I have been trying to research online with very little accurate results. For someone who has had their toenails removed or permanently damaged, are there any procceedures that are currently being done to surgically implant a permanent replacement toenail for aesthetic purposes? 

I have had some patients ask me about this.  There is a technique of transferring nail bed to the affected toe however at the expense of morbidity at the donor site.  I could not understand a good reason to do so in the feet.  Patients mainly request this for cosmetic nail problems in the hand.  This technique may be found in a textbook I believe textbook of nail surgery.  I dont know if it is still in print. 

I actually had the aforementioned procedure performed on my right ring finger as a child for a crush injury to the nail and nail bed.  A plastic surgeon transplanted the lateral half of my right hallux nail to the affected finger nail. The results are sub-par to say the least with chronic deformity of the recipient site.  Personally, there have been no deleterious affects to the donor site but it is likely dependent upon the surgical technique combined with my young age at the time of the procedure?

This sounds similar to artificial fingernails... but how do you adhere it to the skin and how likely is it to fall off and need replacing?

Yes the idea is to create a arteficial nail , however, this technique allows to obtain a nail  whid features very similar to normal nails.  I adhere it to the skin by using a specific Bond for composite resin non toxic, this  bond of composite resin to tooth, is especially effected by moisture contamination and cleanliness of the prepared surface. 
The probability of falling is minimal, depending on the amount of bond that is used (the ideal is 2 to 4 drops) . The lifespan of this nail is 7.8 years because composite fillings shrink with age and may pull away from the nail bed

I would love to find someone in the Dallas area who was skilled at this type of proceedure :)

I would love to find someone in the Dallas area who was skilled at this type of proceedure :)

Unfortunately I'm in Portugal ... but I have several articles about this procedure which I will translate and then send it to you :)

I would like to know if anyone provides this composite resin procedure in the UK?

I had both big toenails removed after ingrowing and the nail bed burned away. I'd love to have replacements made.

In hope,

Ross

Hi,

I am also looking for someone in the Toronto area that could do the same type of procedure.  Does anyone have any contacts?

From what I have read here, this might be an opportunity to team up with a dental lab for the actual toenail prosthesis and then, after receiving it, the podiatrist could "implant" it. This could lead to a new cash-only, cosmetic procedure.

A slight variation on this theme has started gaining favor among some clinicians, who have started to utilize the focused light energy of a laser to treat onychomycosis.  There are several products on the market which promote this modality in the treatment of nail fungus, and Dr. Satterfield is correct, it is cosmetic procedure which is a cash fee-for-service.  A colleague of mine (and former co-resident) is now one of the few "certified laser specialists" who utilize this modality, and she as reported largely favorable results (although she has only recently started to perform the procedures).

I took the opportunity to sit in on several of the treatments with her, to get the feel for things, and it seems to be fairly user-friendly.  I have encouraged her to track her cases to perform a comparative study to generate some data on this topic --the limited amount of study data is a concern that I have about this product/procedure.  While there is limited EBM available to support efficacy of such a treatment modality, i have difficulty trying to "sell" the idea of paying cash out of pocket for such a procedure....

Does anyone have any insight or experience on these laser products?  I don't know that i could find many people in my practice in rural Virginia who would be willing to pay $1000 for the potential for clean, healthy looking nails, but i know that there are many areas where such cosmetic procedures constitute a significant source of practice income....

greetings from Den Haag

Dear Mr  Andre.

i have quite a many patients who ask me about this.

May i ask. does it really work for patients who have no nail plate whatsoever - just the scar tissue left of the nail bed - witth the matrix fully removed.???

if so.. is ithere a particular composite bond adhesive thats better - that you can recommend for no irritation of the nail bed? which is best? im going to talk to a dentist friend about this.

Intesting stuff

Anneleen

Hi Anneleen

This technique works very well  in patients who do not have any nail plate, but to achieve a better result it is important to preserve the scar tissue left of the nail bed, without it will not work as well as the risk of the prosthesis fall of is greater.
There is no particular composite bond adhesive thats better , however in some patients may appear an allergic reaction to certain composite bond adhesives, although this has never happened in my clinical practice.
Regarding the composite resins by my experience, the composite flow appeasr to be easier to work and the final results are better.
If you have any more doubts feel free to contact me.

