Introduction: Why Specialized Surgery Matters
Many patients with pilonidal disease are told they need a wide excision — where tissue is cut out and left to heal slowly, sometimes for months. Unfortunately, this approach has high recurrence rates and difficult recoveries
.At Jandali Plastic Surgery in Trumbull, CT, I use specialized off-midline flap procedures — the modified cleft lift and the Karydakis flap. These procedures:
- Flatten the buttock crease to prevent hair trapping
- Close the incision off the midline (away from the problem area)
- Promote fast, comfortable healing
- Provide much lower recurrence rates than traditional methods
Patients travel from across Connecticut, New York, Massachusetts, Rhode Island, and New Jersey because few surgeons in the region perform these advanced techniques.
The Problems with Older Pilonidal Surgeries
Traditional treatments included:
- Wide excision with open healing — large wounds requiring months of dressing changes, often with painful daily packing.
- Midline closures — incisions placed in the deep crease, prone to reopening and recurrence.
- Repeated drainages — temporary relief, not a cure.
These older approaches had recurrence rates up to 30–50%, leaving patients frustrated and discouraged.
The Modified Cleft Lift Procedure
The cleft lift procedure, first described by Dr. Bascom, reshapes the buttock cleft to eliminate the deep fold where pilonidal disease starts.
My Modified Version Improves on this Technique
- Diseased tissue and sinus tracts are removed
- The incision is shifted off the midline, preventing breakdown
- The buttock cleft is flattened to stop hairs from burrowing
- A tension-free closure allows faster healing
- Cosmetic outcome is improved with a fine-line scar off to the side
Benefits of the Modified Cleft Lift
- Outpatient procedure (go home same day)
- Rapid recovery — most patients return to school or work in 1–2 weeks
- Minimal wound care
- Very low recurrence rate (<5% in most studies)
- Cosmetically acceptable scar placed off-center
The Karydakis Flap Procedure
The Karydakis flap, named after Greek surgeon Dr. George Karydakis, is another effective off-midline closure.
Technique
- Diseased tissue is removed
- A flap of skin and tissue is mobilized from the side
- The flap is advanced across the midline, flattening the cleft
- Incision is placed off to one side
Benefits of the Karydakis Flap
- Off-midline closure (away from the source of recurrence)
- Flattening of the cleft
- Proven long-term success — recurrence rates under 5%
- Faster return to activity compared to open excisions
How I Decide Between the Two Procedures
Both the modified cleft lift and the Karydakis flap are excellent options.
- The modified cleft lift is my go-to for most primary and recurrent cases.
- The Karydakis flap is often chosen when there is more extensive disease or scarring from prior failed surgeries.
In both cases, my focus is on achieving a permanent cure with the least disruption to daily life.
Insurance Coverage for Advanced Pilonidal Surgery
Both the cleft lift and Karydakis flap procedures are fully covered by insurance.
- Considered medically necessary
- Our office handles preauthorization and appeals
- Patients from across Connecticut and surrounding states can have surgery approved
My Experience
I’m Dr. Shareef Jandali, a board-certified plastic surgeon specializing in advanced pilonidal surgery. Few surgeons in New England perform the modified cleft lift and Karydakis flap regularly.
Patients come to my Trumbull, CT office from across Connecticut, New York, Massachusetts, Rhode Island, and New Jersey for these specialized surgeries.
Common Questions About Cleft Lift & Karydakis Surgery
How long is recovery?
Most patients return to work or school in 1–2 weeks.
Is the surgery painful?
Pain is significantly less than traditional wide excision; most patients use oral medication for a few days.
Will I have a scar?
Yes, but it is placed off the midline and is much less visible than old midline scars.
What is the recurrence rate?
Under 5% with modern flap procedures, compared to up to 50% with wide excision.
Can pilonidal disease come back after surgery?
Rarely, but recurrence is uncommon with proper off-midline closure and cleft flattening.
Why don’t more surgeons perform these techniques?
They require specialized training and are more technically demanding than traditional excisions.
Patient Testimonial
“I had three failed excisions before finding Dr. Jandali. He performed a cleft lift procedure and within two weeks I was back at work. It’s been over a year and I have had no recurrences. I only wish I had found him sooner.”
— R.C., New Haven, CT
Serving Connecticut & Beyond
We treat pilonidal patients from:
Trumbull, Fairfield, Bridgeport, Stratford, Milford, Shelton, Norwalk, Westport, Weston, Wilton, Easton, Monroe, Oxford, Derby, Ansonia, Seymour, Newtown, Bethel, and Southbury.
Patients also travel from across Connecticut, New York, Massachusetts, Rhode Island, and New Jersey for these specialized flap surgeries.
Why Choose Jandali Plastic Surgery
- Board-certified plastic surgeon
- Specialization in modified cleft lift and Karydakis flap
- Low recurrence, faster healing, less pain
- Insurance-covered surgery
- Trusted by patients across New England
Contact Us
If you’ve been told you need a painful wide excision, learn about your options for modified cleft lift or Karydakis flap surgery. These advanced procedures are covered by insurance and provide permanent solutions with faster recovery.
Jandali Plastic Surgery
5520 Park Ave, Suite WP-2-300, Trumbull, CT 06611
203-374-0310
