Ingrown nail: laser, phenolization and surgery

An ingrown nail (Unguis incarnatus) is considered a minor disorder, but can cause great discomfort to those affected and also limit everyday activities and sports activities.

There are many natural remedies to relieve symptoms and prevent infection, but the nail won’t straighten on its own without the intervention of a podiatrist or dermatologist.
Fortunately, there are therapies that solve the problem and have a recurrence rate of virtually zero.


Therapy for ingrown nail

Phenolization in ingrown nail


  1. Local anesthesia;
  2. incision and separation of the lateral nail plate;
  3. removal of the ingrown nail strip;
  4. Destruction of the nail matrix with phenol, but only the lateral part.

The matrix (also called nail root) is a deep tissue that lies between the nail plate and the nail bed at the base of the nail.
The dermatologist uses phenol because this chemical substance has special properties, above all it has an antibacterial effect and therefore no antibiotic is necessary after the procedure.

Advantages of phenol treatment:

  1. The wound does not need stitches, so the procedure is non-invasive and can also be used in young children and the elderly who cannot be operated.
  2. The treatment lasts about 20-30 minutes.
  3. After phenolization, the nail no longer grows to the side.
  4. This surgical technique has a success rate of 97-98%.
  5. The healing times are relatively short. The patient can immediately walk on his foot again after treatment and usually complete recovery occurs in less than a month.
    The first two days after phenolization, the leg should be raised to reduce swelling. After 7 days, the check-up is carried out and the dressing is changed.

Contraindications to phenolization are severe circulatory problems.

Laser therapy for ingrown nail

The laser is used to incide and widen the lateral edge (of the skin). In this way, the nail has more room to grow and does not grow in.

Two types of lasers are used:

  • Erbium YAG laser to remove the nail
  • Neodymium doper YAG laser for widening the nail bed

Advantages of laser treatment for ingrown nail:

  • Local anesthesia.
  • Less pain, usually the patient has fewer symptoms in the recovery period.
  • Faster convalescence than invasive surgery.
  • Minimal aesthetic damage, the scar is very discreet in contrast to other surgical scars.
  • Precision, the doctor performs incision and treatment only on the diseased site, the adjacent tissues are not damaged.

The costs for matrix excision by laser are higher, because initially a high investment for the equipment is necessary.
Nowadays, laser treatment is used less often because dermatologists usually prefer phenolization.

When to operate? Surgical intervention on ingrown nails

If the problem cannot be resolved with a podiatrist procedure or recurs, surgical removal of the nail should be considered.

Before considering surgery, the doctor may prescribe an antibiotic to cure the patient.

Surgery is indicated for ingrown nails of the second and third degrees, i.e.:

  • in case of existing infection,
  • when skin and soft tissues cover the lateral nail area.

The specialist for the procedure is the dermatologist.
Usually, surgery gives a good and lasting result.

Description of the surgical technique of Seyed Reza Mousavi and Jaledin Khoshnevice (Vascular Surgery & Reconstructive Cancer Research Center, Shohada—Tajrish Medical Center, Shahid Beheshti Medical Sciences, Tehran – Iran)
A new simple surgical procedure for ingrown nails consists of removing part of the soft tissue at the level of the cuticles (perionyx), where the nail corner enters the skin.

Surgical procedure:

  1. Scraping and removal of granulation tissue.
  2. Removal of part of the soft tissue where the nail corner has entered the skin. Nail matrix or nail-forming tissues are not removed.

The patients are in a lying position.

Phase 1: Before the operation, local anesthesia is performed. Then the affected toe is disinfected with an antiseptic (for example, Betadine) to prevent infection.
The surgeon cuts the soft tissue in the lateral fold of the cuticles, the cutting device must not injure the bent part of the nail.
After removal of the lateral granulation tissue, a superficial or deep incision may remain on the nail side.
The authors of the study prefer to cut off and pull up the edge of the nail from below using a special instrument with a single vigorous movement.

The side area of the nail bed must be lifted without injuring it.
To fix the edge of the nail, a special seam is attached.
The surgeon ensures adequate haemostasis (stopping bleeding) before the procedure is completed.

The authors prefer this simple technique because partial removal of the matrix can reduce nail width after healing.
The removal of the lateral nail strip without removal of the matrix has a recurrence rate of 70%.
This procedure has a low risk of postoperative infection and the pain after the procedure is short-lived.

This technique is straightforward to perform and shows good aesthetic results.

Phase 2: Then a bandage soaked in iodine and a plaster or tube-shaped gauze bandage are applied. To ensure that the bandage is not too tight, blood circulation must be controlled. In addition, painkillers are prescribed.

Phase 3: Dermatologists recommend wearing sandals or special postoperative shoes.

Results of the surgical procedure
Results of the previously described operation:

  • Recurrence occurred in only 1.08% of cases (2 out of 185).
  • After a check-up after a maximum of 6 months, all patients were satisfied and the toenails were normal.
  • The procedure was unsuccessful in 1.7% of cases, so the success rate is over 98%.

How long does it take to heal an ingrown nail? Recovery times

The recovery time depends on the type of surgical intervention performed. With a complete nail removal, the nail takes 3-4 weeks to grow again.
If the doctor has also removed the nail bed, the nail no longer grows back.
The pain passes after about a week.
For a speedy recovery, the recommended postoperative care should be followed.

Postoperative convalescence for ingrown nail

Wound treatment

  • Leave the bandage on for 3 days.
  • The bandage must be removed daily and the area disinfected with an antiseptic.
  • Dry the area well.
  • Finally, create a new bandage.
  • This treatment should be carried out twice a day until recovery.
  • The suture laid in the previously described operation is removed after 3 weeks. Today, surgeons use absorbable threads made of biological material that is absorbed (absorbed) by the body.

Prevention of ingrown nails

  • Stressful activities (for example, jogging) should be avoided for the next two weeks after surgery.
  • For the first two weeks, comfortable or open shoes, for example, sandals, should be worn.
  • High-heeled shoes or tight and uncomfortable shoes must be avoided.
  • One should wear socks to protect the nail.
  • As a precaution, the nail should be cut straight (without rounding it at the corners). Do not cut the nails too short, because then they could grow to the side.

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