Kind Regards
André

I came across a cosmetic nail augmentation procedure on the internet called the Keriflex Nail Restoration System. I have never used this product. It appears that the artificial nail is bonded to a debrided and thinned dystrophic toenail. I am uncertain whether this artificial nail can be bonded to the nail bed such as the product described below by Andre. Here is one website ( http://carepluspodiatry.com/our-services/keriflex-nail-restoration-system/) advertising the product for anyone who is interested. 

Best regards, 

Chris  

Hi Chris

Thank you for your comment, I have found the webpage of this procedure http://www.keryflex.com and after visiting the wesite this seems similar to the technique that I use.

Kind Regards
André

Just an update:

As someone who has lost both of my big toenails due to matrixectomies, I have been doing a pretty thorough job of researching the options available to those of us with...well...no toenails. I recently contacted an authority on the Keryflex procedure (a podiatrist who received his education at Temple University where they do the trainings) and they will not place these nails in cases such as mine where there is only nail bed. The nails do NOT adhere to the nail bed in the absence of at least some sort of nail plate. There must be at least some nail plate available to adhere the resin to. 

I understand the concerns related to the use of fake nails (mainly that it is an excellent environment for fungal growth). I also understand that it must be quite a tremendous challenge to figure out a way to adhere a prosthetic nail to the nail bed (Is there any way to do this?). In my search, I have come across many patented ideas that never achieved popularity and many, many desperate patients frustrated by the aesthetic aftermath of losing their nails. Satisfied with the relief they've had, yes. But also discouraged by the appearance of their feet. Both men and women. Unfortunately many of these people use glue and the dreaded fake nail. This forum is my last hope!


My question is: Is there any way to (safely) attach a nail of some sort to a nail bed without any nail plate whatsoever? 


A final word: I understand this may seem to be merely a cosmetic concern, but it is also a quality of life issue for many people such as myself (yes, even men) and I would appreciate any feedback. I'd love to wear those flip flops again without getting all the strange looks and comments.  : )


Thanks! 

Also, the podiatrist who I contacted at suggested that "Many people, mostly female, choose to paint these toes." Please don't suggest this; it simply does not work. Especially in cases such as mine where it does not look right. If you think having no toenails is looked strangely upon, try being a male with no toenails and pink toenail polish on. Yup, strange indeed...

Thanks again! 

I am in the same position too.  Just one toe nail on my left big toe. Sadly, the doctors recommended the treatment when I was 10, and told my parents it wouldn't look any different and we wouldn't notice!  It's extremely unattractive and effects my quality of life and confidence in lots of ways (dating!/spa days with clients for my job/holidays...). I've tried many things, including the flexi resin, but would like something that won't unpredicatably fall off.

AS the previous message indicates - there are lots of people in the same position, and with all the surgery available today, is there anything that is available to us?

Gosh, we are going to have to start a support group for this issue. Hah. I aam in the same boat as the previous posters. I have been hopefully eyeing this thread for a while because I (too!) have no nails on several of my toes. I have been looking for a solution for years since I had the procedure. Still nothing! Like the other posters said, is there nothing available in this day and age for such a problem? I am tired of using fake nails as a guy. Especially since the last one screwed up my big toe. i have seen the same info about patents online, but nothing that looks like it is available yet. Will there be in the future?

Please give this thread some love! Is there any way to put a permanent nail on a toe without any nail?  

Surely with over 10,500 views someone out there in the U.S. is working on this, right? Haha. And a lot of people would apparently like to know!

Hey. Im in the same boat. 25 years after my matricectomy im still furious. I was 12. The manner of the doctor was outrageous. I was told my toenail wasnt important as im a boy, not a girl and i 'might as well have it off.' I was also told my nails were too big for my toes. well several podiatrists have now confirmed this is not the case.  In my case I feel this was an uncessary mutilation, a small mutliation allbeit. And yes it DID impact my quality of life.

I find it odd that someone was allowed to alter my body permanently with such little awareness or regard for the emotional impact. There really is something difficult for many people about this particular procedure.

It is generally adminstered as if it something faily minimal by practicioners, yet it results in a permanet life long alteration to the body - it removes something. Of course there are worse ways a body can become blemished or altered but when this happens, patients or victims usually are given some sort of recognition that something fairly significant has happened.

