Out-of-State Pilonidal Surgery in Los Angeles
If your local surgeon offered open-wound excision and you have read what that recovery actually looks like, you already know why patients fly to a specialist. We perform a closed-wound bilateral fasciocutaneous gluteal flap with extracellular matrix — no daily packing — for patients from across the country, including those whose previous surgery already failed.
Why patients travel to us for surgery
Bilateral flap with ECM, not cleft lift
A third path between open excision and off-midline cleft lift — closed-wound healing with a discreet midline scar that recreates the natural gluteal anatomy.
Double board-certified lead
Dr. Nasseri is board-certified in general and colorectal surgery (FACS, FASCRS); Dr. Barnajian is board-certified colorectal (FASCRS). Cedars-Sinai academic affiliation.
No open-wound packing
The closed-flap reconstruction means no daily wound packing at home — the most common reason patients call a previous surgery the worst experience of their life.
Revision surgery is routine
A meaningful share of patients arriving have already had one, two, or three previous attempts elsewhere.
The gap is usually larger than the distance
Most pilonidal surgeons perform either open-wound excision or — if you are lucky — cleft lift. Almost none perform a closed bilateral flap reconstruction with extracellular matrix, which lets the wound close in the midline without an off-midline scar across the buttock.
You may not know what your surgeon will do until the OR
General surgeons in mixed practice often default to wide excision because it is what they were taught — even when a closed-wound option would heal in a fraction of the time.
Closed-wound surgery removes the caregiver problem
Open-wound packing turns a spouse, parent, or roommate into an informal wound nurse for weeks. Closed-flap healing removes that dependence entirely.
A midline closure preserves your natural anatomy
Cleft lift moves the scar away from the midline. Our flap technique closes the midline directly, recreating the gluteal cleft rather than relocating around it.
Colorectal subspecialty training matters
Deep tissue handling at the sacrum benefits from training that general-surgery residency alone does not provide. Both surgeons completed FASCRS colorectal fellowships.
What is actually different
Patients researching options usually arrive having read about cleft lift — the dominant alternative to open excision. The bilateral fasciocutaneous flap with extracellular matrix is a different operation built around a different goal: instead of moving the closure off-midline, it reconstructs the midline with vascularized tissue from both gluteal sides, supported by an ECM scaffold and tie-over sutures under controlled tension.
The practical difference shows up in three places — recurrence mechanism, scar location, and what your skin and underlying tissue look like a year later.
| What’s different | Open-wound excision(most common locally) | Cleft lift(most specialists) | Bilateral fasciocutaneous flap + ECM(our technique) |
|---|---|---|---|
| Wound at the end of surgery | Open — packed daily for 6–12+ weeks | Closed off-midline | Closed in the midline |
| Where the scar sits | Midline, but with prolonged open-wound healing | Off-midline (lateral to the cleft, by design) | Midline, blending into the natural cleft |
| What changes about your cleft anatomy | Tissue contracture from open-wound healing | Mechanical flattening or asymmetry possible | Cleft anatomy reconstructed and preserved |
| Recurrence mechanism (if it happens) | Wound never closes, or closes and reopens | Closure tension or scar contracture pulls open | Flap dehiscence — addressed pre-op by patient selection and ECM tissue support |
| Surgeon training behind the technique | General surgery | Mixed (cleft lift specialists) | Colorectal subspecialty + flap reconstruction experience |
Recurrence rate
Recurrence after full healing is 2% or less.
Pain and packing
The closed flap eliminates the open-wound packing routine — no gauze swaps, no spouse changing dressings, no local wound-care visits.
Driving and sitting
Minimal pain on waking. No direct sitting for 48 hours; then cushions or foam pillows, offloading every half hour.
Cosmetic outcome
The scar sits in the midline where the cleft already runs — less visible at a glance than an off-midline scar across the upper buttock.
What happens if you have already had a surgery that failed
A meaningful share of the patients who travel to us have already gone through one, two, or three prior procedures — open excision that never closed, a cleft lift that pulled open at the tension line, a Bascom procedure that recurred within a year. Each prior surgery changes the local anatomy, so revision planning is not the same as planning a first surgery.
Before any flap reconstruction is planned, the team reviews prior operative reports, examines the scar topology, and identifies whether the failure was driven by tension, vascular insufficiency, residual sinus tract, or infection. That determines whether a bilateral flap is the right operation at all — and what modifications the ECM placement and tie-over pattern need.
- Bring every operative report you have. Knowing whether your surgeon used a Karydakis flap, a Bascom pit excision, or wide excision changes the rebuild plan.
- Bring post-op photos if you took them. How the wound looked at 2, 6 and 26 weeks often tells us more than the report.
- Expect a longer pre-op review. Revision consults take more time because we read both the disease and the prior repair.
- A re-do cleft lift is not always the answer. Repeating the same operation with the same mechanism often produces the same outcome.
How your trip and the first weeks are sequenced
Out-of-state patients usually want a calendar before a treatment plan. Pilonidal recovery has one constraint other outpatient surgeries do not: you cannot sit normally on the area for a meaningful stretch. Every logistics decision below is shaped by that.
