Is it appropriate to ask for a Cleft Lift and not entertain suggested alternatives?

TillLater

New Member
I have been diagnosed with Pilonidal Disease. It was lanced. The local general surgeon I saw wanted to do an excision after the infection healed. I had already spent some time on this forum and I knew better; I said no way.

Fast forward a few months later and I have just scheduled an appointment with Dr. Elisa Birnbaum; she's a three hour drive away and she's on the Surgeon Hall of Fame for the Cleft Lift procedure.

I am going up there with the intention of scheduling the Cleft Lift procedure. Period. I can pull a few strings and get some antibiotics if the Cyst begins to flare up prior to my appointment, so it won't be inflamed and infected when I actually sit with her. In my head, I'm attempting to stay three steps ahead of any justifications for alternative procedures.

My question: Given that I have been diagnosed with a mild, one-sinus tunnel Cyst, is it appropriate to flat out ask her for the Cleft Lift? My Cyst bothers me everyday, even when it's not infected. I can't sleep on my back. I don't want any pit-picking or pit-picking-esque procedures. I'm not dealing with an open wound. I've sat quietly for months reading experiences from members of this community and I know what I want and I've done my research and there's a reason why I chose this surgeon.

Can patients do that? Request a certain procedure? What would be the reasons why surgeons who have a record of performing Cleft Lifts start with something else?

Because if Cleft Lift is the procedure that surgeons do when other procedures fail; screw it. I'd rather start with a marginally more invasive procedure and get it over with.

Thoughts? What would be the best way to word my request when we finally sit down in the exam room?
 
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Dr Immerman

Very Helpful
You should say that you've researched this, and want a cleft lift. Some surgeons feel that it is too aggressive a procedure as a first line. Others, feel that the most successful operation is best, even if it seems like a bigger operation than might be needed. It is OK to express your philosophy. If the surgeon can't go along with your request, it is your option to go elsewhere.

Dr Immerman
 

zaara

New Member
You should say that you've researched this, and want a cleft lift. Some surgeons feel that it is too aggressive a procedure as a first line. Others, feel that the most successful operation is best, even if it seems like a bigger operation than might be needed. It is OK to express your philosophy. If the surgeon can't go along with your request, it is your option to go elsewhere.

Dr Immerman

Hi dr immerman I've had this cyst for about 4 years now and started laser hair removal last year and have not had a flare up since but have a sinus opening so I will be getting cleft lift to remove the cyst and pits because I don't want to risk it coming back. I am very scared of the wound getting infected while healing from the surgery what is the chance of this and how can I avoid it?? Also if the wound gets infected does that mean the cyst is back and I need surgery again?
 

Dr Immerman

Very Helpful
I don't know the overall infection rate for the cleft lift, but in my clinic it is 2%. We use pre and post op antibiotics, antiseptics during the surgery, and place a drain. These things prevent infection. There is not that much that can be done after the surgery to prevent infection.

If the wound gets infected, that does not necessarily mean the cyst is back. It depends on how successful the cleft lift was at flattening the cleft, and moving the incision away from the midline. If both of those things were accomplished, it is just a wound infection that will resolve and does not represent new pilonidal disease.

Unfortunately, all "cleft-lifts" are not equal, and some are done more effectively than others. So, it is important to have it done by someone with a lot of experience.

Dr I
 

zaara

New Member
I don't know the overall infection rate for the cleft lift, but in my clinic it is 2%. We use pre and post op antibiotics, antiseptics during the surgery, and place a drain. These things prevent infection. There is not that much that can be done after the surgery to prevent infection.

If the wound gets infected, that does not necessarily mean the cyst is back. It depends on how successful the cleft lift was at flattening the cleft, and moving the incision away from the midline. If both of those things were accomplished, it is just a wound infection that will resolve and does not represent new pilonidal disease.

Unfortunately, all "cleft-lifts" are not equal, and some are done more effectively than others. So, it is important to have it done by someone with a lot of experience.

Dr I

Thank you so much I will be meeting my surgeon to ask more and have been very nervous thanks so much also my surgery is later this year so I was wondering if a cyst gets bigger or spreads if it is NOT infected or going through flare ups?
 

Dr Immerman

Very Helpful
It may or may not. Sinus tracts can develop in any direction and create openings far from the midline that then need attention, making the procedure more extensive. Some people are prone to this, but others do not develop sinus tracts at all. So, it's hard to know whether a delay will cause a problem in your case.

Dr I
 

dipcupcup

New Member
I have been diagnosed with Pilonidal Disease. It was lanced. The local general surgeon I saw wanted to do an excision after the infection healed. I had already spent some time on this forum and I knew better; I said no way.

Fast forward a few months later and I have just scheduled an appointment with Dr. Elisa Birnbaum; she's a three hour drive away and she's on the Surgeon Hall of Fame for the Cleft Lift procedure.

I am going up there with the intention of scheduling the Cleft Lift procedure. Period. I can pull a few strings and get some antibiotics if the Cyst begins to flare up prior to my appointment, so it won't be inflamed and infected when I actually sit with her. In my head, I'm attempting to stay three steps ahead of any justifications for alternative procedures.

My question: Given that I have been diagnosed with a mild, one-sinus tunnel Cyst, is it appropriate to flat out ask her for the Cleft Lift? My Cyst bothers me everyday, even when it's not infected. I can't sleep on my back. I don't want any pit-picking or pit-picking-esque procedures. I'm not dealing with an open wound. I've sat quietly for months reading experiences from members of this community and I know what I want and I've done my research and there's a reason why I chose this surgeon.

Can patients do that? Request a certain procedure? What would be the reasons why surgeons who have a record of performing Cleft Lifts start with something else?

Because if Cleft Lift is the procedure that surgeons do when other procedures fail; screw it. I'd rather start with a marginally more invasive procedure and get it over with.

Thoughts? What would be the best way to word my request when we finally sit down in the exam room?
Thinking of doing the same with Dr. Birnbaum. Any updates?
 
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