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    • DECEMBER 14, 2025
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    Dr. Immerman speaks at the 2020 International Pilonidal Society Conference in London

    Dr. Immerman speaks at the 2020 International Pilonidal Society Conference in London

    This year the IPS conference was on December 5th, at St. Marks Hospital in London, England. Both Dr. Immerman and Dr. Daniels attended this meeting. The program consisted of discussions of diagnosis, research, and management of pilonidal disease. Dr. Immerman described his technique for performing the Bascom Cleft Lift Operation. There were several “minimally invasive” techniques described, as well as case presentations and proposed treatments by surgeons who perform different operations. There was even a live video with a patient from the UK who had been suffering with pilonidal disease for eight years in spite of several operations, which put the disease process into perspective. Overall, it was an excellent conference, and I think everyone came away with a greater understanding of the various treatment options.

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    • AUGUST 11, 2025
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    The Results of 1000 Cleft Lift Patient Surveys

    The Results of 1000 Cleft Lift Patient Surveys

    One of the hardest things in clinical research is to actually get opinions from patients regarding their treatment. You might think that this is easy, because everybody has an opinion, and especially right after an operation. But, as the months go by, patients get on with their lives, they move, they even forget all about their pilonidal disease (which is good!). Therefore, there are many reasons why when surveys are sent out they might not elicit a response. This was even harder before the ubiquitous use of email – when this required either clinic visits, postal surveys, or phone calls. Now, we have applications like Survey Monkey that are very helpful in getting surveys into patients mailboxes.

    Since 2009 we have been sending surveys to our patients, and today we have reached the numerically interesting number of 1000 patient responses! This has no significance, other than it is a nice round number, is the largest reported survey experience of cleft lift patients in the world, and possibly its numerological significance.“The numerological significance of the number “1000” points to a time of significant accomplishments, new beginnings, and a vast potential for growth and transformation.”The significance of this milestone aside, it creates an opportune time to look at the results of our survey. If you would like to see the charts and details, they are all on this webpage.

     

    If you’d like a quick summary here are some of the highlights:

    Ease of Scheduling: 97.6% said scheduling was “Very easy”.

    Satisfaction with Cleft-Lift Surgery: 98.6% Extremely satisfied or Satisfied.

    Recovery Experience:  40.1% Better than expected, 27.3% Easy, 20.0% Very easy.

    Post-op Activity Restrictions: 78.1% Felt restrictions were minimal.

    Opinions on Cleft-Lift as First Surgery from those who had prior operations, 76.4% wish they had started with cleft-lift.

    Opinions on Cleft-Lift as first Surgery for patients who had never had prior operations: 73.7% said “Great choice for me”.

    Appearance of Buttocks/Scar: 90.8%: Were either very happy with it, or not really concerned.In general, patients were very happy with the choice of the cleft lift procedure, and many patients used phrases like:

    “Life-changing”
    “Gave me my life back”
    “I can sit again without pain”
    “No more drainage or open wounds”
    Several used the word “miracle”, particularly after years of suffering or failed surgeries

    We are very proud of these results, and thank all our patients for filling out the forms!

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    • JULY 9, 2025
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    Will Antibiotics Alone Cure Pilonidal Disease

    Will Antibiotics Alone Cure Pilonidal Disease

    The short answer is “no”, but I’ll explain more.

    Often patients with symptoms of pilonidal cysts see a doctor and are put on antibiotics, with hopes that they will alleviate the symptoms. Often, there is not a discussion of exactly what is happening, and what the future will bring – and the patient goes away with the idea that the antibiotics are a definitive treatment for the problem. Unfortunately, this is not the case. The antibiotics may help a flare-up or abscess resolve, but it does not address the cause of the problem, nor the underlying cyst or sinus.If the antibiotics are successful in resolving the current episode of pain and drainage, then there is no emergency in deciding what to do next. However, the chances are very great that this problem will happen again. Every patient has a different approach to this: some prefer a “wait and see” approach, and others want to be proactive in preventing a recurrence. There is no right or wrong answer to this, as long as you understand the situation. Here is a discussion of how to deal with “minimal disease”, in other words pilonidal disease that is not a dramatic problem, but exists, and may need treatment.

    There really isn’t good overall data regarding how many patients with a single abscess or flar-up will go on to future problems, but the literature suggests that it is at least 50%; and probably more as time goes on.So, if you had one episode of pain from pilonidal disease, and it resolved with antibiotics, it is reasonable to research the situation and decide how you want to proceed. It is OK to wait to see if you have further problems – but it might make sense to research what kind of surgery you would want if it recurs, and where you would want to go for that surgery, so it it acts up again you are prepared.

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    • JUNE 29, 2025
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    Scar Appearance after a Cleft Lift

    Scar Appearance after a Cleft Lift

    What does the scar look like after a cleft lift operation?

    This is a commonly asked question, and like most medical questions, the answer depends on various things.

    • The severity of the pilonidal disease before the cleft lift.
    • Whether there have been previous operations, and exactly what kind.
    • If the patient has any dermatologic (skin) or autoimmune diseases.
    • The patient’s specific skin type and propensity for having healing issues.
    • Whether there are post operative suture reactions.

    We have other pages on this website that specifically address the shape of the gluteal cleft after cleft lift surgery, and that is not what we are referring to in this post. This is about how prominent a scar will appear after surgery. Unfortunately, it is impossible to predict this before the operation since there are so many factors involved, however we can discuss the variations in scar appearance to help you understand how this might look.

    Here are a few examples of the scar appearance after a cleft lift:

    This is an incision that healed normally, and the scar looks very good at a year and a half after surgery.This patient had extensive reactions to the dissolving sutures. Here is the appearance 6 months after surgery. At this point the suture material  has been absorbed, but the scar is a bit wider and darker than normal.This patient developed a hypertrophic scar, also called a “keloid”. Note how it is raised and pinker than the surrounding skin. It is unpredictable when this will happen, but in our experience it happen less than 1% of the time, and may be associated with some underlying autoimmune disease.These are some examples of what the healed scar from a cleft lift might look like. In general, even if there are some issues in the first few months after surgery, these scars soften up and the color starts to fade, and the appearance becomes more and more acceptable over time. If you would like to see more examples of the appearance of a cleft lift, this link will take you to a gallery of additional photos.

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