Travel to Los Angeles
Pre-operative consultation in the office: final exam, anesthesia review, pre-op instructions. Light evening; firm dinner plans not required.
Outpatient procedure
Bilateral fasciocutaneous flap with ECM and tie-over sutures. Patients typically wake with minimal pain and discharge the same day to local accommodation. You may stand, walk, or lie on your back, side, or stomach immediately.
Rest at accommodation
No direct sitting for 48 hours. For the first 5 days, sponge baths instead of showering, and wipe to the front after bowel movements. A companion is strongly preferred for this window.
Cushioned sitting begins
After 48 hours, sit on cushions or foam pillows and offload every half hour. Continue sponge baths and front-wiping until the day-5 visit.
Retention sutures out
Return to the office around day 5 for painless removal of 2 retention sutures. Afterward, frequent showering is encouraged, especially after bowel movements.
Skin stitches out, then healing checks
At about 2 weeks, painless removal of the skin stitches; then see the surgeon every 1–2 weeks until healed — typically about 3–4 weeks after surgery. A small percentage develop a small lower-wound opening around weeks 2–3; routine care continues while it heals.
Plan transportation
Around the first 48 hours and the cushion period afterward — no direct sitting, then cushioned sitting with regular offloading.
Plan desk work
Bring a standing, kneeling-chair, or cushion plan until your surgeon clears more normal sitting.
Bring a companion
Strongly preferred for the first 48 hours — for transport, food, and to flag anything to report between video checks.
Two colorectal surgeons who handle the out-of-state and revision caseload
Yosef Nasseri, MD, FACS, FASCRS
Associate Professor of Surgery at Cedars-Sinai Medical Center. Voted Top Doctor for Colon and Rectal Surgery 2015–2020 by Los Angeles Magazine peer survey. Hand-selected by Da Vinci Robotic to train surgeons internationally on robotic colorectal technique.
Moshe Barnajian, MD, FASCRS
Medical degree Drexel University; general surgery residency at Cedars-Sinai; colorectal training at Stony Brook University Hospital. Named “Super Doctors Rising Star” by Los Angeles Magazine. Peer reviewer for Colorectal Disease and Techniques in Coloproctology.
The conversation about your scar
One thing we do that most specialists do not is hold a separate conversation about scar placement and appearance during the consult, not after surgery. Because our technique closes the wound in the midline and reconstructs the natural gluteal cleft, the scar conversation has substance: this is what your closure will look like, where the line will sit, and what the cleft will look like six months out.
- Midline closure means a midline scar — where the cleft already runs, less visible at a glance than a scar relocated across the upper buttock.
- Cleft anatomy is preserved, not reshaped — the bilateral flap reconstructs the cleft instead of flattening it, which some patients prefer cosmetically.
- The ECM scaffold supports tissue regeneration under the flap — a different scar character than weeks of open-wound granulation.
There is no version of pilonidal surgery that leaves no scar, but there is a meaningful difference between the closures available — and the conversation should happen before you book a flight.
Ready to talk through your case?
Request a virtual consultation and meet your surgeon by video before you travel, or call the office at (310) 807-6952 — Mon–Sat 9am–5pm Pacific.
How the wound handoff to your local provider works
Once you fly home, the limiting factor is not distance — it is whether your local physician knows what to look for on a flap closure they have never seen. So the handoff includes enough technical context for them to answer “is this normal?” between video check-ins.
Technique briefing
A short written summary of the operation, closure pattern, suture-removal schedule, and expected wound appearance at each interval.
Operative report and photos
The full operative report with intra-operative photos — useful if a non-emergency question comes up between video visits.
Scheduled video follow-up
Three in-office or video checks within the first two weeks, then weekly until healed. Out-of-state patients move to video after the first post-op check.
Secure messaging
Day-to-day questions go through secure messaging; urgent questions are routed to a same-day call.
Frequently asked questions
I've already had surgeries that left me packing the wound for months — can flap surgery still work for me?+
Will the scar from your technique flatten my natural cleft like a cleft lift can?+
I'm scared about flying home with a fresh wound — what does that look like?+
Can I really have my first consult by video before I fly in?+
What does insurance look like when my plan is out-of-network?+
How long until I can sit, drive, and go back to work?+
Do you treat patients whose previous cleft lift failed?+
What do you send to my local doctor so they know how to handle my follow-up?+
Should my pilonidal surgeon be board-certified in colorectal surgery, or is general surgery enough?+
Why does it matter whether a surgeon performs more than one pilonidal technique?+
Where does the scar sit when the surgery is done?+
Surgical content reviewed by Dr. Yosef Nasseri, MD, FACS, FASCRS, and Dr. Moshe Barnajian, MD, FASCRS. The information on this page is for general educational purposes only and is not a substitute for individualized medical advice. Surgical recommendations are made on a per-case basis after consultation.
Send your prior operative reports and post-op photos, and we will tell you candidly whether the bilateral fasciocutaneous flap is the right operation for your case — before you book any travel.
Or call directly — Mon–Sat 9am–5pm Pacific · 8635 W 3rd St #880W, Los Angeles, CA 90048
(310) 807-6952