Cleft Lift/RAF Procedure to cure Pilonidal Disease | Results
WARNING: GRAPHIC The following before and after photos of pilonidal surgery patients may be considered graphic by some. If you do not wish to view surgical photos, please navigate away from this page. Check out the informational gallery for labeled photos explaining Pilonidal Disease.
The following are a series of before and after photos of patients who underwent The Cleft Lift/Pilonidal RAF(rotation and advancement flap) Procedure at The Sternberg Clinic in San Francisco. Please note that, except where indicated, patients are photographed lying on their stomachs with their buttocks in view. So, the photo’s left side represents the patient’s left side.
Important Terms to Know
- The Cleft Lift/ Rotation and Advancement Flap (RAF): An outpatient surgical procedure that is intended to cure Pilonidal Disease
- Natal Cleft: The area between the buttock cheeks, also known as the gluteal cleft or butt crack. It extends from the top of the butt crack to the anus including the sides of the buttocks that are hidden when standing.
- Sinus: A tunnel from under the skin to an area above or to the side of the natal cleft midline. A sinus drains infected material from the pilonidal abscess.
- Midline Pits: Dilated hair follicles on the midline of the natal cleft caused by repeat micro-trauma. This is the source of the Pilonidal infection.
Before and After Pilonidal Surgery at The Sternberg Clinic
The following photos depict patients who have traveled to San Francisco for curative surgery with Dr. Sternberg. Their presenting situations are shown alongside the final results after the Pilonidal RAF /Cleft Lift Procedure. In some cases, intraoperative findings are demonstrated, as well as the immediate postoperative photos.
Note: The ‘Before Surgery’ comparison photos are taken in the operating room, after the area has been cleaned and shaved, but no incisions have been made. The wounds you see are what these patients have been walking around with for months and sometimes years before coming to The Sternberg Clinic.
28-year-old Male with an 8-year-long battle with Pilonidal Disease
“After seven years and five failed surgeries, I was worried I would have to live with my Pilonidal Disease for my entire life. Thankfully, a doctor in the Bay Area directed me to Dr. Sternberg’s clinic. Dr. Sternberg was incredibly friendly, and his expertise was immediately evident in identifying why previous surgeries were likely unsuccessful. He was honest in acknowledging the high difficulty of my case but still believed that another operation with him would be the right choice. Due to the nature of having multiple failed surgeries, my recovery was longer than usual, but in the end, it was an absolute success! I have no pain, no drainage, and can finally live my life without compromising because of this disease. I am so thankful for finding Dr. Sternberg and can’t recommend him enough to anyone struggling with Pilonidal Disease.”
-Patient T.B.
Abscess Cavity during Surgery
Incision Immediately After Surgery
Off Midline Incision 2months Post-Op
24-year-old Male with 3 Failed Operations for Pilonidal Disease
DM is a healthy 24-year-old male from the southern US who first developed pilonidal disease 5 years ago and underwent a right to left rhomboid flap procedure in February of 2020. The operation seemed to work at first, but over the ensuing 3 years, he developed some intermittent drainage from the wound, and by early 2024, it was clear that he had an open wound in his natal cleft. So, he underwent a series of two open excisions each more significant than the prior one by the same surgeon. Neither one healed. He has not been able to attend school or work for the last year , and has been going to wound care with multiple doctor visits. He was instructed not to leave the house, exercise, or sit. His wound care doctor advised him to fly to San Francisco. Dr. Sternberg successfully performed a Pilonidal RAF and he is well and active again.
Incision Immediately After Surgery
Incision Immediately After Surgery
18-year-old Male with Recurrent Pilonidal Disease
DK is an 18-year-old college student who developed a very symptomatic pilonidal abscess that kept recurring following drainage procedures or antibiotics. He had to withdraw from college due to his recurrent abscesses. He traveled from the Midwest to San Francisco and Dr. Sternberg performed a Pilonidal RAF Procedure and he is active and back at school.
25-year-old Male with 2 Failed Excisional Operations
BM is a 25-year-old athletic male who lives in Idaho and loves exploring the outdoors. 2 years ago he developed a symptomatic pilonidal sinus which prevented him from hiking and running. He underwent excisional surgery with a midline closure and developed an early postoperative wound infection. He met with a new surgeon who advised a rhomboid flap procedure, which he had. A portion of the flap immediately broke down and he was left with an open wound in his residual natal cleft. Dr. Sternberg performed a Pilonidal RAF and he has healed nicely and is back to his usual vigorous activity.
Breakdown of Failed Flap Procedure
Incision Immediately After Surgery
Symptomatic Pilonidal Sinus in 19-year-old Male
John is a 19-year-old male who developed a symptomatic pilonidal sinus. A local surgeon had advised him to undergo a wide-excisional operation and have the wound left open. He did his homework and met with Dr. Sternberg who suggested a better solution, the Pilonidal RAF.
Incision Immediately After Surgery
19-year-old Male with 2 year history of Pilonidal Disease
Jack is a 19-year-old male who had a symptomatic pilonidal sinus for two years. He lives outside of California, where a local surgeon suggested that he undergo a wide excision and have his wound left open with an anticipated several month recovery. He traveled to San Francisco and Dr. Sternberg performed a Pilonidal RAF with an excellent outcome.
Who is a Candidate for The Pilonidal RAF/Cleft Lift Procedure?
Any patient with a symptomatic pilonidal abscess/sinus (often incorrectly called a cyst) or an issue such as a recurrent wound, abscess, or non-healing wound following surgery.
Here are examples of some patient issues that preceded a curative operation by Dr. Sternberg.
Natal Cleft Hidden
This photo demonstrates the natal cleft and how it is concealed from view when standing. This photo shows a pilonidal sufferer standing. The vertical black lines indicate the line of skin contact between both buttock cheeks. The horizontal line serves as a reference to the horizon and marks the lowest part of the buttock exposed when a patient sits on a chair.
Please note how the natal cleft is completely hidden, and there is no sign that the patient has a chronic pilonidal problem.
Deep Cleft Revealed
The patient’s buttock cheeks are spread apart to reveal a deep cleft or valley. The shaded area represents the NATAL CLEFT (the area that extends from the top of the buttock crack to the anus and includes the interior sides of the buttock cheeks). Multiple dilated midline pits (more clearly shown in the other non-shaded photos below) are also visible.
Pilonidal Sinus Disease (PSD)
This is a classic example of a symptomatic primary pilonidal sinus. This patient, a male in his early 20s, has developed several large, dilated midline pits (which are previously infected hair follicles) and a draining sinus located in the upper left portion of his natal cleft.
Midline Pits
Here is the classic example of a patient who has multiple midline natal cleft (buttock cleft) pits which are the essential factor for developing pilonidal disease.
Non-Healing Wounds from Failed Surgery
Here are examples of two patients with non-healing wounds resulting from pilonidal surgery performed by another surgeon. Notice that the wounds are located in the midline, which is a significant flaw in most pilonidal surgeries, as midline wounds remain in the deep, moist, airless cleft and struggle to heal.
The Flap Procedure
In the Pilonidal RAF, an island of skin is removed from one side of the cleft as the cleft will be made shallower during the procedure and would result in wrinkled redundant skin of the skin island wasn’t removed. The skin island is outlined on the left in purple in this patient with a non-healing wound from a prior operation by another surgeon. The second photo is the immediate postoperative result after surgery with Dr. Sternberg.
Take the First Step
Cure your Pilonidal Disease!
