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Hidradenitis Suppurativa Surgery: Options, Recovery and Honest Numbers

What deroofing, excision and drainage really involve, what the recurrence numbers say, and what surgery on my own HS lesions taught me about recovery.

By Luca Vizzielli · November 4, 2026 · 10 min read

Personal experience and general information only. This is not medical advice, diagnosis or treatment guidance.

Sterile gauze, dressing pads and antiseptic arranged on a bedside table for daily wound care

Surgery for hidradenitis suppurativa ranges from draining a single painful abscess to removing an entire affected area of skin, with a tissue-sparing office procedure called deroofing sitting in between. Done for the right lesion, it can bring real and lasting relief in the treated spot. What it cannot do is cure HS, because the operation removes damaged tissue, not the disease process behind it. I have been under the surgeon's instruments for my own lesions, including one on my face that had grown to about 4 centimeters, so this is not theory for me. Here is what the main procedures actually involve, what the recurrence numbers honestly say, and what recovery felt like from the patient side of the dressing.

What are the surgical options for hidradenitis suppurativa?

Dermatologists and surgeons use a handful of procedures for HS, and they are not interchangeable. The North American clinical management guidelines for HS, published by the United States and Canadian Hidradenitis Suppurativa Foundations, describe when each one fits.

  • Incision and drainage. The lesion is opened so the pus can escape. The guidelines recommend it only for acute abscesses, to relieve pain, because recurrence at that spot approaches 100 percent. It is an emergency valve, not a repair. If you keep ending up in this loop, I have written separately about the lump that will not drain.
  • Deroofing. The surgeon removes the "roof" of skin over a recurrent nodule or tunnel, cleans the base, and leaves it open to heal. It is typically done in the office under local anesthesia, and the guidelines consider deroofing or excision the best options for lesions that keep coming back in the same place.
  • Punch debridement. Essentially a mini deroofing for small lesions, done with a punch tool. The guidelines prefer it over simple drainage for small recurrent spots.
  • Limited local excision. The lesion is cut out with a small margin. Quicker than wide excision, but recurrence in the area is more common.
  • Wide excision. All visibly affected tissue is removed together with a margin of surrounding skin, usually in an operating room. It is the option for extensive, chronic disease in an area, and it opens a second question: how the wound gets closed, whether by letting it heal open, by stitches, or by a skin graft or flap.
  • CO2 laser excision. A laser vaporizes or cuts away diseased tissue, with the wound usually left to heal open. The guidelines note low recurrence, but the wounds take longer to close.

Does surgery make hidradenitis suppurativa go away for good?

No. There is no cure for HS, surgical or otherwise, and the honest way to think about an operation is as local control. The guidelines put it plainly: surgery alone does not alter the biology of the disease. A wide excision can leave the operated area disease free, and for many people that is life changing, but HS can still appear at the edge of the scar or in a different body fold entirely.

The numbers help set expectations. A systematic review and meta-analysis in the Journal of the American Academy of Dermatology pooled 22 studies and estimated average recurrence at 13 percent after wide excision, 22 percent after local excision and 27 percent after deroofing. Within the wide excision group, wounds closed with flaps or grafts recurred less often than those closed directly. Other studies land in different places, and a large series of 590 patients cited by the guidelines found deroofing and wide excision roughly equal, so the spread between studies is real. The pattern that repeats everywhere: the more radically the diseased tissue is removed, the less often that spot flares again, and nothing brings the risk to zero.

So when a surgeon offers you a procedure, the fair question is not "will this fix my HS" but "how likely is this particular spot to stay quiet, and what does that cost me in wound size and recovery". That is a trade you are allowed to weigh like an adult, with real numbers on the table.

Why do dermatologists keep talking about deroofing?

Because for the right lesion it hits a sweet spot: meaningful results, small procedure, done in a clinic chair rather than an operating room.

The classic study is van der Zee and colleagues' 2010 paper in the Journal of the American Academy of Dermatology: 88 recurrent Hurley stage I and II lesions deroofed under local anesthesia. Seventeen percent recurred, after a median of about five months, while the other 83 percent stayed quiet over a median follow-up approaching three years. Patients rated their satisfaction 8 out of 10, and 90 percent said they would recommend the procedure to other people with HS. The average wound was about 3 centimeters and took around two weeks to heal.

Fifteen years later the technique is holding up. A 2025 prospective study in Dermatologic Surgery followed 115 deroofed lesions in 44 patients across Hurley stages I to III and found recurrence of 10 percent at three months and 11 percent at twelve, along with improved pain and quality of life scores. Notably, deroofing worked as an add-on for patients already on adalimumab, not only as a standalone fix. A 2022 review in Cutis adds the comparison that makes patients' eyes widen: in the data it cites, deroofing carried a 12.5 percent complication rate versus 26 percent for local excision, with less recurrence as well.

If your disease is further along, with tunnels and scarring across a whole region, deroofing single lesions stops being the right tool, and that is where the wide excision conversation starts. Knowing your Hurley stage makes that conversation much easier to follow.

