Cleft Lift Report; Surgery Date: 6/17/2021; Earl McAllister; Tampa, FL

NostalgiaSilver

New Member
Country flag
I had my cleft lift done on June 17, 2021 by Dr. McAllister on Tampa. He's on the list as one of the surgeons that perform the procedure in the United States.

I would like to provide a report of my recovery and help clarify some things that may be confusing about the procedure, the logistics, and also I can see from some previous posts that there was some unresolved confusion on the forums about the surgeon himself as well. Hopefully, this will help provide useful information if you're planning to have the cleft lift procedure done by Dr. McAllister or anyone else.

Background

My pilonidal was very minor. I had no pain as long as it didn't flare up. When it did flare up, it would hurt slightly. The first time it flared up was in January 2019, when I noticed it, and another time later that same year. In 2019 I saw a couple surgeons knowledgeable about the procedure and at the time, they both didn't want to do any operation on it (not cleft lift nor even pit-picking), because it was too minor. Which was a sensible recommendation.

I had no flare-ups after that until last month. It was a very minor flare-up that resolved on its own. Didn't even need a course of antibiotics like I used the first two times. However, it was a reminder that I still had this and this time I decided to seek another surgeon, living in Florida, that would do the procedure for a few reasons.

At first, I was planning on living in Florida long-term, and since there are a few surgeons in this state that do the procedure, I figured I could get it done anytime. However, that plan changed as I chose a different career path which both involves a lot of study-time the first few years and would involve me moving around a lot potentially the first couple of years until I get settled in the industry that I want to work in.

I just graduated in May and started work remotely for an organization based in Albuquerque, NM and I'll be moving there next end of July (my dad will come and help me move since I recently had the procedure done and I have a cat). Now, even though I don't plan to live there long-term, there are no surgeons there that perform the cleft lift. And even in the states that I plan to live in after that, there may be like one in each of those entire states. And I absolutely was not going to settle for closed or open excision.

I realized that it was going to be a much bigger hassle for me to get it done if I needed to in the next couple years especially as employers have us return to the office and me not being settled anywhere in particular. I would probably have to take more PTO and possibly pay a lot more too. It would also really distract me from my work studies. So I figured, it would be great if I could get it done now before I move while its easiest (only living 2 hours away from the surgeon, remote work, and living with roommates still for the next month since I'm finishing my college apartment lease), than deal with those logistical complications later.

First Visit

I told him about my situation. He took a look and said that the cleft lift would be good for me. He did say that I could wait if I wanted to, but he'd be willing to do the procedure if I wanted. He did warn though that even with the cleft lift being very reliable, still occasionally there are some people that struggle with the wound for a couple months or more. I asked him about pit-picking too, and he said that he didn't find it to be that effective so he just goes for the cleft lift now. Which is a fair opinion as I see a few other top pilonidal surgeons say the same thing, although they respect that some patients may want to try the minimally invasive technique first. I told him that I'd prefer to have the cleft lift done then ASAP before I move. He was willing to do that and we scheduled for June 17, 2021.

In this visit, I also want to address this aspect which I asked about.

Do I need someone to assist afterwards?
You do need someone to drive you to and from (Uber and Lyft don't count, and they do check). They also want someone to stay with you for 24 hours after the procedure as general anesthesia wears off. That said, with a JP drain (which McAllister uses), you should be self-sufficient in terms of wound care. I mean it can be tricky sometimes navigating back there, and I'm not flexible at all, but it was doable. If you have a JP drain, there's not much you need to do except cover the area where the tube comes out with a bandage, and blow-dry the area after taking a shower (I recommend a long mirror). My roommates were helpful in feeding my cat and taking care of the litter box since I didn't want to bend over out of an abundance of caution. I also used a grabber tool which was quite useful to avoid having to kneel down. But I was pretty much self-sufficient otherwise. Hopefully that helps for those of you who have no one to take care of you, I think it's quite doable aside from the driving and 24-hour thing.

Does he indeed perform the cleft lift?
I can see that some users in the past were questioning this or were concerned, but based on my consultation with him and surgery day and the aftermath, I am confident that I got the right procedure. The reason there is confusion or misunderstanding is because I believe that the front office there doesn't know about it, and often times (as you'll see later) the receptionists may not give correct information. But as long as you actually speak to Dr. McAllister himself, I believe you'll see that it's legitimate and that you will indeed get the correct cleft lift procedure.

Days Before Surgery

Since I didn't know what my recovery was like and how long it would take, I decided to get like 70-80% moved out of my apartment the day before. I got stuff into boxes, took out all the trash, got rid of all the items I didn't need anymore, etc. I also sold big heavy things I didn't need anymore. That way, it's easy the day I actually start moving (July 30), and my dad can easily put my stuff in my car or ship it through UPS the day he comes over. Additionally, I did some cleaning too.

