i had a pilonidal abscess for years and just thought it was a recurring pimple that headed up and drained every month or two. finally i got tired of it and wanted it removed. dermatologist referred me to a surgeon. the surgeon did a z-plasty on me right out of the gate as a first surgery (2 weeks ago before i found this site). i have very little natal cleft midline indentation remaining. i wonder if this is permanent or will my natal cleft reform as time passes? i don't plan on doing any nude modeling so i don't think it's that big a deal. i have since found this site (the surgery was 2 weeks ago and i didn't know about this site then). from what i can tell from the info persented on this site, a z-plasty seems to be an unusual choice as a first surgery. do any of the experienced members here have any thoughts on a z-plasty right out of the gate? i'm a little older than average for this disease (38 YO). it might have formed later for me because i got seriously into weighlifting at around age 32-- and my glutes and hamstrings grew much larger than ever before because of heavy leg and squatting workouts. this added weight to the tissues pulling on the sacrum which caused the usual stretched folicles that start the disease. anywho, it's only a guess. who knows really. when the whole thing is healed, i hope to write up my experience for the "personal stories" page.