What is recovery from HS surgery really like?

Here is the part the brochures undersell. Most HS wounds, after deroofing and often after excision, are not stitched shut. They are left open to heal from the base upward, which doctors call healing by secondary intention. It sounds alarming and looks worse, but in HS it is often deliberate, because closed wounds in diseased skin can trap trouble, and the meta-analysis found secondary intention healing was the most common choice after deroofing and local excision. In practice it means weeks of daily wound care: gentle cleansing, a moist dressing, repeat.

I can tell you what that looked like in my case. A surgeon who operated on several of my cysts and abscesses used a laser to make the smallest possible opening, drained the lesion, and packed the cavity with gauze moistened with povidone iodine. I then had to change that dressing every single day, and I could not do it alone; I needed another person's help, day after day, which is its own lesson in humility. For the lesion on my face, the wound was packed with gauze for months before the operation to shrink the cyst and the eventual scar. None of this was dramatic, but it was relentless, and if you are scheduling a procedure it is worth planning for that rhythm: the dressing changes, the help you might need, the laundry.

That was the wound care prescribed in my case, not a template for yours, because practice varies and some antiseptics are no longer favoured for healing tissue. The boring essentials, clean hands, clean dressings, clean clothes, matter more than any product. And some signs mean the plan needs a medical review rather than patience: fever, rapidly increasing pain, or warmth, swelling and redness spreading around the wound. My rule from those months was simple. When the wound surprised me, I asked, and asking early was never the wrong call.

Can you stay on your medication through HS surgery?

This worry is common, especially for people on biologics, and it has unusually good data behind it. The SHARPS randomized trial, published in JAMA Surgery in 2021, enrolled 206 people with moderate to severe HS undergoing wide excision and randomized them to continue adalimumab right through surgery or to receive placebo. The group that stayed on the drug responded better overall, 48 percent versus 34 percent, and showed no increase in wound infections, complications or bleeding. The authors concluded the biologic did not need to be interrupted for surgery, and the North American guidelines similarly note that continuing medical therapy around a procedure is likely to be beneficial.

That is reporting, not an instruction. Whether your specific medication continues through your specific operation is a call for your dermatologist and surgeon to make together. The useful takeaway is that "you will have to come off your meds" is no longer a safe assumption, and it is a fine thing to question if you hear it.

How do you decide whether surgery is worth it?

Spend any time in the HS community and you will hear every verdict on surgery that exists, from people who regret the scar to people who say an operation gave them their life back. Both are telling the truth about their own case, which is exactly why someone else's outcome, good or bad, is a poor basis for your decision.

What actually shapes the outcome, in the studies and in my experience, is less mysterious:

  • Matching the procedure to the lesion. A recurrent nodule in one spot is a deroofing conversation. A region full of interconnected tunnels is an excision conversation. An acute abscess at 2 a.m. is drainage, and drainage alone will not be the end of that story.
  • A team that knows HS. The procedures are not exotic, but knowing how far tunnels extend, and how HS skin recovers, is specific experience. It is reasonable to ask how often a clinic treats HS, which procedure they would choose for your lesion and why, what the wound care will involve week by week, and what the plan is if the spot recurs.
  • Keeping the rest of the plan running. Surgery removes damaged tissue; it does not address why your skin makes these lesions. The research above points toward combining procedures with medical therapy rather than choosing between them, and the same logic applies to everything else you do for your HS.

That last point is my own story in one line. Operations solved individual lesions for me, and I am grateful for every one that ended, but the quiet skin I have lived in for about seven years did not come from the scalpel. It came from the slow, whole-picture work, including an elimination and reintroduction approach to food, that I describe honestly, failures included, in my book. Surgery was a chapter, not the plot.

FAQ

Is deroofing better than wide excision? They answer different problems. Deroofing is a smaller office procedure suited to recurrent nodules and tunnels in a defined spot, with recurrence between roughly 10 and 27 percent across studies. Wide excision removes a whole affected area, shows the lowest recurrence in the pooled data at around 13 percent, and costs more in wound size, healing time and scarring. The lesion, the stage and the body site decide, not a league table.

Does an abscess drained in the ER count as treatment? It counts as relief, and relief matters when the pain is unbearable. But in the guideline data, lesions treated with incision and drainage alone come back at rates approaching 100 percent, so a definitive procedure or a medical plan still needs to follow.

How long does healing take after deroofing? In the published series, an average wound of about 3 centimeters healed in around two weeks, with daily cleansing and dressing changes while it stays open. Larger excisions take considerably longer, especially when they are left open without stitches.

Will HS surgery leave a scar? Yes, every option leaves some scar. In the van der Zee study most patients considered the cosmetic result acceptable, and satisfaction with deroofing averaged 8 out of 10. For many of us the comparison that matters is not scar versus perfect skin, it is scar versus the recurring lesion that was there before.

Whatever you decide, decide it with a dermatologist who has your chart open, knows your stage and your medications, and can say out loud which procedure fits which lesion and why. That conversation, with honest numbers in it, is the real starting point.

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