Butt Seriously Readers: Click Here to see Dr. Evan Goldstein’s PG-13 Demo of Anal Dilation

Toggle Menu



Pilonidal cysts are pockets of tissue that are usually filled with hair, fluid, or air. These cysts can cause a localized infection, abscess, or both. We specialize in treating and removing pilonidal cysts that refuse to heal. Visit our NYC office or give us a call for more information.

BOOK CONSULTATION (212) 206-1501

Table of contents

Do you have a recurring problem with ingrown hairs at your tailbone or between your buttcheeks? Learn about pilonidal cysts today to see if you need medical attention for your long-term butt pimples. Bespoke Surgical is an elite anal surgery practice in NYC that features pilonidal cyst specialists, so we’re equipped to help you. Schedule an appointment today.

What Is A Pilonidal Cyst And What Are Its Causes?

Pilonidal cysts are pockets of tissue that are usually filled with hair, fluid, or air. They are typically started by loose hairs that have punctured the skin. The body reacts to form a cyst in order to try and force out the hair. Friction, tight clothes, or sitting for long periods of time can all cause a pilonidal cyst.

How does this happen? According to Dr. Goldstein, a cyst on top of the butt crack area occurs because of its hair and deep creases. Localized friction from normal daily activities rubs repeatedly, like sitting and walking. This, in turn, causes a hair follicle to become ingrown, instead of growing out normally. The follicle tracks its way into the depths of the skin crease, which causes a localized infection, abscess, or both.

Talk about a literal pain in the ass! And one doesn’t necessarily have to have a hairy ass for this to occur, though an abundance of hair is a major predisposing factor. Another cause can be that one has coarse hair that just so happens to be in the perfect spot which leads to this bothersome condition.

What Are Pilonidal Cyst Symptoms?

Generally, patients will feel a painful cyst on their buttocks crack. Most people gradually feel tenderness and pressure over the tailbone and don’t really know what to make of it. However, you should seek medical attention if you experience any of the following:

  • If the area is inflamed or feels tender.
  • Pain that worsens when sitting.
  • An abscess with draining pus or blood, which may have a foul odor.
  • Nausea, fever or fatigue.

Pilonidal Cyst Risk Factors

  • Coarse body hair, especially in the buttocks area
  • Being overweight/obese
  • Excessive sweating, especially in the buttocks area
  • Pressure in the buttocks area from long periods of sitting or tight clothing
  • Family history of pilonidal cysts

What Is Pilonidal Disease?

Pilonidal disease is a chronic skin condition where people face repeated issues of pineal cysts in posterior pelvic areas. It is indicated by one or more sinus tracts, which are cavities with a narrow opening on the skin surface. In most cases, the cavity is filled with nests of hair. A non-inflamed lump is known as a pilonidal cyst, but if the sinus becomes infected a pilonidal abscess may form.

How to Treat a Pilonidal Cyst

If caught early, pilonidal cyst treatment starts with simple techniques. Warm baths or warm compresses can decrease the localized infection. If it’s a recurring problem or isn’t healing, you’ll want to consider taking further action.

Preventative measures like laser hair removal in the patch of one’s butt-crease and padding on hard seating may be just what is needed to decrease recurrence.

If you want to take further steps, consider investing in a pubic hair care kit specially designed to reduce ingrown hair in your buttcrack.

When Do I Need Pilonidal Cyst Surgery?

If your pilonidal cyst doesn’t heal, you’ll want to see a doctor. Pilonidal disease that is painful or infected needs medical attention as well.

In short: if you have a hair follicle (a dimple or pimple on the crease) and a tract/abscess that is constantly draining secretions, then something needs to be done surgically.

How Long Does a Pilonidal Cyst Surgery Take?

An average pilonidal cystectomy takes around 45 minutes. Pilonidal cyst drainage is imperative for the initial treatment of an abscess. The key is to make sure you see a surgical specialist who focuses on the appropriate placement of the incision. Strategic placement not only will lead to the immediate resolution, but also will allow for the minimization of the amount of tissue needed for the subsequent surgical excision. One will feel so much relief with this drainage and then, of course, the addition of antibiotics. We like to note that for this procedure, local anesthesia in the region has limited efficacy due to the localized inflamed tissues.

Post-procedure, the drainage cavity is irrigated and then packed. Patients are advised to take baths the evening after the procedure and then daily to assist in improvement. With the antibiotics and the local cleaning routine, all should improve within a few days.

The usual protocol is to schedule a follow-up appointment about two weeks post-incision and drainage, and then plan for the future subsequent excision. This usually is warranted as the above drainage just takes care of the abscess, but fails to remove the actual pilonidal hair follicle, which is the cause of the issue at hand.

