THE SURGERYCENTERPLANO DERMATOLOGY

Pilonidal Disease & the Bascom Cleft Lift

Pilonidal disease is usually called a cyst. It is really an infection: abscesses and sinus tracts near the tailbone, where hair and debris work into the deep cleft between the buttocks and the area cannot heal. The result is a cycle — painful flare-up, drainage, wait for the next one.

Two things are worth saying plainly. It is nobody's fault: the cause is anatomy, hair, friction, and often heredity — not hygiene — and almost no one talks about it. And it is miserable. Sitting hurts. Many patients quietly plan their lives around it for years. You do not have to.

Traditional excision removes the infection but leaves the deep cleft that caused it, which is why the disease so often returns. The Bascom cleft lift is a lift and a shift: diseased tissue out, the closure shifted off the midline to skin that actually heals, and the cleft flattened so nothing traps hair and moisture again. Disease, infection, and anatomy — fixed in one outpatient operation, successful in 95 to 97 percent of patients in large published series.

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Illustration of the cleft lift concept

When to come in

  • Recurring abscesses or drainage near the tailbone
  • A pilonidal wound from previous surgery that has never fully healed
  • Disease that has come back after excision or other procedures
  • Pain with sitting that you have been told to live with

How we treat it

Bascom cleft lift

The definitive repair: diseased tissue removed, closure shifted off the midline, cleft flattened so the disease has nowhere to return.

Drainage of an acute abscess

An acutely infected abscess is drained first for relief; the cleft lift then addresses the cause once things settle.

Your surgeon will walk you through what to expect — including preparation and aftercare — before anything is scheduled.

A lift and a shift, drawn simply

01The problemA deep midline cleft traps hair and debris; pits and abscesses form where healing is hardest.
02The lift and the shiftDiseased tissue is removed; healthy skin is brought across, moving the closure off the midline.
03The resultA shallow, flattened cleft and a gently curved closure beside the midline — nothing left for the disease to return to.

Traditional excision vs. the Bascom cleft lift

CompareSimple (midline) excisionBascom cleft lift
What it addressesRemoves the infected tissue, but the deep midline cleft — the cause — remains.Removes the disease and reshapes the cleft, so the cause is corrected too.
Where the wound sitsIn the midline crease — the most difficult place on the body for a wound to heal.Shifted off the midline to healthy, well-aired skin that heals reliably.
HealingOpen wounds commonly take months, often with daily packing and dressing changes.Typically heals in weeks, with simple dressings and no packing.
SettingFrequently a hospital operation.Outpatient — you go home the same day.
Chance of cureRecurrence reported as high as 30-50% in published series.95-97% success in large published series, including recurrent disease.

Figures reflect ranges reported in the published surgical literature and patient-advocacy resources for midline excision and the Bascom cleft lift; individual results vary, and your surgeon will discuss what applies to you.

Common questions

Answers reflect the typical course — your surgeon will go over the specifics of your own plan.

General anesthesia is the most common approach — it is the safest way to keep you comfortable while you are positioned face-down for the operation. Your surgeon will go over the anesthesia plan with you before anything is scheduled.

Usually, yes. A small drain exits the skin well away from the incision and empties into a self-contained bulb that you empty a few times a day. It typically stays in for about two days, and removing it is quick and simple.

Minimal — and that is much of the point. The incision is closed with dissolvable sutures and skin glue: no open wound, no daily packing. Most patients can shower the day after surgery.

Yes — sitting is not just allowed, it is encouraged, starting the day after surgery on a cushioned but supportive surface. Gentle pressure on the area actually helps the healing tissue settle.

Generally much milder than patients expect — most discomfort is managed with simple oral medication in the first days. The chronic pain of the disease itself, by contrast, is what patients are usually gladdest to be rid of.

Most patients are back within a few days. If your work involves prolonged sitting or heavy lifting, plan on one to two weeks. Your surgeon will tailor this to what you actually do all day.

Walking is encouraged from the first week. More vigorous activity — running, swimming — typically resumes once the drain is out, and full unrestricted exercise follows complete healing, usually within three to six weeks.

A gently curved scar that sits off to the side of the midline, and a cleft that is noticeably shallower and flatter than before. That reshaping is not a side effect — it is the treatment, and it is why the disease does not come back.

Related procedures

Cyst Removal

Complete excision of painful, infected, or bothersome cysts, including the sac, to help prevent recurrence.

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Benign Lesion Removal

Seborrheic keratoses, skin tags, warts, and other benign growths, removed with attention to cosmetic outcome.

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Keloid & Scar Revision

Surgical revision of raised, thickened, or uncomfortable scars to improve appearance and function.

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