A close-up photo capturing a surgeon's gloved hand holding a cotton ball with nail polish remover, emphasizing the importance of removing nail polish prior to surgery.

What Happens If You Don’T Remove Nail Polish Before Surgery?

Having surgery can be stressful enough without worrying about your nail polish. You may have heard that you need to remove it before going under the knife, but why is that exactly? If you’re short on time, here’s a quick answer: Leaving nail polish on during surgery increases your risk of infection and can interfere with monitoring equipment.

Now let’s dive into the details.

In this comprehensive guide, we’ll explore why it’s so important to remove your nail polish before surgery. We’ll look at how it can lead to surgical site infections, disrupt pulse oximetry monitoring, and cause other problems during and after your procedure.

We’ll also provide tips on how and when to remove nail polish, and alternatives if you just can’t bear to part with your manicure.

Nail Polish Can Increase Infection Risk

Bacteria Can Get Trapped Under Polish

Wearing nail polish when undergoing surgery may seem harmless, but it can actually increase the risk of post-operative infection. Here’s why:

Nail polish, especially chipped polish, provides the perfect environment for microbes like bacteria and fungi to thrive. The nooks and crannies that form as polish chips away are ideal hiding spots for these germs (Yang et al., 2015). Fingernails also harbor bacteria naturally.

When polish is applied on top, it seals everything underneath – dirt, debris, and bacteria get trapped and can proliferate (Gupta et al., 2007).

During surgery, even the most sterilized environment can’t prevent some bacteria from entering through incisions. With nail polish on, pathogens have a cozy, protective layer that allows them to invade more easily.

This significantly raises the chances of developing a postoperative infection – one study found 2x the risk when patients wore polish (Parry et al., 2010).

Infections lead to extended hospital stays, extra medications, and delayed healing. That bright polish suddenly seems not so pretty! To avoid unnecessary complications, docs recommend removing any traces of it before an operation.

Chipped Polish Also Poses a Threat

Even nail polish that looks flawless can be problematic before surgery. As polish ages, micro-cracks and chips can form that are invisible to the naked eye (Mazonakis, 2022). These minuscule imperfections create additional nooks for bacteria.

On top of that, chipped polish indicates the surface is more porous overall. This allows pathogens to attach more easily and survive beneath the polish layer (Yang et al., 2015). Even if you can’t see any chips, older polish likely has microscopic defects that pose an infection risk.

Some statistics on how common infections can be after surgery:

  • Up to 5% of patients develop a surgical site infection (SSI) (CDC, 2022)
  • SSIs account for 20% of all healthcare-associated infections (HAIs) (CDC, 2022)
  • The average SSI leads to a one week longer hospital stay (CDC, 2022)

Removing nail polish prior to surgery is a simple way patients can lower their risk of developing an SSI and enjoy better healing. Any chips, cracks, or peeling polish should definitely be taken off. Even if a manicure looks perfect, removing it as a precaution is wise.

It Can Interfere with Monitoring Equipment

Problems With Pulse Oximetry Readings

Wearing nail polish during surgery can cause issues with pulse oximetry, a non-invasive method used to monitor heart rate and blood oxygen levels. Pulse oximeters work by shining a light through the finger and measuring how much light is absorbed.

Nail polish can block some of the light from penetrating the finger, leading to inaccurate readings.

Since pulse oximetry is one of the main ways anesthesia providers monitor patients during surgery, inaccurate readings due to nail polish can make it difficult to detect emerging issues. For example, if blood oxygen levels are dropping but the pulse oximeter doesn’t detect it due to blocked light from nail polish, the anesthesiologist may not realize a patient needs more oxygen in a timely manner.

Some studies have found that dark-colored nail polishes like black, brown, blue, and green have the biggest impact on pulse oximeter accuracy. However, even light sheer polishes can potentially interfere.

For the most reliable monitoring, surgeons request that patients remove all nail products before their procedure.

Other Disruptions

In addition to pulse oximetry concerns, nail polish can cause other issues during surgery and recovery:

  • ECG/EKG leads are often placed on the fingers or hands to monitor heart rhythm. Nail polish could potentially create a barrier interfering with conduction.
  • Nail polish could conceal underlying nail bed issues like infection or trauma that providers need to be aware of.
  • Oxygen saturation probes that clip onto the fingertips may not get an adequate seal over polished nails.
  • Nail polish could chip or peel off into a surgical wound, raising infection risks.
  • Chipped polish on the fingers might compromise hand hygiene practices after surgery.

To avoid any possible problems, the American Society of Anesthesiologists recommends people remove nail polish and artificial nails before having surgery. Checking in with bright, bare nails ensures monitoring devices function properly and doctors can easily assess the hands before and after the procedure.

Additional Issues to Consider

Polish Could Chip or Crack During Surgery

During surgery, your hands may be moved around frequently to accommodate the procedure. If you have nail polish on, this movement could cause the polish to chip or even crack. Chipped nail polish could get into the surgical area and contaminate it.

Cracked polish could also harbor bacteria if it lifts up from the nail. Both situations should be avoided if possible.

Dark Colors May Obscure Underlying Tissue

Doctors need to be able to visualize the underlying nail bed tissue clearly during surgery. Dark colored nail polish can potentially obscure the true color of the skin and make visualization more difficult. Light pink or nude polishes would be preferable if you need to keep polish on for a procedure.

Doctors May Need Access to Nails and Cuticles

In some surgeries, doctors may need access to the nail itself or the surrounding cuticle area. For example, if a hand or finger surgery is being performed, nail polish could get in the way. According to the American Academy of Dermatology (https://www.aad.org/public/everyday-care/nail-care-secrets/nail-care), it’s important to have bare nails before a hand surgery.

