Question 1

What is hidradenitis suppurativa, in plain language?

Accepted Answer

HS is a chronic inflammatory condition of the hair follicles in skin-fold regions — most often the underarms, groin, buttocks, perianal area, and under the breasts. The follicle plugs, ruptures into the surrounding tissue, and over time forms recurrent nodules, abscesses, and tunnels (sinus tracts). It is not contagious, not caused by poor hygiene, and not the patient's fault.

Question 2

Is HS the same as a recurrent abscess, pilonidal disease, or a fistula?

Accepted Answer

No, but it is frequently misdiagnosed as all three. Many HS patients arrive after years of repeat incision-and-drainage procedures for what was labeled an abscess, or after a fistula workup that found nothing. The pattern that distinguishes HS is recurrence in the same skin-fold regions, multiple sites, and tunnels that re-open after they appear to heal.

Question 3

Can HS be cured?

Accepted Answer

No. HS is a chronic condition. Honest goals are disease control: closing existing tunnels, reducing new flares, and getting patients to a quality of life where the disease is not the center of their week. Anyone promising cure is overstating what current medicine can deliver.

Question 4

Should I see a dermatologist, a colorectal surgeon, or both?

Accepted Answer

Both is often correct. Dermatology manages the systemic inflammatory side of HS (topicals, antibiotics, hormonal therapy, biologics like adalimumab or secukinumab). A surgeon trained in this anatomy addresses the established tunnels and the follicles that keep producing disease. We co-manage routinely and will coordinate with your dermatologist.

Question 5

What does the two-laser protocol actually do?

Accepted Answer

Two different lasers address two different parts of the disease. The Nd:YAG 1064 nm follicle laser destroys the hair follicles in affected skin so fewer new lesions form. The CO₂ laser deroofs and excises established tunnels with millimeter precision and lets the wound heal cleanly by secondary intention. Used together they treat both the disease that exists and the follicles that produce more.

Question 6

Why CO₂ laser instead of traditional wide excision?

Accepted Answer

CO₂ laser lets us follow the tunnel walls precisely and remove only diseased tissue, preserving healthy skin. Wide excision removes a large block of tissue and often requires flap reconstruction with weeks of immobility. CO₂ produces a smaller wound, less bleeding, and a recovery patients can usually manage at home. For appropriately selected disease, the recurrence data are favorable.

Question 7

Do I need both lasers or just one?

Accepted Answer

It depends on your disease. Some Hurley I patients with no established tunnels start with follicle laser only. Some Hurley II patients need CO₂ closure of a specific region plus follicle laser elsewhere. Most patients with active tunnels benefit from both: CO₂ to close what exists, Nd:YAG to reduce what forms next. The plan is decided at consultation, not before.

Question 8

How does this fit with biologics like Humira or Cosentyx?

Accepted Answer

It complements them. Biologics dampen the systemic inflammation that drives new flares; they rarely close established tunnels. We do not ask patients to stop their biologic for treatment, and many patients continue both during and after their procedural course.

Question 9

Am I too early for treatment? I only have occasional nodules.

Accepted Answer

Hurley I disease — recurrent nodules without established tunnels — is often the best window for follicle-directed laser. Treating early can meaningfully reduce the trajectory of the disease. You are not 'too early' if the disease is affecting your life.

Question 10

Am I too advanced? My disease is everywhere.

Accepted Answer

Diffuse Hurley III disease across very large surface areas is sometimes better served by a combined plan with a plastic surgeon for staged reconstruction. We will tell you honestly at consultation if that is the case and help arrange the appropriate referral. Most patients we see with extensive disease are still candidates for laser-based treatment with realistic expectations.

Question 11

I smoke. Can I still be treated?

Accepted Answer

Yes. We do not refuse treatment to patients who smoke. We will talk about it plainly because nicotine impairs wound healing and is the single largest patient-controlled factor in HS severity. Cutting down or stopping before and after surgery materially improves your result.

Question 12

I'm overweight. Will you treat me?

Accepted Answer

Yes. BMI alone does not disqualify anyone. Weight is one input into surgical planning — particularly for gluteal and inguinal disease where folding skin matters — but the decision is made on disease pattern, not on a number.

Question 13

Will I be awake?

Accepted Answer

Follicle laser sessions are performed awake, with topical cooling and occasional short-acting numbing. CO₂ tunnel closure is performed under local anesthesia for small areas, IV sedation for moderate cases, or general anesthesia in an accredited surgery center for extensive work. The choice is made together based on the area treated and your preference.

Question 14

How long does the procedure take?