I also tried to do some meal-prepping ahead of time, and looked at some generic guides on nutrition about what vitamins and foods to avoid beforehand and what foods to eat.

I also arranged with my friend who was going to drive me, and I will be compensating him soon with a very nice and expensive dinner for his assistance.
 

NostalgiaSilver

New Member
Country flag
Day of Surgery (6/17/2021)

I didn't get much sleep since I was busy getting stuff moved out of my room and handling other stuff. They collected my deductible and coinsurance payment, which came out to slightly over $600 not including the anesthesia (still need to get billed for that separately). Before insurance, it was around $2,000. I did ask a couple times beforehand to make sure everything was in network, including the anesthesiologist.

Probably the most nerve-racking time was when they got me in the hospital bed and hooked me up to the heart monitor and put IV in my hand to pump water in. The setting for water rate was actually pretty high so my forearm got kind of uncomfortable until a nurse turned it down. Since so much water was put into my system from that, I had to use the restroom at that point.

The anesthesiologist came over for a bit to talk, and I was actually waiting for this opportunity so I could address a concern that I always go over after reading incidents on the internet of this occurring. I always talk about mitigating the risk of mitigating anesthesia awareness anytime a family member or I undergoes surgery. I ask them, if they have it, whether they can use a BIS monitor (which can be a last line of defense in that situation). My mother had a hysterectomy last year, and after I asked, their team happily obliged to use it. The anesthesiologist here explained however that while they didn't have the BIS, it wasn't going to be an issue in this case since they weren't using a paralytic. So I wasn't going to end up in that nightmare scenario where I can't alert that I'm actually conscious under anesthesia and would be able to move around to indicate as such. Great news, as that was actually one of my main fears, after reading some horrible anecdotal accounts of that on Reddit.

Right before the wheeled me into the operating room, they made sure I knew the procedure I would be getting. One of the nurses actually pointed out I'm guessing to one of the new nurses there that sometimes it's referred to as the "Bascom Procedure" and how many patients travel for hours to have it done here since he's on the list, which was nice because it reassured me that I was indeed getting the procedure done that I was looking for.

After that, they just wheeled me in to the operating room. Then they started injecting the anesthetic and had me breathe deeply into the oxygen mask, and that was that. The next thing I knew, I was back where I started outside the operating room with a sore ass and a drain on me, which the nurses explained how to take care of. They said I was under for about an hour total. They had me sit in a wheelchair and brought me out to my friend's car. My coccyx cushion was ready to go in the passenger seat which I sat on. Then my friend got me Chipotle and my pain meds at Walgreens, which I had one of. I was in the car for a few hours with a few breaks here and there (being 2 hours away), which was probably not ideal, but it didn't cause any issues.

Dr. McAllister called me and told me I could remove the all the tape and bandages two days later, shower, and then just cover the site where the tube was coming out, and I didn't need to do anything else since glue was used. This is actually a part I was not fully clear on until my post-op appointment yesterday because I got contradicting information from the nurses and the front office that were talking about irrigating and packing the wound with gauze, which wasn't correct. That's really my only complaint honestly, but it's easily resolved as Dr. McAllister stays in touch with you through his cell number. I was able to ask him questions in text the following days whenever I wasn't sure about something, and that phone call with him clarified that I didn't need to do any wound packing or irrigation. So I recommend indeed following up with him about your post-op care.

Days After Surgery

Generally, pain was low. I only took two tablets of the prescribed pain medication total, and one was in the car. Otherwise, I pretty much just relied on 200 mg of NSAID twice daily, and occasionally 500 mg of Tylenol in the middle of the day if I was feeling extra sore. I was able to drive the next evening, albeit with the coccyx cushion and with careful entry and exit out of the car. Keep in mind, that you do have to be 24 hours free of having taken any prescription pain medication or anesthetic in your body.

My only scare really was the low-grade fever I had 5-6 days post-op. It started when I felt achy and got some chills. That's when I took my second tablet of the prescribed pain medication since the area was getting really achy. I checked and I was at 100 degrees. I took a shower and then I was at 99.5 degrees. Then I slept and most of the night I was at 99 degrees. I did text Dr. McAllister in the morning as I was quite concerned that it was the beginning of an infection. He had me send him a picture of the drain and said it was fine and there was no sign of infection. The low-grade fever too resolved itself and I didn't get it again. Honestly, I don't know what happened there.

I had a lot of anxiety around bowel movements, especially wiping. First, you think you're going to poop all over the bandages (if they're still there). Then, at least I was, concerned about contaminating the stitched area while wiping. All I can recommend is using small pieces of toilet paper, being careful and precise, and not wiping towards the incision. I also recommend stool softeners. I got some hemorrhoids too which was really annoying, but I used PreparationH (the store brand version) and it helped.

