Dr. Marc Garfield, DPM, FACFAS
Board Certified by the American Board of Foot and Ankle Surgery
Board Certified by the American Board of Foot and Ankle Surgery
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LASER TOENAIL TREATMENT Now In Hampton Roads/Williamsburg



Lightfoot Podiatry Center offers the most flexible treatment plans, using the highest powered laser, to clear toenail fungus.

Before you can have your nails treated, it is important to evaluate your health and your feet to determine if this treatment is in your best interest.

The initial consultation will involve reviewing your medical history and evaluating your toenails to determine if your problem is fungus or other skin and toenail conditions that look like fungus.  This often requires a culture.  The initial consultation and labs are generally billed through your insurance, unless you decline. Cultures take 6 weeks to obtain results, and are not 100% accurate, but are still helpful.

Skin issues such as: eczema, damage to the toenail from shoe pressures, psoriasis, lupus and many other conditions may look like fungus but will not respond to nail fungus treatments.  Laser treatments occasionally help to remodel these irregular toenails and many of my patients find improvements with laser treatments despite negative cultures.

Patients wanting to undergo a laser treatment can have their nails treated once, at no additional costs when patients are being seen for a New Patient Office Visit. If patients have more than one condition to be evaluated on the same day, then the laser treatment may be rescheduled for a separate visit and included in that visit.

Laser treatment kills actively growing fungus, but does not stop spores from re-growing under the toenail, nor prevent fungus from re-infecting from your skin, shoes or home environment.

As your nails begin to clear, you will have 3 options to maintain the improvement:

1.      Pay $100 per treatment every 3-4 weeks for 3-18 months (depends on severity and rate of nail growth) until toenails clear.  This is not billed to or covered by insurance.

2.     Apply topical medications: These will prevent new infections from getting under the toenail, but will not stop spores (if they are present) from growing new fungus under the toenails

3.     Take a short (usually 5 day) course of oral medication (Pills) per month.  This is not the FDA approved use of the medication, as that involves 84 days of continual medication use.

Clearing of the toenails may not be visible for 3 months due to the fact that 3-5 mm of your toenail is under your skin and the nail grow forward at a rate of 1-2 mm per month.  If no follow up care is utilized, then the fungus in your toenail may redevelop before you can see observable changes.

I do not consider the oral medications to be risky or unsafe, in healthy patients.  These medications have some potential for adverse effects on your white count, sense of taste and liver as well as other more minor effects.  Major side effects are rare and avoidable when appropriate labwork is reviewed during treatment.   You can review the package inserts for details on side effects.  The most common FDA approved medication used for nail fungus is Terbinifine (Lamisil).  Terbinifine is the safest and most effective of the oral antifungal medications .  Most insurance companies will cover treatment for nail fungus when oral medication is appropriately used. You should check with your plan for specific coverage questions. 



 How does the laser work?

This laser is specially designed to shine through your toenail and destroy the organisms embedded in and under your nail causing the infection.  The laser increases the temperature under your toenail to 140 degrees. This is adequate to kill actively growing fungus, but not spores.  The spores will later develop into an active growing fungus that can be killed with a later treatment. So more than one treatment would be needed to keep the infection from coming back.

Laser capability is measured in  Joules per centimeter squared, also called the fluence. Our laser (by Aerolase) has a fluence ranging from 25 to 318 J/cm squared compared to the 12 -255 J/cm squared power of other competing lasers used for toenail fungus around the United States.    I am the only Aerolase provider in Virginia at the time of this posting.

Having this much more power available means that when other lasers fail to correct your problem, I can treat your nail fungus successfully. Thankfully, with proper application of the stronger fluence, there is no more discomfort with the higher power than with lower powered settings or devices. 

Is this laser painful?

There is generally a slight pain during treatment. There is never any pain after treatment. Some sensitive patients will feel a snap of pain on the toe, this is addressed by cooling the toe during the procedure. 
This treatment does not harm or affect your activity in any way.
The Aerolase 1064 Nd:YAG laser has been used safely on all skin types for toenail procedures as well as hair reduction, wart treatments and varicose vein treatments (All of which can be done here on your foot and ankle).  This device was specifically designed to transfer the greatest amount of energy into the least painful laser pulse on the market.

  Is this treatment safe?

 There are no age or health restrictions for LASER treatments.  In clinical studies there have been no adverse effects, injuries, disabilities or known side effects from Aerolase Nd: 1064 YAG  laser treatments. 

As you may know, the use of the pills available for the treatment of fungal toenails, carries with it possible problems for your liver, kidneys or white blood cells.  This laser does not! Although permanent liver damage is rare, I have had several patients loose their sense of taste taking Lamisil (AKA Terbinifine).  This side effect comes on very suddenly and last for 1-6 months.  I have not had patients where this has become permanent,  but permanent loss of taste has been reported in the Lamisil package insert. 

Does my insurance pay for this? 

Because this treatment is considered aesthetic (cosmetic), health insurance plans do not cover this treatment.  We accept major credit cards and personal checks or you may use your Flexible Spending Account from work (Check with four FSA provider to ensure that your plan allows this expense, rules changes year to year).

Is it permanent?

 Nothing can make you impervious to re-infection.  During your initial consultation and subsequent follow up appointments, we will offer products and  recommendations to reduce your exposure and susceptibility to toenail fungus.

How Much Does It Cost?

  • Because treatment regimens vary from one patient to the next, We are charging a per treatment cost of $100 per treatment regardless of how many toes I am treating (It actually takes the same amount of time). 
  • 6-10 treatments is typical.
  • Your first treatment will be complimentary with a NEW PATIENT OFFICE VISIT for Nail Fungus only-IF multiple conditions need to be addressed, then the Laser treatment or the other conditions will be seen on a separate visit.
  • Patients with an appropriate medical history may be treated with oral medications at any time during the treatment. This may require having blood drawn and checking labs.
  •  Like the $1,700 course of Lamisil pills, the treatment is not guaranteed, but you may chose another treatment option at any time, if you do not feel that the laser is helping your condition.

  What else can be treated with the laser?

Varicose Veins
Warts can be treated with NO post treatment pain (mild discomfort during the treatment, due to higher powered settings), generally resolving in 1-3 treatments
Wounds: Clinical research has shown rapid healing with laser applications
Hair reduction on the feet or toes to improve your feet for sandal season. (Only actively growing hairs can be eliminated, and hair grows in 3-9 crops per year requiring multiple treatments to fully remove hair)
Dark pigment lesion reduction
Dark ink tatoo reduction/removal often requires 3-5 or more treatments depending upon the ink, skin color and extent.


To make an appointment, call (757)345-3679


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