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Cleft lift surgery for pilonidal disease

Published 13 March 2026 ·Last reviewed 13 March 2026 by the editorial team ·How we create our content

At a glance

The cleft lift is a surgical technique for pilonidal disease that works by reshaping the natal cleft — the groove between the buttocks where pilonidal disease develops. Rather than simply removing the diseased tissue and leaving an open wound, the cleft lift flattens the area, removing the environment that allows the disease to recur.

It is increasingly recognised as one of the more effective surgical options for pilonidal disease, particularly for people with recurrent disease who have not had success with other approaches.

How it works

The principle

Pilonidal disease develops in the natal cleft because this area creates a warm, moist, enclosed environment where loose hair can become embedded and cause infection. The deeper the cleft, the more prone the area is to disease.

The cleft lift addresses this by:

  1. Removing the diseased tissue — excising the sinuses, tracts, and any infected tissue
  2. Reshaping the cleft — using a skin flap to flatten the area
  3. Moving the wound off the midline — placing the surgical closure to one side, away from the deepest part of the cleft
  4. Creating a flatter surface — so hair, moisture, and debris no longer accumulate

The procedure

  • Performed under general anaesthesia
  • The diseased tissue is excised
  • A skin flap is raised from one side of the cleft
  • The flap is advanced to cover the defect and flatten the area
  • The wound is closed with sutures, with the scar line positioned off the midline
  • A drain is typically placed to prevent fluid collection

The procedure usually takes one to two hours and is often done as a day case or with an overnight stay.

Who benefits most

The cleft lift is particularly considered for:

  • Recurrent pilonidal disease — people who have had previous surgeries that failed
  • Complex disease with multiple sinuses or extensive tracts
  • Deep natal cleft — where the anatomy makes recurrence more likely with other approaches
  • Failed open-wound healing — people whose previous wide excision wounds did not heal properly
  • Primary treatment — increasingly used as a first-line surgical option

Recovery

Week 1

  • A drain is typically removed within the first few days
  • Wound care involves keeping the closure clean and dry
  • Limited sitting — many people use a cushion or limit sitting time
  • Pain is usually manageable with standard pain relief
  • Light walking is encouraged

Weeks 2 to 3

  • Sutures or staples may be removed
  • Gradual return to normal sitting and light activities
  • The wound is assessed for healing progress
  • Most people can return to work (desk work) during this period

Weeks 3 to 6

  • Full activities typically resume
  • The wound continues to strengthen
  • Follow-up appointments to confirm complete healing
  • Hair removal in the area may be recommended to prevent recurrence

Long-term

  • The flattened cleft reduces recurrence risk significantly
  • Regular hygiene and hair removal in the area are commonly recommended
  • Most people describe the area feeling different — flatter and less prone to the problems they experienced before

Success rates

The cleft lift has among the highest reported success rates for pilonidal surgery:

  • Published studies generally report healing rates above 90 percent
  • Recurrence rates are lower than for most other pilonidal procedures
  • The off-midline wound closure is a key factor — midline wounds are more prone to breakdown

These rates are encouraging, though individual results depend on factors including disease complexity, surgical technique, and post-operative care.

Compared to other approaches

  • Wide excision with open healing — higher recurrence rate, much longer healing time
  • Bascom procedure — less extensive than cleft lift, may be suitable for less complex disease
  • Karydakis flap — similar principle of off-midline closure, comparable outcomes in some studies
  • Limberg flap — different flap design, comparable success rates for some disease patterns

The choice between these options depends on disease extent, surgeon expertise, and individual anatomy. The cleft lift is often favoured for recurrent or complex disease.

Finding a surgeon

The cleft lift is a specialised technique. Not all surgeons who treat pilonidal disease perform it. If you are considering a cleft lift:

  • Ask your surgeon specifically about their experience with the cleft lift technique
  • Some people choose to be referred to a surgeon with particular cleft lift expertise
  • Published surgical outcomes can vary significantly between surgeons with different experience levels
  • For recurrent disease, the expertise of the surgeon may matter more than the specific technique chosen

Common questions

What is a cleft lift?

A cleft lift (sometimes called a modified Bascom cleft lift) is a surgical procedure that reshapes the natal cleft — the groove between the buttocks. By flattening this cleft, the procedure removes the environment where pilonidal disease develops. The diseased tissue is excised, and skin flaps are used to close the wound and flatten the area.

Why is the cleft lift considered effective?

The cleft lift addresses the root cause of pilonidal disease — the deep natal cleft that traps hair, moisture, and debris. By flattening this area, the procedure eliminates the conditions that allow disease to recur. Published success rates are generally high, often above 90 percent, making it one of the more effective options for recurrent pilonidal disease.

Who is it suitable for?

Cleft lift surgery is particularly considered for people with recurrent pilonidal disease — those who have had previous surgeries that failed or abscesses that keep returning. It is also increasingly used as a primary procedure for people with significant disease. It may be especially beneficial for people with a deep natal cleft.

What is recovery like?

Recovery from a cleft lift typically involves a closed wound with a drain in place for the first few days. Most people return to light activities within one to two weeks and full activities within three to four weeks. The closed wound approach means healing is generally faster than open-wound pilonidal surgeries, though individual experiences vary.

Are there specialist surgeons for this?

Cleft lift surgery is a specialised technique, and not all surgeons perform it. Some people describe travelling to see a surgeon with specific cleft lift expertise, particularly those with recurrent disease who want the best chance of a definitive outcome. Asking your surgeon about their experience with the cleft lift specifically is reasonable.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Increasing redness, swelling, or fever
  • Wound that stops healing or starts producing pus
  • Recurrence of symptoms after treatment

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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