What's the Difference?
One of the most important decisions when planning treatment is whether the procedure should be temporary or permanent.
Although both procedures begin by removing the offending edge of the nail, what happens afterwards is very different.
The choice depends on why the ingrown toenail developed and how likely it is to recur.
Temporary Partial Nail Avulsion
A temporary procedure removes only the painful strip of nail.
The nail matrix—the tissue responsible for producing the nail—is left untouched.
Over the following months, the removed portion gradually grows back.
This approach preserves the full width of the nail.
When Is a Temporary Procedure Appropriate?
A temporary procedure may be suitable for:
- A first episode of an ingrown toenail.
- An ingrown toenail caused by recent trauma.
- Children or teenagers with a reasonable chance of the problem resolving as they grow.
- Patients who strongly prefer to avoid a permanent procedure.
- Situations where the diagnosis remains uncertain.
Because the nail grows back, there is always a possibility that it may become ingrown again.
Permanent Partial Nail Avulsion
A permanent procedure also removes the offending nail edge.
However, the narrow section of nail matrix that produces that edge is then treated so it no longer grows.
Only the problematic edge is permanently removed.
The remainder of the nail continues to grow normally.
The nail is simply a little narrower than before.
When Is a Permanent Procedure Recommended?
A permanent procedure is often considered when:
- The ingrown toenail keeps returning.
- Previous temporary procedures have failed.
- The nail is naturally very curved.
- Recurrent infections have occurred.
- There is chronic pain.
- Conservative treatment has been unsuccessful.
- The patient wants the best chance of avoiding future recurrence.
For many patients, this provides the most predictable long-term solution.
What About Appearance?
One concern many patients have is how their toenail will look afterwards.
Fortunately, because only a narrow strip of nail is removed, the cosmetic appearance usually changes very little.
Most people who have not been told a permanent procedure has been performed never notice the difference.
Can a Permanent Procedure Be Reversed?
No.
Once the treated portion of the nail matrix has been successfully destroyed, that narrow strip of nail will not regrow.
For this reason, the decision should always be discussed carefully before treatment.
Which Procedure Has the Lowest Recurrence Rate?
Temporary procedures have an important role in selected patients.
However, because the nail grows back exactly as before, recurrence is naturally more common.
Permanent procedures significantly reduce recurrence because the offending nail edge no longer returns.
This is one of the main reasons they are recommended for chronic or recurrent ingrown toenails.
Evidence Update
Numerous studies have shown that permanent partial nail procedures combined with matrix treatment have lower recurrence rates than temporary nail avulsions alone, particularly in patients with chronic or recurrent disease.
Patient Tip
If your ingrown toenail has already returned once or twice after previous treatment, discuss whether a permanent procedure is likely to provide a better long-term outcome.