Additionally, an IV is often placed on the hand or wrist prior to surgery. Nail polish could interfere with proper IV placement and monitoring during the procedure. The IV site needs to be easily accessible and visible.

Finally, a pulse oximeter is commonly used during operations to measure oxygen levels. This small device goes on your fingertip and senses blood flow. Polish on the fingers might not allow it to function properly.

When and How to Remove Nail Polish Before Surgery

Ideally, Remove Polish 7-10 Days Before

Experts recommend removing nail polish at least 7-10 days before undergoing surgery. This allows enough time for any remaining traces of chemicals from the polish or remover to dissipate from the nail bed area.

Leaving polish on closer to surgery day increases the risk of negative reactions with surgical prep solutions, anesthesia, or other medications administered.

Many modern nail polishes and removers contain ingredients like formaldehyde, toluene, and dibutyl phthalate. Although considered safe for regular use, these chemicals can potentially leach into the body through the nail bed and cause issues if they interact with surgical drugs.

Acetone removers are also very drying when left on too long.

Dermatologists advise patients aim for a full 7-10 days polish-free prior to any operation as a best practice. This helps avoid potential problems. Some may recommend erring on the longer side of 10-14 days removal time if your specific surgery and medical profile warrants extra caution.

Acetone is the Most Effective Remover

When taking off nail polish pre-surgery, acetone-based removers dissolve polish most quickly and thoroughly. Gentler removers like those with ethyl acetate may require more rubbing and pressure to lift color, which can irritate skin and cuticles. Acetone dries fast as well.

Using aluminum foil wraps or remover-soaked cotton balls on nails for 5-10 minutes allows acetone to penetrate better versus just wiping.then scrubbing gently with a soft brush removes any remaining flecks stuck near the cuticles or edges without trauma to the nail bed.

This helps get nails cleaner for surgery day.

However, be aware that acetone can dry out nails and skin aggressively with prolonged use. Moisturize well after removing polish and avoid very frequent acetone soaks. For those with existing skin conditions, check with your dermatologist first if aggressively removing old polish layers is wise within 10 days pre-surgery.

Be Thorough With Removal

Do not forget to remove nail polish thoroughly from every digit, including less visible toes that will be prepped and visible during the surgical process. Overlooked pinky toes or index fingers with leftover flecks of color could prompt operating room delays or other issues.

Technicians also advise gently scrubbing underneath free edges and near sides of nail beds with a soft brush. These areas commonly harbor hidden remnants of color. Push back or trim cuticles if needed to fully view the nail bed and ensure total removal.

Use a magnifying glass and bright light to scan for any microscopic bits on the underside or edges of treated nails afterwards. Even tiny flecks of color or clumped glitter can potentially contaminate surgery sites or interfere with procedures.

Meticulously clean under nails as well using soap and an old toothbrush.

Remind technicians to double check during surgical prep that all nails are visibly clean. Speaking up ensures peace of mind and avoids problems once in the operating room when you will be sedated. Staying polish-free for 1-2 weeks after surgery while recovering is also wise.

Alternatives if You Can’t Part With Your Manicure

Gel Manicures May Be Left Intact

If you just got a fresh gel manicure and your surgery is coming up, you may be wondering if you can leave it on or if it needs to be removed. The good news is that gel polish is typically safe to keep for surgery!

Gel manicures form a durable, plastic-like coating on the nails that adheres tightly to the nail plate. This allows oxygen to pass through to the nail bed underneath, unlike traditional polish which can block oxygen transfer.

Several studies have found gel polish to be compatible with pulse oximetry monitoring during surgery. Pulse oximeters clip onto the finger and measure heart rate and blood oxygen saturation. As long as the gel manicure is not chipping or cracked, it should not interfere with getting an accurate reading (1).

However, some hospitals still require removal of any nail polish prior to surgery. This policy helps avoid any potential issues with the anesthesiologist monitoring vital signs. Check with your surgeon to see if their office has a policy about keeping gel polish.

They may allow you to simply neatly trim and file the nails if removing the polish altogether seems unbearable!

Creative Bandaging Solutions

If your surgeon says that all nail color absolutely must go before heading into the OR, don’t despair! There are some creative solutions to keep your nails looking stylish even if your pretty manicure has to come off.

One idea is to apply nail wraps instead of polish for a polished look that can stay on for surgery. Nail wraps look like painted nails but are made of thin, flexible material that adheres to the natural nail. These allow for medical monitoring without interference and are easily kept clean.

Not to mention, the patterns and designs available with nail wraps are amazing!

If you must remove all nail color but can’t fathom bare nails, hospital socks can be used to make “false nails” as a temporary fix. Simply cut small pieces of sock to fit over the nail and glue in place with a small dab of medical tape or bandage adhesive.

This trick gives the appearance of painted nails while exposing the natural nail for your procedure.

For gel polish, soaking in acetone may be required for removal prior to surgery. But plan ahead and get them redone immediately after to reward yourself for making it through! The American Academy of Dermatology confirms gel and traditional manicures are safe after surgery once you are feeling up for it (2).

Just be sure to keep the incision site dry when washing your hands or getting nails done. With a little creativity, you can have great nails before, during and after your procedure!


As you can see, leaving on your nail polish before surgery comes with quite a few risks. While you may be attached to your latest manicure, it’s best to remove it completely prior to your procedure. Doing so will help avoid surgical site infections, monitoring disruptions, and other issues.

Talk with your doctor about the exact timeline for taking off polish. And if you just can’t part with your nails, explore gel manicure or creative bandaging options. With some minor preparation, you can safely keep up your stylish tips and enjoy peace of mind before your operation.

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