Pilonidal Cyst Surgery Recovery

Now, because it’s natural for this cyst to be chronically infected, there is a chance of a post-operative infection after pilonidal cyst surgery. Most surgeons not only give antibiotics in the operating room and irrigate the wound with antibiotic solution, but also give pills post-operatively to decrease the chance of reinfection. That said, with the usual offset to midline incision, you may get central wound opening that clearly is a preferred outcome versus leaving the entire wound open. Dr. Goldstein usually discusses with his clients that he would rather have a small opening that will heal quickly with in-office tactics, than have ones entire excised cyst cavity left open. For the most part, these heal quite well and rather easily, with the post operative pain being no different than the pain experienced when it was present.

After a successful complete excision, the pilonidal cyst removal wound is evaluated a week or so post-surgery and the staples are removed partially or fully at that time, if appropriate. Initially, one will be gentle with pressure-causing maneuvers so as to not separate the closure. Due to this particular region of the body, it can indeed still occur. Once everything has healed, in order to prevent recurrence, most clients get laser hair removal in the patch of the ass crack. This, along with proper pressure reducing mechanisms, allow for decreased recurrences of this pain in the ass, also know as a pilonidal cyst.

Pilonidal Cyst Removal Surgery Recovery Time

How long it will take for you to heal depends on the way your surgery was done. If the incision was closed, it will probably take about 4 weeks to completely heal. If your incision is left open, it may take from a few weeks to several months to heal and scar over. Most people can go back to work and most activities after 2-4 weeks.

Pilonidal Cyst Removal Services at Bespoke Surgical

Bespoke Surgical is uniquely equipped to handle your booty with care. A lot of people see dermatologists as the first line of evaluation and treatment, yet from Dr. Goldstein’s experience, most do not go deep enough on their excisions to remove the entire cyst.

Also, most chronic cysts need both local anesthesia and sedation for complete excision because the pimple that one sees is just the tip of the iceberg the full pilonidal cyst is quite large. Dr. Goldstein usually informs his clients that the incisions themselves can be quite large, larger than one may think. Our office is prepared with the know-how and equipment to extract the entire cyst.

With appropriate surgical techniques, offset to the midline incision and tissue transfer or excision with a rotational flap, one should achieve appropriate removal and closure as a one-stage procedure. This is why it’s imperative one sees a surgeon who performs a lot of these each year with full knowledge of the most up-to-date pilonidal cyst removal techniques. If you’re located in or near New York City, Bespoke Surgical might just be the practice for you.

We offer pilonidal cyst removal surgery at our New York City location. To schedule your consultation, contact us today.

Ready to become a client?

New Client Appointment

“During finals week of my sophomore year at NYU, you know, the time when you sit amongst the quiet stacks of books in the library for hours on end in the most uncomfortable desk chair, I started to literally feel a pain in my ass. It took me a few days to ascertain if it was coming from my actual asshole or a region in close proximity. After my go-to pain reliever, Advil, did nothing to minimize any pain and I started to develop more symptoms – a fever and localized swelling. I realized that it was from an infection in the area around my tailbone. Fuck, what a burden!

I did some Googling (after all, who doesn’t?) and realized it was indeed a pilonidal cyst. Yet, I must admit, I did need some assistance on the actual pronunciation of my new found friend. I subsequently took all the advice of warm baths and cushioning my seats, and managed to get an appointment with Dr. Goldstein for an evaluation. He confirmed Google’s diagnosis and, before I knew, it was all drained. That itself hurt just as much as the pilonidal cyst itself, but my symptoms abated almost immediately and I was finally able to study and pass all my exams.

Once things settled down, unfortunately, it became a chronic issue associated with persisting drainage, so Dr. Goldstein decided to perform a surgical procedure for excision of the entire cyst, tract, and all that came with it. While this may seem daunting, the procedure was straightforward and healed normally. Per Dr. Goldstein’s suggestion, I got laser hair removal, which has so far prevented any recurrence and now I am back to those fucking hard chairs studying for my doctorate. Now I come prepared with a cushion, though.”



Dr. Evan Goldstein, D.O.

Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, NYC’s leading sexual health private practice. He received his osteopathic doctorate from the University of Medicine and Dentistry School in 2002 and completed his residency in General Surgery at Maimonides Medical Center. In 2020, he was named one of NYC’s top LGBTQ+ business leaders by Crain’s New York and he is involved with GLSEN, ACRIA, HRC, and Callen-Lorde’s Howard J. Brown Society. All of these experiences and affiliations have shaped his whole-life approach towards the practice of private surgical care and sexual wellness.

Read More       Dr. Evan Goldstein’s NPI record  Click to send an email to egoldstein@bespokesurgical.com



How Many Dating App Matches Does It Take To Find A Hookup?

When it comes to finding a hookup on dating apps, it’s truly a numbers game....

Learn More


The Landscaping “Down There” Survey

What does the modern American’s hair removal routine really look like and what’s the motivation...

Learn More


The Nudity Confidence Survey

The recent Vanderpump Rules drama has captivated audiences in the reality TV universe and shined...

Learn More