Surgical procedures are increasingly integrated into HS care, regardless of disease severity. With many surgical options now considered earlier in treatment—alongside medication—it’s important to remember that no two surgeries or patient experiences are alike. Procedures are tailored to individual needs, so keep an open mind!

Modern Operating Room: Sterile Surgical Table Awaits Under Bright Lights

Is Surgery Right for You?

Choosing surgery is deeply personal. While it’s not a “cure” for HS, it can significantly improve quality of life by reducing pain, drainage, and recurrent flares—helping you reclaim comfort and confidence.

Set realistic goals: Focus on symptom relief and improved daily function, not total elimination of HS. Success looks different for everyone!

Finding the Right Surgeon

Start with a qualified surgeon experienced in HS—whether a general surgeon, plastic surgeon, or dermatologic surgeon. Key considerations:

  • Ask about their HS-specific experience (number of patients treated, preferred techniques).
  • Ensure they help you define clear goals for surgery (e.g., pain reduction, improved mobility).
  • Advocate for yourself: You’re under no obligation to proceed if uncomfortable with their approach. Second opinions are valid and encouraged!

Procedural Options

Incision and Drainage (I&D)

  • Purpose: Temporary relief for severe, painful abscesses.
  • Limitations: Nearly 100% recurrence rate. Avoid for perianal abscesses (risk of fistulas).
  • Post-Care: Cover with gauze; no need for packing.
  • Tip: Seek HS-informed dermatologists over ER/urgent care for this procedure.

Mini or Full Deroofing/Unroofing

  • Best For: Recurrent nodules (mini) or Stage I-II HS (full).
  • Process: Removal of abscess “roof” and biofilm, leaving wounds open to heal from the inside out.
  • Benefits: Minimal scarring, reduced recurrence by replacing HS-affected tissue with scar (no hair follicles).
  • Example: https://hsconnect.org/deroofing-videos/

CO2 Laser Marsupialization

  • How It Works: A laser acts like a precise “knife,” vaporizing diseased tissue while sparing healthy skin.
  • Flexibility: Can be done under local or general anesthesia.
  • Healing: Left open to heal naturally (secondary intention).

Wide Excision Surgery

  • Best For: Severe, localized HS with tunneling.
  • Process: Removal of all diseased tissue and scar, leaving wounds open to heal.
  • Reality Check: While effective for targeted areas, it won’t prevent new flares elsewhere.
  • Success Stories: Many patients report years of relief post-surgery.

Avoid Primary Closure: Closing wounds with stitches/staples traps disease, increasing infection and recurrence risks.

Skin Grafts/Flaps

  • Use Sparingly: Typically for complex wounds (e.g., near genitals).
  • Risks: Grafts/flaps may fail, require donor-site recovery, or complicate future surgeries.
  • Discuss Thoroughly: Ensure the benefits outweigh risks for your case.

Gland Removal? Think Twice!

  • Myth Alert: HS is not a gland disease. Surgeons claiming gland removal is necessary likely lack updated HS knowledge.
  • Fact: Sweat glands are tiny and incidental in HS surgery—focus on removing diseased tissue, not glands.

Why Surgery Might Fail

  • Inexperienced surgeon.
  • Incomplete removal of diseased tissue/tunnels.
  • Premature wound closure or inadequate excision depth.

Success Stories & Real Talk

While some share negative experiences, many patients report years of relief post-surgery—even if HS eventually recurs. Balance research with hope!

Additional Resources

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