Mild case but want to get this taken care of ASAP: weighing my options. Please help.


New Member
First of all I would like to say the quality of thought and analysis on this website is higher than anywhere else I've seen on the internet since about 2010. I'm glad the internet can serve people even if it takes some inflamed asscracks to make that happen.

The purposes of this post is only to bring new ideas to my upcoming doctor's appointment and I will not do anything suggested here without consulting my doctor. I am not soliciting medical advice, only soliciting medical stories and hypothetical "if I were you but I'm not so talk to your doctor first blah blah blah."

I have done lots of research so far. I am familiar with Dr. Immerman, Wadie, Sternberg and Bascom. I am familiar with the treatment options which are management, draining/lancing, gips, pit picking, wide excision with open wound, cleft lift. I have read the directory of surgeons.



26/M hairy but not like some guys. Ass crack isn't too deep. Have had saccral dimple my whole life, I think I had the pit before but thought it was the dimple. Have been doing some serious horseback riding past two months which I think caused it. Noticed mild pain when rolling up from my back, had to roll around the area on a cheek. Doctor prescribed penicillin which did absolutely nothing. No idea why he did this. At this point I'm not really in much pain, can still sit indefintiely, etc. But I now know it's definitely a small pilonidal cyst/abscess. My quality of life is basically unchanged at this point but I've decided to deal with this ASAP as it looks like it can get worse and luckily (or unluckily haha), I'm close to my out of pocket maximum already and Immerman is in-network and they already pre-approved me. I have also mentally parted with the funds already as this is the exact type of thing my apocalypse fund is for. It's actually good that it is going to use.

My GP told me I need to go to the ER right now and get it lanced. Then get a wide excision with open wounds. I immediately thought "there must be a better way" so I told him then he got very pissed off and hit me with the "I am a doctor you should listen to me." There's no way I'm the first patient he's ever had offer him something alternative, so I'm surprised he got emotional so quickly. I don't even live in his town anymore so I'm ditching that MD. He's a good guy though.

I then found this website. I can see no reason for wide excision basically ever. I am optimizing for no recurrence, easy recovery, low cost, just like everyone else. No recurrence is the most important of those.

I have urgent work-related travel coming up from September 1 so want to have this either done or postponed with high peace-of-mind by August 24 at the latest. I know these restrictions are not always realistic with health things, but this would be icing on the cake.

But basically, considering my quality of life has not really suffered that much yet, do I even need surgery? Should I just get it lanced and wait to see what happens? Dr. Immerman's website says they almost usually just keep progressing but obviously, he has a financial interest in the cleft lift. Not saying he's a bad MD or anything like that, because the cleft lift would almost certainly heal me for good so I think he has every right to suggest that. Dr. Immerman himself also said pit picking in my case might not be a bad idea but he just doesn't do it because they're not as permanently good as cleft lift. So I see where he's coming from.

From what I've read cleft lift recovery isn't that bad at all. I might not even miss more than one week in the gym.

Right now I have four options:

1. Commit to Dr. Immerman and get it done (photo pre-approved but he said I could also be candidate for pit picking which he does not do). Immerman has already gotten my insurance to OK it and he can fit me in at the optimally convenient time for my work/life schedule.

2. Consultation with Dr. Wadie (I live in NC but honestly don't mind flying). Consultation with Dr. Wadie will not include surgery and I might have to then wait for that, which I really cannot do with my work schedule.

3. Lance it at urgent care locally and see what happens.

4. Do nothing and continue with hygeine + tea tree oil and then go on my 6 months of work travel, and hope nothing bad happens while I'm out. I do know there are people in the UK and Benelux who can do this, potentially for cheaper. Potentially for free, though that would be dishonest toward their countries healthcare systems (even though I did pay an NHS surcharge when I did a Master's there, but I digress) so that would be only an absolute last resort.

Thanks everyone for reading this. After I pick a plan and execute, I have committed to spending just as much time helping others as I have spent soliciting help on here.


New Member
Update: I cleaned and band-aided the abscess before bed last night and within 12 hours it is visibly smaller and less red, and the band aid did not have that much blood on it when I re band-aided it just now. I'm going to throw tea tree oil into the mix soon and manage it for now.


New Member
23/F with no “typical” risk factors either

I first had a pilonidal abscess in 2014, where I had it lanced once and then it laid dormant for almost six years. This March, another abscess formed. I teach, so it was incredibly painful and obviously in the way. I had it lanced then because it was right when COVID-19 started increasing in the US, and where I lived in Texas was/is a “hot spot”. Plus, my last one lasted me six years, so why not? Then, another abscess formed in June after I took a long road trip home to visit. Had it lanced again. When I returned to Texas, I did a ton of research and decided a Bascom cleft lift (BCL) was honestly the best option for anyone, so long as the surgeon is trained in it and has an individual high success/low recurrence rate. I found the database on this forum that listed surgeons who performed the BCL, and found one in North Texas. I had the surgery performed last Friday, and so far - so good.

Honestly, I wished I had this surgery performed when I first was diagnosed. Based on multiple studies and peer-reviewed journals, plus the plethora of stories/experiences on this forum alone, I figured the BCL was my best option in terms of cost efficacy, least amount of time in recovery, and least chance for recurrence...the trinity of success in beating this, I suppose. From someone who has a “mild” case, too, if I were you, I’d take care of it sooner rather than later. You never know when an abscess would flare up, and it sounds like you have a good amount of time if you get the surgery done soon. Best of luck!