Traveling for a Bascom Cleft Lift: How to Choose a Pilonidal Surgeon
By Reza Rahbar, MD, FACS, FASCRS
Board-Certified Colon & Rectal Surgeon
Carolina Rectal Health Institute | Cary, North Carolina
Patients with pilonidal disease often spend months or years cycling through pain, swelling, drainage, antibiotics, abscess procedures, and wounds that never fully heal. Some have already undergone one or more operations only to have the disease return.
That is why patients increasingly search beyond their hometown for a Bascom cleft lift surgeon or pilonidal surgery specialist. For the right patient, traveling for an expert evaluation may be worthwhile—especially when the alternative is another midline excision, prolonged packing, or another failed wound.
At Carolina Rectal Health Institute in Cary, North Carolina, Dr. Reza Rahbar evaluates primary, recurrent, and complex pilonidal disease. This guide explains when specialized care may help, how the Bascom cleft lift differs from traditional surgery, and what patients traveling from another state or country should consider.
When Does Pilonidal Disease Need Specialist Care?
A first pilonidal abscess may only require drainage. Chronic disease is different. Specialist evaluation is particularly important when you have:
• Repeated painful abscesses near the tailbone
• Ongoing drainage, bleeding, or multiple sinus openings
• A wound that has not healed after prior surgery
• Disease that returns after excision, pit picking, or another procedure
• Pits or tracts extending low in the cleft toward the anus
• Significant scarring or distortion after previous operations
• Pain that interferes with sitting, school, work, sports, or travel
These patterns suggest that the anatomy of the cleft—not simply a single “cyst”—may be sustaining the problem.
Why the Bascom Cleft Lift Is Different
Traditional pilonidal surgery often focuses on removing the visibly diseased tissue. When the incision remains in the deep midline cleft, however, moisture, friction, hair, pressure, and limited airflow can continue to interfere with healing.
The Bascom cleft lift is an off-midline reconstructive operation. It is designed to:
• Remove diseased skin, pits, and sinus tracts
• Flatten and reshape the deep natal cleft
• Move the incision away from the vulnerable midline
• Create a cleaner, drier environment that is more favorable for healing
• Close the wound rather than leave a large cavity requiring prolonged packing
The procedure addresses both the diseased tissue and the anatomy that contributes to recurrence. That distinction is especially important for patients with complex disease, recurrent disease, or a chronic nonhealing wound.
What Does the Medical Evidence Show?
The American Society of Colon and Rectal Surgeons recognizes flap-based procedures, including the cleft-lift approach, as an option for complex or recurrent chronic pilonidal disease. Research also supports the broader principle that off-midline closure is preferable to closing a wound directly in the midline.
Published results vary because studies include different types of patients, different definitions of healing and recurrence, and different lengths of follow-up. A recent prospective study of 392 patients treated at a high-volume center included primary extensive disease, recurrent disease, and wounds that had failed to heal after prior surgery. Most patients healed without an unexpected problem during the first three months, while long-term recurrence was higher among the most difficult recurrent and nonhealing cases.
The important point is not that any operation can promise a perfect result. It is that technique, patient selection, disease complexity, and experienced follow-up all matter. Patients should be cautious of guaranteed success rates or a one-size-fits-all operation.
Who May Benefit From a Cleft Lift?
A Bascom cleft lift may be considered for:
• Chronic pilonidal sinus disease
• Recurrent infections or abscesses
• Multiple midline pits or branching tracts
• A nonhealing wound after wide excision
• Recurrence after a previous pilonidal operation
• Extensive disease reaching the lower cleft
• Patients seeking a closed, off-midline repair instead of another open wound
Not every patient requires a cleft lift. Limited disease may sometimes be managed with observation, hair control, drainage of an acute abscess, or a less extensive procedure. The right operation depends on the location and extent of disease, previous treatment, scarring, symptoms, and your goals.
How to Choose a Pilonidal Cleft-Lift Surgeon
If you are considering travel for surgery, ask specific questions rather than relying only on the name of the procedure.
1. Does the surgeon routinely evaluate recurrent and failed pilonidal surgery?
Redo operations can be more difficult because normal tissue planes may be replaced by scar, the cleft may be distorted, and disease may extend lower than expected.
2. Will the final incision be completely off the midline?
Moving the incision out of the deep cleft is a central principle of the operation. Ask the surgeon to explain how the cleft will be reshaped and where the incision is expected to lie.
3. Does the surgeon understand complex perianal anatomy?
Pilonidal disease near the anus can be confused with an anal fistula or another condition. Fellowship training in colon and rectal surgery provides focused expertise in this region.
4. Will the surgeon discuss alternatives honestly?
A specialist should explain whether you need surgery at all, why a cleft lift is or is not appropriate, what alternatives exist, and what complications or recurrence remain possible.