Personally, as an extra precaution, I really tried to shower (at least the area) after every bowel movement and rinsed the whole area off. There were a couple times when I couldn't, but generally I did. I would then blow dry the area, then put a large bandaid over the JP tubing exit site and secure with a piece of adhesive medical tape. Care for the JP drain was straightforward. Towards the end, I had some old blood clots going into it, but the surgeon said that was normal when I showed him. I recommend you buy a couple boxes of large bandaids, adhesive tape, keep scissors, and have a blow-dryer with a cool air button or setting. Also a good mirror, preferably both a long one and a makeup mirror. I used these tools daily to help maintain the area.

I spent a lot of time laying around. I slept a lot the first few days. But I could sit if needed with my coccyx cushion. I believe, some amount of sitting is actually good because it helps push fluid out. I could also walk around. It was definitely doable to work from home, and do simple chores. I avoided lifting anything heavy and if I had to pick up something from the ground, I either kneeled so I wouldn't have to bend or used the grabber tool (very useful). I tried to avoid putting too much force on that area with straining or quick jerky movements. At 8 days post-op, I noticed a significant reduction in pain and soreness.

First Post-Op Appointment (6/29/2021)

JP drain was removed. Stitches were removed. He said everything looked great and that I was healing quickly. At first, he thought I was 3 weeks post-op, I suppose based on how quickly I had healed. I had a bunch of questions that I asked him in regards to restrictions on activity, care for the area, and other logistical things. He thinks that in mid-late July, I'll be able to do things like lift heavy boxes if I need to (I asked with respect to moving just in case), though I personally probably won't unless it's necessary just out of an abundance of caution.

The area was a little more sore again for a day after that, but I noticed another dramatic improvement today. I've stopped using the coccyx cushion (he said I don't need to use it anymore) and even sitting for extended periods of time isn't giving me much soreness anymore. Additionally, I'm getting a better idea of how the area looks and feels now, and I can tell that where there used to be a pretty deep valley, that area is quite flattened and shallow now - which I believe is the point of the cleft lift because it makes the area inhospitable for future pilonidal sinuses. Right now I have a tiny suture at the top and bottom which he will remove at my next appointment on July 21, 2021 (which I set in the first place because I want to really make sure everything is good after healing has mostly completed before I move to the other side of the country).

Overall, I have to say I'm quite impressed both from the procedure and my body's ability to heal and recover quickly. I'll be giving updates in the future as well about how things are going. But everything seems like it's going really well. Hopefully, this also helps you prepare for your cleft lift surgery, as well as give you some further clarification if you're specifically seeking Dr. McAllister to do the cleft lift. I believe he's a great option if you're in Florida.
 
Last edited:

Momo Baggins

New Member
Country flag
Hey hey, I got my cleft lift done on June 17 as well! Cheers! It was interesting to read the similarities and differences in our experiences (this was a very thorough and informative post, btw)... My disease wasn't as minor as yours but would probably be considered moderate. I had a few very painful flareups (two of which required draining, 3 of which went away with just antibiotics) but decided, like you, to be proactive and get the cleft lift while I have the money saved and a job with good insurance. I had my procedure done by Dr. Immerman in Wisconsin who does the Bascom lift, but it sounds like yours may have been a little different. All of my sutures were internal and dissolvable and the entire length of the incision on the outside was reinforced with steri-strips. [The strips came off about 2.5 weeks post-op and my incision was already 80% scar at that point, much to my surprise.] I also had a JP drain. While I had my boyfriend with me to help, I do agree that it's pretty manageable by yourself if you don't have someone to assist. He did help immensely with lightening the mood, though.

The most painful day for me was day 4, I was able to get the drain removed (I drained very little) which was very quick and only mildly uncomfortable, but the second we got out to the car I got a surge of pain. I'm assuming this was from the tissue inside now squishing together where 4 inches of tube had just been. We had a 9 hour drive back to Michigan that was pretty hellish. We stopped probably 4 times so I could walk around and give my ass a break. I actually found my coccyx cushion to be MORE uncomfortable. Around the 10 day mark I was feeling significantly better and had most of my mobility back as far as stretching and bending goes. But as of today, at almost one month post-op, I'm still struggling to lay on my back. I can do it for about 10 minutes before the discomfort starts to set in. It's nothing extreme but enough to make me roll over.

It was a strange experience gazing upon my new anatomy once all of the bandages were off. I'm not particularly vain, especially not about my butt, so I don't care how it looks but it does feel different when I walk sometimes as well. I'm also really happy with how everything went, from the manner of the surgeon and nurses to the whole healing process. The human body is an incredible thing. I hope your healing continues to improve every day!
 
Top