This procedure clearly has the risk of causing other problems down the line beyond the initial physical problem. There are many hundreds, thousands of people out there who are also feeling awkward about it. I remember the message board for Dr Brodkin who at one time was working on a prosthetic nail implant - he seems now to have given up - hundreds and hundreds of people leaving messages desperate for some kind of cosmetic solution.

i tried having resin nails placed using dental bonding methods, but i was unlucky, it didnt stay on while most others apparently do stay on for a fair while.

In the end I had a small skin graft over the lumpy scarred, dipped section of my toe. Once healed a permanent cosmetics artist drew a toenail there. I was careful not to use a regular tattoo artist as they have too much of a penchant for black lines around evrything.Perhaps im lucky that the way my toe has become shaped it kinda suited the intended procedure. there is a fleshy nub that hides the lack of depth of the tattooed nail. Also if im feeling fancy i can paint a thin layer of opaque nail varnish over it. All in all this cost me about 2500 pounds - I'm in the UK and it was worth every penny. It looks good enough to not feel self concious. I still dont parade around in flip flops. But it really is pretty good.

Surprisingly despite fearing it would sound like a freak request I found three cosmetic surgeons who were happy to do it.

I just got tired of how much it was affecting me. Im not saying this would suit everone but thats my story x

Sx

Wow, Stopo. I think that the lengths that you've gone to to remedy your problem really demonstrate how unhappy many of us are with the appearance of our feet after having a matrixectomy. I myself have searched far and wide for a solution to no avail, and also find it incredibly, incredibly frustrating. My podiatrist also seemed to have very little concern for the aesthetic aftermath of the procedure. "We'll just remove them and you'll feel so much more comfortable!" - it sounds great at the time, but the first time you meet a girl who sees you in flip flops and says "You have no nails?" one feels differently.  I understand that when it comes to the decision of removing an ingrown nail vs. keeping your nail, removal is the way to go. But I find it terribly disappointing that there is no option to correct the deformity afterwards. We are, after all, a culture that places a lot of emphasis on the appearance of nails. Much like hair, there are specialists whose job it is to make them look good (nail parlors, fake nail kits at the grocery store, aisles and aisles of nail polish, etc). Whether or not any medical professional feels that the appearance of a normal nail plate is important, it is simply a matter of fact. I guarantee that if they had their nails removed and went on a cruise or to the beach with friends, they would feel differently. 

It is my understanding that a solution still does not exist to this unique problem because it is difficult to adhere a nail plate to smooth skin. As Mr. Fereirra earlier stated, without scar tissue, the risk of prosthesis fail is greater. This is pretty easy to understand, as the nail has nothing to adhere to - just smooth skin. I do not think that any kind of bond will bring a long term solution. It will inevitably fall off.  A true solution will probably involve some sort of prosthetic implant. In this day and age, I'm pretty sure anything is possible. Considering the technology we have and the bright medical professionals that exist out there, I am hopeful that someone has been paying attention and something will come about soon. It will simply involve some creative thinking from the right podiatrist or cosmetic surgeon who has an entrepreneurial side.  I work for a major university/ teaching hospital in my area and have contacted several people re: this issue- a couple of podiatrists and one cosmetic surgeon. They said it is certainly an interesting issue, and were confident that there is a way to accomplish a prosthesis.  They said that they would do some "brainstorming" and see what available research exists. It would be reassuring to hear that others are working on this issue as well, as it apparently affects many peoples' quality of life. 

This thread has over 16,600 views, more than any other topic here- I have watched it climb. Clearly, as the previous posters indicate, there is a need for this sort of thing. For now, summer is once again here and I will continue to wear my sneakers to avoid strange looks/comments. Hopefully by next year, something will exist for all of us! 

