Hidradenitis Suppurativa Surgery - HS Excision, Abscess Treatment

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How Surgical Treatment Can Help

Break the Cycle of Flare-Ups

By removing the affected tissue where HS originates, surgery can significantly reduce or eliminate recurrent painful flares in treated areas.

Relief from Chronic Pain

Many HS patients live with daily pain. Surgical treatment addresses the source, providing relief that medications alone often cannot achieve.

Improved Quality of Life

HS affects every aspect of life—from clothing choices to intimacy to career. Effective treatment restores the freedom to live without constant limitation.

Potential Insurance Coverage

Unlike cosmetic procedures, HS surgery is a medical treatment that may be covered by PPO insurance plans. Our office can assist with benefit verification.

Expected Results

Surgical treatment for hidradenitis suppurativa can provide significant, lasting relief—but it's important to understand both what surgery can and cannot accomplish. Dr. Neavin provides honest expectations so patients can make informed decisions.

Elimination of Disease in Treated Areas

When affected tissue is completely excised, HS does not typically recur in that specific location. However, HS can develop in other areas, so surgery addresses existing disease rather than "curing" the underlying condition.

Significant Pain Reduction

Most patients experience dramatic improvement in pain levels following complete healing. The chronic, daily discomfort from active HS lesions is eliminated in treated areas.

Trading HS Damage for Surgical Scars

Surgery involves an exchange: the irregular, often disfiguring scarring from HS is replaced with planned surgical scars. While scars remain, they are typically more predictable and often less symptomatic than HS damage.

Patient Stories

5-Star Experiences

“

I suffered with HS for over a decade. Dr. Neavin was the first doctor who really listened and offered a real solution. The surgery changed my life—I can finally wear what I want and not be in constant pain.

— HS Surgery Patient

"After years of antibiotics and failed treatments, surgery gave me my life back. Dr. Neavin was compassionate and honest about what to expect. I wish I had done this sooner."

— Hidradenitis Suppurativa Patient

Surgical Treatment Options for Hidradenitis Suppurativa

The surgical approach depends on disease severity, location, and extent of involvement. Dr. Neavin evaluates each patient individually to determine the most appropriate technique for their specific situation.

Incision and Drainage

For acute, painful abscesses, incision and drainage provides immediate relief by releasing accumulated pus. However, this is a temporizing measure rather than definitive treatment—the underlying disease process remains, and recurrence is common.

This approach may be appropriate for managing acute flares but does not address the chronic, recurring nature of HS. Dr. Neavin typically recommends more definitive treatment for patients with established disease.

Deroofing (Unroofing)

Deroofing involves removing the “roof” of sinus tracts and tunnels while preserving the floor, allowing wounds to heal from the base up. This technique is useful for patients with interconnected tunnels beneath the skin surface.

The procedure preserves more tissue than wide excision and may be appropriate for moderate disease. Healing occurs by secondary intention (the wound gradually fills in) or with skin grafting.

Wide Local Excision

Wide excision removes all affected tissue along with a margin of healthy tissue to ensure complete disease removal. This is the most definitive surgical treatment and offers the lowest recurrence rates in treated areas.

For advanced HS (Hurley Stage III) with extensive scarring and tunneling, wide excision may be the only approach that provides lasting relief. The resulting wound may be closed primarily, left to heal by secondary intention, or reconstructed with skin grafts or flaps.

Reconstruction Options

After excision of HS tissue, reconstruction depends on wound size and location. Options include primary closure (directly suturing the wound), healing by secondary intention (allowing the wound to fill in naturally), skin grafting (transplanting skin from another body area), or local tissue flaps.

Dr. Neavin’s plastic surgery expertise allows him to select the reconstructive approach that optimizes both function and appearance while ensuring complete healing.

Patient Profile

Candidates

Ideal Candidates

Have been diagnosed with hidradenitis suppurativa by a dermatologist or physician
Have moderate to severe disease (Hurley Stage II or III)
Have not achieved adequate control with medical management alone
Experience recurrent, painful flares that significantly impact quality of life
Have developed tunneling, sinus tracts, or significant scarring
Are motivated to follow post-operative care instructions for optimal healing
Are non-smokers or willing to quit (smoking significantly impairs healing)
Are in otherwise reasonable health for surgery

Not Ideal Candidates

Have mild disease (Hurley Stage I) that may respond to medical treatment
Have not yet tried appropriate medical therapies
Are active smokers unwilling to quit
Have uncontrolled diabetes or other conditions that impair wound healing
Have unrealistic expectations about scarring (surgery trades HS damage for surgical scars)
Are not committed to lifestyle modifications that support healing

Estimated Investment

$5,000 - $20,000+ (varies significantly by extent)

