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Surgical team performing advanced flap-based pilonidal repair
Advanced Flap-Based Repair

Advanced, Flap-Based Pilonidal Cyst Treatment in Los Angeles

A groundbreaking outpatient procedure developed by Dr. Yosef Nasseri and Dr. Moshe Barnajian — bilateral fasciocutaneous gluteal flaps with tie-over sutures and extracellular matrix — built to drive recurrence toward zero.

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(310) 627-2330 · In-person in LA & virtual nationwide
About 1 hourOutpatient, home same day
Near-zero recurrenceThe technique’s core goal
Discreet scarBlends into the natural crease
Our Mantra

If the entire cyst and sinus tract are not removed, the disease will return

Dr. Nasseri and Dr. Barnajian developed their flap-based approach with two clear objectives.

Objective one

Drive the post-surgery recurrence rate of pilonidal cysts down to near zero.

Objective two

Leave patients with a discreet midline scar that blends seamlessly into the natural crease for an almost invisible cosmetic outcome.

How It Works

How this cutting-edge technique works

The entire operation takes about an hour, and you are free to go home once you have awakened from anesthesia.

1

Remove the problem area

The diseased tissue is excised in an elongated ellipse, taking the entire cyst track with it.

2

Create bilateral fasciocutaneous gluteal flaps

Skin and a thin layer of underlying tissue are gently lifted from each side of the incision. Because the flaps stay connected to their native blood supply, they heal quickly.

3

Add regenerative matrix

A sheet of extracellular matrix (ECM) is placed under the flaps. ECM acts like a scaffold that encourages your own cells to knit new, healthy tissue.

4

Tie-over sutures for a snug fit

The flaps are folded toward the midline and secured with “tie-over” sutures that hold gentle pressure — a built-in dressing that protects the repair for the first few days.

Diagram of flap-based pilonidal cyst repair
Flap-Based vs. Traditional

Why it beats traditional wide excision

Traditional wide excision

  • Can leave a raw cavity that must heal from the inside out over weeks
  • Weeks of open wound care and dressing changes
  • Leaves the deep cleft where hair and debris collect — the usual spark for a new cyst

Advanced flap-based repair

  • Less open wound care — a closed flap heals like a regular incision
  • Faster return to normal life — most patients sit, drive, and work sooner
  • Lower chance of new tracts — healthy tissue over the midline eliminates the deep cleft
Why Choose Us

Why choose this technique at the Pilonidal Institute

Outpatient convenience

Return home the same day, minimizing disruption to daily life.

Minimal discomfort

Most individuals experience little to no pain post-procedure.

Aesthetic results

A discreet midline scar that aligns with the natural buttock crease.

Low complication rates

Minimal risk of wound infection or reopening.

Exceptional success rate

Clinical studies have demonstrated a near-zero recurrence rate, significantly outperforming traditional methods.

Specialist surgeons

Board-certified colorectal surgeons who treat pilonidal disease every week.

Pilonidal Institute surgeon walking through the Los Angeles clinic
3 visits in 2 weeksThen weekly until healed
After Surgery

Hands-on care that follows surgery

Equally important is the care that follows. Patients see our team three times within the first two weeks and once a week thereafter until the wound is fully healed.

At each visit, we inspect the incision, trim or shave surrounding hair, and address even the smallest sign of irritation before it can slow recovery. This vigilant follow-up helps every flap heal cleanly, comfortably, and exactly as planned.

  • Walk the same day; desk work or school within 1–2 weeks
  • No daily packing — wound care is far simpler than open excision
  • Full activity, including exercise, usually within 3–4 weeks

Traveling for treatment? Start virtually.

Patients come to us from across the country. A virtual consultation lets us review your case and plan your visit before you book a flight.

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The Surgeons Behind the Technique

Meet your surgeons

Dr. Nasseri and Dr. Barnajian developed and refined this flap-based procedure at the Pilonidal Institute in Los Angeles.

Dr. Yosef Nasseri, colorectal surgeon

Dr. Yosef Nasseri

Board-Certified Colorectal Surgeon

Co-developer of the bilateral fasciocutaneous gluteal flap technique with ECM and tie-over sutures.


Dr. Moshe Barnajian, colorectal surgeon

Dr. Moshe Barnajian

Board-Certified Colorectal Surgeon

Co-developer of the technique; specializes in recurrent and complex pilonidal disease.

In the Operating Room & Beyond

Precision surgery, real recovery

Surgeons performing flap-based pilonidal repair
Pilonidal Institute surgeon in the procedure room
Dr. Yosef Nasseri of the Pilonidal Institute
Active recovery after pilonidal surgery
Back to cycling after pilonidal repair
Answers

Frequently asked questions about flap-based treatment

What is flap-based pilonidal cyst treatment?+
Flap-based pilonidal cyst treatment is an advanced surgical technique that completely removes the pilonidal disease and then reconstructs the area using a flap of the patient’s own healthy tissue. Instead of leaving an open midline wound to heal slowly, the surgeon closes the defect. This lowers tension on the wound, speeds healing, and dramatically reduces the chance the cyst comes back. At the Pilonidal Institute in Los Angeles, Dr. Yosef Nasseri and Dr. Moshe Barnajian specialize in these fasciocutaneous gluteal flap procedures.
Is flap surgery better than traditional pilonidal surgery?+
For most patients with recurrent or complex disease, flap-based repair offers real advantages. Traditional wide excision left open to heal can take weeks to months of daily wound packing and carries recurrence rates as high as 30 to 40 percent. Flap-based treatment closes the wound primarily and has published recurrence rates in the low single digits with a much faster return to normal activity.
What is the recurrence rate after flap-based pilonidal cyst treatment?+
Modern flap techniques report recurrence rates that are typically under 5 percent, compared with 15 to 40 percent for older approaches. The keys to keeping recurrence low are complete removal of all the sinus tracts, tension-free closure, and eliminating the deep cleft — exactly what our Los Angeles flap procedures are designed to do.
How long is recovery after pilonidal flap surgery?+
Most patients walk the same day and return to desk work or school within 1 to 2 weeks. Because the wound is closed rather than left open, there is no daily packing, and wound care is far simpler than with traditional excision. Full activity, including exercise, usually resumes within 3 to 4 weeks depending on how you heal.
Can flap surgery fix a pilonidal cyst that keeps coming back?+
Yes. Flap-based reconstruction is often the best option for recurrent pilonidal disease or a wound that never healed after previous surgery. By bringing in healthy, well-vascularized tissue, it corrects the underlying reasons the disease came back in the first place, which is why it is a cornerstone of our practice at the Pilonidal Institute.
How do I schedule a consultation in Los Angeles?+
Call the Pilonidal Institute at (310) 627-2330 to schedule a consultation with Dr. Nasseri or Dr. Barnajian, or request a virtual consultation if you are traveling from out of the area. Our Los Angeles team will review your history, examine the area, and recommend the most durable plan.
Los Angeles · Pilonidal Institute

Ready to end recurring pilonidal disease? Our surgeons will evaluate your cyst, recommend the right repair, and help stop it from coming back.

Schedule your consultation today — in person in Los Angeles or by virtual visit from anywhere.

(310) 627-2330
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