1470 nm Intralesional Laser Tunnel Closure for HS

The premise

Why tracts require a procedure

A sinus tract is not inflammatory tissue. It is an epithelialized channel — a tunnel under the skin with a surface layer of cells that behaves like the skin itself. Antibiotics do not close it. Biologics do not close it. Once it is there, the only way to remove it is to act on the tract lining directly.

Left in place, tracts perpetuate the disease — draining intermittently, expanding, recruiting adjacent follicles, and over time connecting into the diffuse networks characteristic of Hurley III. The question for a patient with established tracts is not whether to have a procedure but which one — and which one preserves the most life around it.

Our preference is the smallest intervention that addresses the disease. For most patients with accessible tracts that is the 1470 nm intralesional radial-fiber technique — the same approach used in Dr. Kamrava's established pilonidal SiLaC program, applied to HS sinus tract anatomy.

How it works

Radial-fiber pull-back coagulation

The mechanism is mechanical and thermal, not excisional.

Introduce
A thin radial-emitting laser fiber is introduced into the tract through an existing surface opening. No new incision is made.
Coagulate
The 1470 nm diode laser delivers thermal energy through the radial fiber tip. The wavelength is preferentially absorbed by water and hemoglobin in the tract lining, coagulating the epithelium circumferentially.
Withdraw
The fiber is slowly withdrawn at a controlled rate, treating the full length of the tract from inside. As the lining is coagulated, the tract collapses on itself.

Setting & anesthesia

In-office. Local anesthesia. No hospital.

Setting: In-office procedure room — the same dedicated suite used for pilonidal SiLaC and anal skin-tag work. No OR. No ASC. No hospital admission. Walk in, walk out.
Anesthesia: Local infiltration only, with NitroNox (nitrous oxide / oxygen blend) available for patients who request additional anxiolysis. No IV sedation. No general anesthesia.
Post-procedure care: A small pressure dressing for 24–48 hours, standard wound observation, no specialized dressing changes.

The session itself

What a session looks like

Focal single tract

approximately 30 minutes

Multi-tract, single region

60–90 minutes

Multi-region (staged)

60–90 minutes per staged visit

Session times are ranges, not promises — they will be refined as case volume accumulates.

Closed-wound model

No open wound. No daily dressing changes.

This is the central clinical differentiator. The radial-fiber technique acts on the tract from within. Surrounding skin is preserved entirely — there is no skin incision, no excision, no surface ablation, and no open wound bed left to heal by secondary intention.

Post-procedure care is a small pressure dressing for 24–48 hours and standard wound observation. The post-operative course is substantially less intensive than excisional or wide-excision approaches.

Full week-by-week recovery profile on the recovery page.

Staging

One session, or several

Focal disease (single tract): Single session, no staging.
Multi-tract, single region: Single session when the patient tolerates it and time permits, or staged at 4–6 week intervals based on preference and pain tolerance.
Multi-region disease: Staged across multiple visits at 4–8 week intervals. Sequence determined by symptom severity (most symptomatic region first) and patient preference.

Staging decisions are made collaboratively with the patient at consultation.

What success looks like

Outcomes — published literature

Published series of intralesional 1470 nm laser treatment of HS sinus tracts report meaningful rates of primary tract healing and durable closure beyond 12 months. Specific outcome figures will be cited once the underlying references are verified by Dr. Kamrava.

New tunnels can form in adjacent untreated follicles regardless of treated-tract success. This is the disease, not a treatment failure. It is why follicle-directed 1064 nm Nd:YAG therapy is offered alongside tunnel closure.

Re-treatment policy: If outcomes are inadequate at 6 months, additional sessions are provided at no additional cost.

Limits & risks

What this is not, and what to know

Not a cure for HS. This procedure addresses tracts that have already formed. It does not change the underlying inflammatory drive — that remains a chronic medical management question.
Recurrence in adjacent untreated follicles. Common in HS. The treated tracts close; new disease can arise in nearby follicles unless the inflammatory field is controlled medically and with 1064 nm follicle-directed therapy.
Bleeding and infection. Low rate with closed-wound intralesional technique; named because every procedure carries them.
Injection-site tenderness. Expected at the local-anesthesia infiltration sites. Usually controlled with over-the-counter analgesics.
Pigmentary change. Possible at injection or surface-opening sites, particularly in darker Fitzpatrick types.
Inadequate primary healing. If a treated tract is not adequately closed at six months, additional sessions are provided at no charge.
Not appropriate for diffuse confluent disease. Extensive confluent Hurley III without identifiable tract architecture may still require staged excisional approaches with a reconstructive team. We will tell you if that is the case.

By region

Anatomic notes

Perianal & perineal

Sphincter preservation is structural rather than aspirational with this technique — no surrounding tissue is excised. The colorectal training that drives this practice is the reason we approach this region with confidence.

Gluteal & natal cleft

Distinguishing HS from pilonidal disease changes the plan. The 1470 nm fiber technique is the same one used in Dr. Kamrava's pilonidal SiLaC program — adjacent anatomy, same mechanism.

Inguinal & groin

Dense lymphatics and high mechanical stress make conservative tissue handling disproportionately important. A closed-wound, intralesional technique is well-suited here.

Sequencing

Where this fits with follicle therapy and medical care

Tunnel closure addresses structural disease. 1064 nm follicle-directed therapy addresses the inflammation that produces new structural disease. Medical therapy (dermatology-managed, often including biologics) controls the underlying disease process that makes both necessary. The three work together — they are not alternatives.

Read about follicle-directed therapy →Read the full treatment model →

Laser tunnel closure for HS, from the inside out.