A prominent feature of hidradenitis suppurativa is the development of subcutaneous tunnels and sinus tracts within affected anatomic areas. Even with optimal medical control of the disease, these tunnels can persist and lead to symptoms such as pain, drainage, and disfiguring scarring. Deroofing is a procedure that can be performed in the outpatient setting to remove these tunnels and promote wound healing and long-term remission. The procedure involves incising tunnels, debriding the contents, and, often, allowing the surgical wounds to heal by secondary intention. The procedure has a high success rate and low risk of complications when performed appropriately. With scar contracture over time, the final appearance is often cosmetically acceptable with a high patient satisfaction rate.