Take care.  

thats great steve that you instigted some awareness and possible research into it with those people at your place of work. as far as i understand it though - there are many cases where podiatrists can now simply remove a thin sliver of nail and matrix on the affected side... using phenol. lazers etc... a podiatrist i saw and tried a porsthesis said it was brutal what had been done to my toe. my brother had ingrowns on both feet last year and he had this method - his nails look completely normal. knowing that their are effective conservative methods available makes me more sad i had the whole thing removed... but then i did have mine done in 1983... maybe then these other methods werent available. im still furious, all the same. lol.

one other thing... there is a couple of places in the states who make prosthetic body parts for people. i noticed that along side the fake eyes, noses etc.... they also did a prosthetic toe - like a sheath that goes ove your actual toe and has a nail on it. my first thoughtn was that it was creepy, then i thought about the real unfortunates who had missing fingers etc... whos lives were being imeasurably improved by these prosthesis - which look incredibly realistic - you'd never tell. i almost contemplated looking into it. not that i consider my missing nail anything like in the league of most of the prosthetic work they do. But they do do this. it looks as far as i can tell, one hundred percent realistic, you cannot see the join and it matches your skin perfectly. i have nop idea how much it costs. ill post some links when i find it again.... a bit much perhaps, or not... its up to the individual i guess.

For Stopo and the others who have been brave enough to speak out and share their stories, thank you.

As podiatrists, we only know what we have learned from our mentors. We have been told these stories...."The patient can paint nail polish over the hardened skin once it heals...." "Once it hardens, the patient will find the remaining skin cosmetically fine."

From your stories that you have shared here, this is not always the case. I am glad that you have spoken up. The fact that in your case, Stopo, you were willing to pay over 2000 pounds UK to have the skin tatooed and you are still looking to have a prosthesis made to camouflage the area, this is not the case. This is not cosmetically "fine." We, as podiatrists, need to find a different answer.

What we were trying to do was to find an answer to the PAIN our patients were experiencing with onycocryptosis and we did do that successfully. What we have not done, however, was to find a cosmetically pleasing answer. For that we must keep looking.

There is obviously a deep indentation once we remove the nail. Often times, when we remove the nail, it is a diseased or fungal nail, and so it is easily sacrified. Perhaps we should rethink sacrificing the entire nail for the purpose of curing a single border problem!

Check out these two products: Keryflex and Just for Toenails.

There are graft matric surgical procedures but I canot justify this for toenails and they require very advanced microsurgical skill to harvest and successfully graft matrix tissue.

I was told by a MNT, (medical nail technician) in an office in North Carolina that Just For Nails can be used with no intact nail plate. Other than this I cannot say from personal experience. However, this general topic is a good one to illustrate a principle in podiatric surgery of all types that I have learned over the years: Independent of the technical skill of the surgeon and choice of procedure and how perfect the procedure and post-operative course is, the tolerance (by the patient) of any post-surgical imperfection, even if carefully explained, outlined, drawn and consented to, is directly proportional to the degree of problem pre-surgical.  More easily explained: Trivial issues pre-op equals major problems with that scar you explained, small degree of stiffness you explained, abscence of toenail you explained, etc. etc. etc. The active businesswoman who tells you, "I don't care about any scar on the skin" may be telling the truth, but if her bunion pre-op was a small little bump that a shoe modification could have taken care of, she will make that trivial scar into a nightmare for you. If she was limping home from work every day because of her bunion, that scar would not even be brought up.

This is why in all my pre-op discussions, I reiterate these points and ask the patients to really evaluate the effect of their problem in their daily lives.

Deart Barbara, thank you for your post. It is insightful to hear how the attitude towards this procedure is handed down from previous generations of doctors and foot doctors.

And Dr Bryan, i think youare spot on about the degree of pre op distress versus the final cosmetic result. I also think theres something to be said about having fuller awareness of what you are consenting to. What i mean is an adult might fare better in this situation than a child or teenager who has no idea how he might feel in the long run. I was a very young teenager, i didnt like it, but i that point i didnt completely understand how i might feel as an adult, since a child isnt predisposed to thinking about such things. I also  understand that a border problem or ingrown is quite common during teenage years. these are difficult years enough for a young person to come to terms with body image and changes without adding this to the whole thing.

I understand that there area cases where permanent whole nail removal is necessary, unfortunately. but the entire removal for a nail problem where there is potential for it to be treated much more minimally is a not a duty of care. Peoples bodies are precious to them. Body image is a difficult thing in this day and age. And in the UK., ill informed GPS need to stop sending people straight to the operating theatre for full removal without referral to a podiatrist. In the search for a cosmetic improvement ive come across vast swathes of poeple in the same people who never even got to see a specialist before being sent to theatre. But thats another matter lol.

Kind Regards Stopoo