The Cosmetic Aspects of the Cleft Lift for Pilonidal Disease

What does the contour of the gluteal area look like after a cleft lift?

When I am performing a cleft lift we are dealing with patients of various body shape, amount of body hair, and location of their pilonidal cysts, sinuses and wounds- so the final appearance is different from person to person, and the subjective opinion regarding the change is quite personal.  My feeling is that although we are making a significant change in the contour, we are turning it into a shape that is very natural.

Here are some examples:

These are photos of post op cleft lift patients with the actual scar Photoshop out so it doesn't distract from the evaluation of the contour.

What do our patients think about the appearance of their cleft lift?

I recently published an article regarding patient satisfaction with the cleft lift procedure performed at our clinic. One of the questions asked how the patient felt about the appearance of the buttocks and scar (see graph below). Of 490 respondents, 98.8% felt it was acceptable. Only six were “very unhappy with the appearance” (1.22%). (Keep in mind that some of these patients had endured multiple previous operations, and started out with severe scarring and distortion even before they had their cleft lift.)


When surgeons first learn to perform the cleft lift procedure for removal of pilonidal cysts, sinuses, and wounds, their main goal is to remove the pilonidal disease and prevent recurrence. However, as we learn the procedure the goals expand to making the procedure less painful, make recovery smoother, and make the cosmetic appearance more natural.

If you have your surgery done by someone who performs these frequently, you may end up with a better cosmetic result.

In general, I feel that the cleft lift operation is the best procedure to cure pilonidal disease. But, it is not for everybody, and I understand if the cosmetic change is not something that a patient can accept.

If you feel that you can not tolerate the change in shape of the cleft or the presence of  the scar – then the cleft lift is not the best option for you as your first operation for pilonidal disease. If other operations fail, it can always be considered as a secondary procedure.

Patient Satisfaction with the Cleft Lift Procedure


As surgeons, when we do operations we have certain parameters that we look at to determine success of a procedure. But, patients can view things very differently, and what we consider a success, may not be what is working for our patients.

Here is an article I just published in a peer-reviewed, online, medical journal regarding the opinions of 500 patients regarding their cleft lift procedure.

Overall, 494 (98.8%) were “extremely satisfied” or “satisfied” with their procedure, and 496 (93.8%) feel that this is a reasonable first choice for a patient with pilonidal disease.

You can read all the  details here.


Letter from a grateful family


With permission, I thought I’d share a recent correspondence from a patient’s father, who is a physician who has retired from surgery and now works in a wound care clinic. He has been trying to get his daughter’s pilonidal wound to heal after three failed operations. He found that in spite of diligent wound care for over a year, that the wound kept partially healing, and then re-opening. Eventually, he brought her to see me for a cleft-lift. The communication below occurred four months after the cleft-lift procedure.

… Her surgical wound is completely healed and is beautiful. You did a masterful job of fitting those flaps together and the elevation of the edges near the anus healed and have flattened with anatomic contour. There have been none of the little pepper sized defects along the incision which for the last 2 years led to more openings, more disappointments and more misery.

She is reconnecting with activities she had been restricted from for 2 years. She is getting back many of the intangibles in her life which were taken from her by this unfortunate disease. She is losing weight and getting to be herself again and for that, I am eternally grateful to you. You did something for us that I nor the sum of my practice experience and contacts could have done. You educated me through your website about this affliction and gave us great hope. You were straightforward and encouraging in your contacts with us showing unsurpassed professionalism. I hope you and all of those important to you are doing well in these quite difficult times. Please accept our sincere gratitude, best regards and congratulations on such a fine outcome.

If I can in anyway help get the same educational message out about pilonidal disease, sign me up. What we never realized and I was never taught in Med school or in practice is that “pilonidal cyst” is a complete misnomer for this affliction. It really is a “disease” because it affects so much more than just that eccentric edge of the heightened gluteal cleft – especially when it just won’t go away!!! Please keep up your work. You have been blessed with a remarkable talent to really make a difference in patients and families lives particularly when most physicians don’t really understand pilonidal disease nor want to attend to those in need. I tell everyone who knows what we went through, the outcome we are now at, thanks to you!!

I read your paper with great interest and congratulate you on the content, presentation of honest data and the conclusions you draw. This is a paper that should be referenced in every general surgery text book because as you point out, the cleft lift procedure was not and is not taught in medical schools or in residencies – to include plastic surgery – as a more definitive solution to pilonidal disease based upon an anatomic etiology. Obviously, not every surgeon will have or develop the skills for this procedure that a master such as yourself has, but the anatomic knowledge of what causes the problem needs to be taught and the specialized, experienced approach that specialists such as you provide needs to be more widely recognized.

I think that this doctor is very articulate in expressing the relief that many patients and family feel after a cleft-lift successfully heals, often after many failed attempts with surgery and wound care. He is also pointing out the significant gaps in medical education about this difficult disease.

Even having your own surgeon and wound care expert in the house won’t make some wounds heal if the shape of the cleft is causing problems. Sometimes only a cleft-lift will help.

This is why I have limited my practice to pilonidal repair and cleft lift. It is results like these that make being a surgeon worthwhile.