Nail Excision: When Is It Necessary & What to Expect? | Kosmoderma

Is your toenail constantly painful, infected, or just won’t heal no matter what you try?

Whether it’s a recurring ingrown nail, severe fungal infection, or nail trauma, you may have been told about something called nail excision. But what is it exactly? Is it painful? And how do you know when it’s the right choice?

This blog walks you through when nail excision becomes necessary, what happens during the procedure, and how to care for your toe or finger afterward, so you can take the next step confidently.

What Is Nail Excision?

Nail excision (also called nail avulsion or nail removal) is a minor surgical procedure where part or all of the nail is removed, typically from a toe, often the big toe.

There Are Two Main Types:

1. Partial Nail Excision (PNA): Only the affected portion of the nail is removed.
2. Total Nail Excision (TNA): The entire nail is removed, usually when the nail bed is extensively involved.

Sometimes, chemical cauterization (phenolization) is used to prevent the regrowth of the problematic part of the nail permanently.

When Is Nail Excision Necessary?

Not every nail issue needs surgery. But excision becomes necessary when:

• Ingrown toenails keep recurring, despite conservative care
• There’s a severe infection or abscess formation
• You have a fungal nail that’s unresponsive to medication
• The nail is thickened, deformed, or painful due to trauma
• There’s a subungual hematoma (blood under nail), causing pressure
• Suspected nail tumors (benign or malignant) need biopsy or removal

If walking becomes painful, shoes hurt your toe, or you can’t trim the nail properly, it’s time to consult a specialist.

What Happens During a Nail Excision Procedure?

Here’s what to expect step by step:

✅ Before the Procedure:

• Area cleaned and numbed with local anaesthesia
• You’ll feel pressure but no pain

✅ During the Procedure:

• The nail (partial or full) is carefully lifted and removed
• If permanent removal is needed, phenol or sodium hydroxide is applied to the nail matrix
• Wound is cleaned, dressed, and protected with a light bandage

Procedure time: 30–45 minutes

Stitches: Usually not needed

What Is Recovery Like?

Recovery is generally quick, but some care is needed.

First 24–48 Hours

• Keep foot elevated
• Apply prescribed antibiotic cream
• Change dressing as instructed
• Avoid getting it wet

1–2 Weeks

• Wear open-toed or roomy footwear
• Walking is usually okay after a couple of days
• Mild oozing or soreness is normal

Full Healing

• Partial excision: ~2–3 weeks
• Total excision: ~6–8 weeks
• Regrowth: May take 3–6 months (if not permanently removed)

Is Nail Excision Painful?

Nope—you won’t feel pain during the procedure thanks to local anesthesia.

Post-procedure soreness is usually mild and manageable with over-the-counter pain relievers like paracetamol or ibuprofen.

Will the Nail Grow Back?

If no chemical is used: The nail will regrow—but may take months

If the matrix is cauterized, that portion of the nail is permanently removed

This helps prevent repeat ingrown nails or other chronic issues.

Top Tips for Smooth Healing

• Keep the area clean and dry
• Don’t force off any crust or scab
• Avoid tight shoes during recovery
• Follow up if there’s redness, pus, or worsening pain

A topical antifungal or antiseptic may be advised for ongoing protection.

Conclusion: The Relief You’ve Been Waiting For

If you’ve been battling stubborn nail pain, infections, or deformities, nail excision might be the simple solution that brings relief fast. It’s quick, effective, and can stop the cycle of repeated issues once and for all.

Ready to Finally Get Rid of That Painful Nail?

Schedule your expert nail consultation today and let our specialists guide you to the safest and most effective treatment—no more guesswork, no more discomfort.