The cost of hidradenitis suppurativa surgery varies considerably based on disease severity, areas involved, surgical technique required, and whether reconstruction (such as skin grafting) is needed. Patients with limited disease may fall at the lower end of this range, while those with extensive involvement requiring staged procedures will be at the higher end. Important: HS surgery is a medical procedure, not cosmetic surgery. Unlike most procedures at our practice, surgical treatment for hidradenitis suppurativa may be covered by health insurance. Our office accepts PPO insurance plans and can assist with benefit verification before your consultation. We will provide documentation and work with your insurance company to seek coverage for your treatment. HMO plans are not accepted. For patients without insurance coverage or with high deductibles, we offer payment plans to help make treatment accessible. The cost of surgery must be weighed against the ongoing costs of managing uncontrolled HS—including medications, wound care supplies, lost work time, and the immeasurable cost to quality of life. Please call our office at (310) 858-8811 for a no-obligation insurance benefit assessment.

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Understanding Hidradenitis Suppurativa

What Causes HS?

Hidradenitis suppurativa begins with blockage of hair follicles and apocrine sweat glands, leading to inflammation, infection, and eventually the formation of painful nodules, abscesses, and tunnels under the skin. While the exact cause isn't fully understood, there appears to be a genetic component—HS often runs in families. The condition is NOT caused by poor hygiene, and patients should never feel ashamed or blamed for their disease. Contributing factors may include obesity, smoking, hormonal influences, and immune system dysfunction. HS most commonly affects areas where skin rubs together: armpits, groin, under the breasts, and between the buttocks. It typically begins after puberty and can persist for decades, often worsening over time without appropriate treatment.

Surgery Day Journey

Pre-Operative Preparation

Before surgery, you'll have detailed consultations to plan your procedure. The affected areas are mapped, and the surgical approach is determined based on disease extent. You may need pre-operative medical clearance depending on your health history. Instructions regarding medications, smoking cessation, and wound preparation are provided.

Day of Surgery

You'll arrive at our accredited surgical facility and meet with the surgical and anesthesia teams. Depending on the extent of surgery, you'll receive local anesthesia with sedation or general anesthesia. Surgery duration varies from 1-3+ hours based on areas treated and reconstruction required.

The Surgical Procedure

Dr. Neavin carefully excises all affected tissue, including sinus tracts and tunnels. Margins are assessed to ensure complete removal. The wound is then managed according to the predetermined plan—primary closure, healing by secondary intention, or reconstruction with grafts or flaps.

The Artisan Promise

Comprehensive
Aftercare Support

Proper wound care is critical for successful HS surgery outcomes. Dr. Neavin's team provides detailed guidance and ongoing support throughout your healing journey.

Wound Care Management

Wound care requirements depend on your specific procedure. Patients may need daily dressing changes, wound packing, or specialized wound care techniques. Detailed written and verbal instructions are provided, and our team is available for questions. Some patients benefit from home health nursing visits for complex wound management.

ctivity and Lifestyle Modifications

Activity restrictions protect healing wounds and vary by surgery location and extent. Smoking cessation is absolutely essential—smoking dramatically impairs wound healing and increases complication risk. Weight management and friction reduction in affected areas support long-term success. Loose, breathable clothing helps during recovery.

Follow-Up Care

Regular follow-up appointments monitor wound healing and address any concerns. Dr. Neavin tracks your progress closely, adjusting wound care as healing progresses. Long-term follow-up monitors for any recurrence and addresses new areas if needed. Coordination with your dermatologist continues for ongoing HS management.

Healing Timeline

Every patient heals differently, but this timeline offers a general guide for your return to daily life.

Week 1-2: Initial Healing Phase

Recovery varies significantly based on the extent of surgery and reconstruction method. Wounds require careful management with dressing changes as directed. Pain is managed with medication and typically improves daily. For wounds healing by secondary intention, expect drainage that decreases over time. Activity is limited to protect healing tissues. You'll have follow-up appointments to monitor wound healing.

Weeks 3-6: Progressive Healing

Wounds continue to contract and heal. Patients with primary closure or skin grafts may have sutures removed during this period. Those healing by secondary intention continue wound care with gradually decreasing dressing changes. Light activities can typically resume as approved by Dr. Neavin. Pain continues to diminish as healing progresses.

Months 2-3: Approaching Wound Closure

Most surgical wounds achieve significant closure by this point, though healing by secondary intention may continue. Physical therapy may be recommended for procedures in areas affecting mobility (armpits, groin). Patients can gradually return to normal activities. The absence of active HS symptoms becomes increasingly apparent.

Months 4-12: Scar Maturation and Final Results

Complete wound healing and scar maturation continues for up to a year. Scars typically start red or pink and fade over time. Scar massage and silicone treatments may be recommended. Most patients report dramatic improvement in quality of life compared to living with active HS. Follow-up monitors for any recurrence.