5. Is there a clear plan for patients who travel?
Preoperative review, timing of the in-person examination, postoperative communication, drain or wound management, and safe return travel should be discussed before you purchase tickets.
Why Patients Consider Carolina RHI
Dr. Reza Rahbar is board-certified in colon and rectal surgery and general surgery. He completed general surgery training at Harvard Medical School’s Beth Israel Deaconess Medical Center and fellowship training in colon and rectal surgery at Louisiana State University.
His practice focuses on conditions involving the colon, rectum, anus, and surrounding soft tissues—including complex pilonidal disease. For each patient, the goal is to choose the least disruptive treatment that offers a durable path to healing.
At Carolina RHI, patients receive:
• Direct evaluation by a fellowship-trained colorectal surgeon
• Individual review of primary, recurrent, and previously operated disease
• A treatment plan based on anatomy rather than a standardized package
• Clear discussion of expected recovery, limitations, risks, and alternatives
• Coordinated follow-up for patients traveling to Cary, North Carolina
Planning Travel to Cary, North Carolina
Carolina RHI is located in Cary, near Raleigh and Raleigh-Durham International Airport. Patients considering travel from another state or country should contact the office before making travel arrangements.
Before your visit, our team may ask for prior operative reports, clinic notes, imaging, and other relevant records. Photographs should only be transmitted using the secure method provided by the practice. Depending on your location, medical licensing rules, insurance requirements, and the complexity of your condition may affect how the initial evaluation is performed.
Travel planning should account for:
• An in-person examination before surgery
• The need for a responsible adult on the day of an outpatient procedure
• A nearby place to stay if observation before return travel is recommended
• Restrictions on prolonged sitting, driving, lifting, or strenuous activity
• Drain care, if a drain is used
• A follow-up plan with Carolina RHI and, when appropriate, a clinician near home
Do not assume that it is safe to fly or drive a long distance immediately after surgery. The recommended timing depends on the operation, your health, your recovery, and the length of the trip.
What Is Recovery Like After a Bascom Cleft Lift?
Recovery varies, but the cleft lift is generally performed as an outpatient procedure with a closed incision. Patients usually walk the day of surgery. A temporary drain may be placed and removed after the drainage decreases.
Many patients can resume light daily activity relatively quickly, but return to work, school, athletics, and unrestricted sitting must be individualized. The most important goal is not simply a fast recovery—it is dependable healing without creating another chronic wound.
You will receive specific instructions about bathing, dressings, medications, drain care, physical activity, warning signs, and follow-up. Contact the surgical team promptly for fever, worsening redness, increasing drainage, wound separation, uncontrolled pain, or other concerns.
Frequently Asked Questions
Can a cleft lift work after previous pilonidal surgery has failed?
Yes. The cleft lift is often considered for recurrent disease and chronic nonhealing wounds. Prior operations may make reconstruction more complex, so an individualized examination is essential.
Is a cleft lift the same as removing a pilonidal cyst?
No. A simple excision removes tissue. A true cleft lift also reconstructs and shallows the natal cleft and places the closure away from the midline.
Does every patient need a cleft lift?
No. Treatment should match the extent of disease. Some patients need drainage of an acute abscess, conservative care, or a smaller procedure. Others benefit from definitive off-midline reconstruction.
Will I need to pack an open wound?
A cleft lift is normally performed with a closed, off-midline incision rather than a large open cavity. Individual operative findings can affect the final plan.
Can I travel to Carolina RHI from outside North Carolina or outside the United States?
Patients may contact Carolina RHI for an individualized review and travel plan. The timing of evaluation, surgery, postoperative observation, and return travel depends on medical, licensing, insurance, and logistical considerations.
How do I start?
Call Carolina RHI at 984-306-2011 or use the online scheduling link to request a consultation. Tell the office that you are traveling for evaluation of pilonidal disease, and do not purchase tickets until the clinical plan and timing are confirmed.
A Durable Solution Starts With the Right Evaluation
If you have recurrent pilonidal disease, a wound that will not heal, or a previous operation that failed, another routine excision may not address the reason the problem persists.
The first step is a careful assessment of the disease, the shape of the cleft, previous incisions, and your individual goals. From there, Dr. Rahbar can determine whether the Bascom cleft lift or another approach offers the best path forward.
Carolina Rectal Health Institute
600 New Waverly Place, Suite 203
Cary, NC 27518
984-306-2011
Medical references:
American Society of Colon and Rectal Surgeons. Clinical Practice Guidelines for the Management of Pilonidal Disease.
Pedersen N, et al. Distinct recurrence patterns according to disease manifestation in pilonidal sinus disease treated with cleft lift surgery at 5 years’ follow-up. Colorectal Disease. 2025;27(1):e17238.
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