Accepted Answer

Follicle laser: 20–45 minutes per session, typically a series of four to six over four to six months. CO₂ tunnel closure: 45 minutes to three hours depending on the extent of disease mapped on the day.

Question 15

Will I need to stay overnight?

Accepted Answer

No. Both procedures are outpatient. You go home the same day with a dressing in place, a written aftercare protocol, prescriptions if needed, and a direct contact path.

Question 16

Can someone come with me?

Accepted Answer

Yes, and for any procedure involving sedation or general anesthesia you must have a responsible adult to drive you home and ideally stay with you the first night.

Question 17

How long until I can return to desk work?

Accepted Answer

Follicle laser: same day or next day. CO₂ tunnel closure: most patients return to desk work in one to two weeks. Physically demanding work and prolonged sitting take longer, particularly for perianal and gluteal locations.

Question 18

How long until I can exercise?

Accepted Answer

Walking begins immediately. Light cardio at two to three weeks. Resistance training, swimming, and high-friction activity (cycling, rowing) at four to six weeks depending on the wound. We give individualized clearance at follow-up.

Question 19

How painful is the recovery?

Accepted Answer

Days one through three are the hardest. We use a scheduled non-opioid regimen with a short opioid course as needed. By week two most patients are off opioids and managing with non-opioid medication and dressing changes alone.

Question 20

Will I have a noticeable scar?

Accepted Answer

Healing by secondary intention produces a flatter, softer scar than most patients expect. The healed skin matures over six to twelve months and pigment evens out gradually. Full details are on the /recovery page.

Question 21

Do you take insurance?

Accepted Answer

Some elements of HS care are covered by insurance and some are not. The follicle laser series is generally a cash-pay service. CO₂ tunnel closure may be partially covered depending on your plan and the surgical coding. We provide written estimates before any procedure and superbills for out-of-network submission. See /pricing for our current structure.

Question 22

What does a consultation cost?

Accepted Answer

Consultation fees and current procedure ranges are listed on /pricing. We do not quote pricing by phone before a clinician has reviewed your case because honest pricing requires understanding what you actually have.

Question 23

Do you offer payment plans?

Accepted Answer

We work with third-party medical financing for patients who need to spread payment over time. The intake team can walk you through options at the time of scheduling.

Question 24

Can my visit be virtual?

Accepted Answer

Initial consultations can be virtual for patients outside Southern California. The in-person visit is required before any procedure. Follow-up visits are commonly done by video for out-of-area patients.

Question 25

How long should I plan to be in Los Angeles for surgery?

Accepted Answer

Seven to ten days is our standard recommendation for CO₂ tunnel closure: one to two days before for evaluation and preoperative work, the procedure day, and four to six days of early recovery before flying home. Your case may differ — some patients need more time, some less.

Question 26

Where do patients usually stay?

Accepted Answer

We can share a short list of nearby hotels and short-stay apartments that other patients have used. The practice is in Beverly Hills with easy access from LAX and Burbank airports.

Question 27

Will you coordinate with my doctor at home?

Accepted Answer

Yes. We send operative reports, photographs (with your consent), and a written follow-up plan to whichever clinician will see you locally — dermatology, primary care, or your home surgeon.

Question 28

What if I have a problem after I get home?

Accepted Answer

You will have a direct phone path to the practice during business hours and a defined after-hours pathway. For straightforward post-operative questions we typically use photographs and video. We will help arrange local evaluation if something requires hands-on assessment.

Question 29

What are realistic outcomes?

Accepted Answer

Most patients see meaningful disease reduction. Many achieve long stretches free of flares. Some achieve durable closure of treated tunnels. None are cured, and some will require maintenance treatment over time. We discuss your specific likelihood at consultation.

Question 30

Can the disease come back after treatment?

Accepted Answer

New disease can develop in untreated follicles, and this is one reason follicle laser is part of the protocol. Treated tunnels closed with CO₂ tend to stay closed; new tunnels can form elsewhere. Long-term management is the realistic frame.

Question 31

What is the evidence behind these techniques?

Accepted Answer

The /evidence page lists the published studies that inform our approach, what each study established, and — importantly — what it did not establish. We try to be honest about both.

Question 32

What if I'm not a good candidate?

Accepted Answer

We will tell you, and we will tell you what we think would help instead — whether that is dermatologic optimization, a different surgical approach, or a referral to a colleague better suited to your case. A consultation is not a commitment to a procedure.

Honest answers to the questions HS patients actually ask.

Understanding the disease

How the two-laser protocol works

Am I a candidate?

What the procedure is like

Recovery and getting back to life

Insurance, pricing, and scheduling

If you're coming from out of town

What to expect — honestly

Bring your questions to a consultation.