Safety &
Potential Risks

Surgery for hidradenitis suppurativa carries risks that must be weighed against the significant impact of living with uncontrolled disease. Dr. Neavin discusses all potential complications thoroughly so patients can make informed decisions about their care.

Important Considerations

Wound Healing Complications: HS surgery involves treating already-compromised tissue, and wound healing can be challenging. Delayed healing, wound separation, or infection may occur. Smoking, diabetes, and obesity increase these risks significantly.
Scarring: Surgical scars are unavoidable. While scars from planned surgery are typically more predictable than HS scarring, they will be permanent. Scar appearance varies by individual healing characteristics.
Recurrence in Treated Areas: While uncommon with adequate excision margins, HS can occasionally recur at the edge of treated areas. New disease can also develop in previously unaffected locations.
Skin Graft Complications: When skin grafting is required, partial graft loss can occur. This typically heals with additional wound care but may require secondary procedures.
Restricted Range of Motion: Depending on location and reconstruction method, some temporary or permanent limitation of movement may occur, though surgery often improves mobility compared to advanced HS scarring.
Bleeding and Infection: Standard surgical risks apply. Meticulous technique and appropriate antibiotics minimize these risks.
Need for Multiple Procedures: Patients with extensive disease may require staged procedures to address all affected areas safely.

Frequently Asked Questions

Will surgery cure my hidradenitis suppurativa?

Surgery removes the affected tissue in treated areas, and HS typically does not recur in those specific locations when excision is complete. However, HS is a systemic condition, and new disease can develop in other areas. Surgery is best viewed as definitive treatment for affected areas rather than a cure for the underlying condition. Many patients find that addressing their most problematic areas provides dramatic quality of life improvement.

How do I know if I need surgery versus continuing medical treatment?

Surgery is typically recommended when medical management (antibiotics, biologics, lifestyle modifications) fails to adequately control the disease, or when significant scarring, tunneling, or sinus tracts have developed. Patients with Hurley Stage II or III disease who experience frequent, painful flares affecting quality of life are often good surgical candidates. Dr. Neavin works collaboratively with dermatologists to determine when surgery is appropriate.

Will insurance cover HS surgery?

Hidradenitis suppurativa surgery is a medical procedure (not cosmetic) and may be covered by PPO health insurance plans. Coverage varies by plan, and pre-authorization is often required. Our office can verify your benefits and assist with insurance documentation. We do not accept HMO plans. Please call (310) 858-8811 for a complimentary benefit assessment.

How long is recovery from HS surgery?

Recovery varies significantly based on surgery extent, location, and reconstruction method. Patients with limited excision and primary closure may return to light activities within 2-3 weeks. Those with larger excisions healing by secondary intention may require 6-12 weeks for complete wound closure. Dr. Neavin provides realistic timelines based on your specific surgical plan.

Will I have significant scarring?

Yes, surgery involves trading HS damage for surgical scars. The goal is exchanging irregular, often symptomatic HS scarring for planned surgical scars that are typically more predictable and less problematic. Scars are permanent but fade over time. For most patients, the improvement in symptoms and quality of life far outweighs concerns about surgical scarring.

Dr. Tim Neavin

The Artisan

Artistry Meets
Surgical Precision

Hidradenitis suppurativa requires a surgeon who understands both the physical and emotional toll of this chronic condition. Dr. Tim Neavin approaches HS treatment with the compassion and expertise these patients deserve.

As a board-certified plastic surgeon with extensive experience in reconstructive procedures, Dr. Neavin possesses the technical skills required for complex HS surgery—including wide excision, wound management, and reconstructive techniques such as skin grafting. His plastic surgery training provides advantages in minimizing scarring and optimizing aesthetic outcomes even when treating a medical condition.

Dr. Neavin understands that HS patients have often endured years of suffering, failed treatments, and the social isolation that comes with a misunderstood condition. Many have been told there’s nothing that can be done or have been bounced between dermatologists without finding relief. He takes time to listen to each patient’s journey, thoroughly evaluate disease severity, and create a treatment plan tailored to their specific situation.

For patients whose HS has not responded adequately to medical management, surgery may offer the relief they’ve been seeking. Dr. Neavin works collaboratively with dermatologists and other specialists to ensure comprehensive care, and his Beverly Hills practice provides a discreet, supportive environment for discussing this sensitive condition.

Diplomate American Board of
Plastic Surgery

Philosophy "Surgery with
Symmetry"

Beverly Hills & Santa Barbara

Start Your Transformation

Schedule your private consultation with Dr. Neavin today.

Hidradenitis Suppurativa Expert surgical treatment for a condition that affects far more than just your skin—reclaim your comfort, confidence, and quality of life.