Few surgeons truly have a desire or interest in taking care of pilonidal patients and many of their operations make the problem worse.  

Not everyone should be performing the cleft lift.  It is technically demanding, requires good three-dimensional planning, and adequate patience to meticulously perform the operation. So, if the surgeon you’re consulting with doesn’t seem confident about the procedure or admits to performing it infrequently, consider another surgeon.

Some red flags that should encourage you to do more research:

• If the surgeon performs traditional surgery (open procedures or excisions with midline closures) and reserves the cleft lift for recurrences. The CL shouldn’t be reserved for recurrences and isn’t any more extreme or invasive than a typical excisional procedure.
• If the surgeon advises only removing the top draining sinus hole and leaving the lower holes/pits in place.  The source of pilonidal disease is the lower holes/midline pits.  The top draining sinus is the result of the disease, and if it is removed, it will just come back in a bigger and angrier form.
• If the surgeon admits to lacking experience with the procedure but would like to try it in your case.  Don’t take a chance with experimentation.  The best way for a surgeon to learn how to perform the CL is in a mentorship experience.
• If the surgeon recommends another flap procedure instead of the cleft lift procedure.  While some flap procedures work (e.g., the Modified Limberg Flap) for pilonidal disease, they are less reliable, often more invasive, are more disfiguring, and require a longer recovery period.