get good advice and competent surgery from a board certified general or colo-rectal surgeon. Unfortunately, pilonidal disease is not one of those situations, and you should carefully investigate your surgeon. Firstly, you should question him/her about their training, experience and success rates with the procedure they propose. You should also seek recommendations from patients, and there are several good places on the internet to do this. In particular, the website pilonidal.org and the Facebook group Pilonidal Cyst Support Group. Many of the patients or family members on this site are happy to have private discussions regarding their care.