Toenail Fungus Laser Treatment 
with the Cool Touch VARIABreeze™ Laser

What is laser treatment for toenail fungus?


Dr. Neil Zwiebel has been treating toenail fungus with lasers for since 2009. He is currently using the VARIABreeze ™ foot laser by the Cool Touch Laser Company. This laser has been shown to kill the fungus that lives in, around and under the toenail. The Cool Touch VARIABreeze™ toenail laser is FDA approved for the treatment of toenail fungus. The approval is for the temporary clearing of the toenail. The laser light passes through the toenail without causing damage to the toenail or the surrounding skin. The Cool Breeze Laser is the only laser to use precise temperature monitoring to ensure a safe treatment of the toenail. The Cool Breeze Laser uses the 1064nm wavelength of infrared light to effectively treat and kill the fungus.

At the time of the procedure, the toenail will not become instantly clear, it will take time for the previously infected nail to grow out and the new nail to form. This can take 6 to 12 months depending on the rate of growth of the toenail. During this time there may be a need for additional laser treatments. Periodic treatments may be needed to maintain the results.

Cool-Breeze-Treatment-PictureHow is the procedure performed?

The Cool Breeze VARIABreeze™ laser is applied by the doctor to cover the entire nail. When the appropriate temperature is reached a burst of cold spray is released to cool the nail and stop the heating process of the toenail. Patients are able to walk in and walk out and go about their normal day. There is no anesthesia required and no down time associated with this treatment. The procedure typically takes about 30 minutes. We start with 3 treatments, 2 weeks apart. A follow up is performed 4 to 8 weeks following the third treatment.

During the procedure most people may feel a slight heat sensation with minimal to mild discomfort. There is no specific preparation for the procedure other than the removal of any nail polish or nail decorations the day of or the day prior to treatment.

On the day of the procedure Dr. Zwiebel will trim and file down the toenails to remove as much of the fungal infected toenail as possible. This will help reduce thickness of the infected toenail and aide the removal of any loose and detached nail debris caused by the fungus. This allows for better treatment with the laser by allowing the laser beam to penetrate closer to the nail bed and the sites of infection.

Will the fungus come back?

Currently all the lasers on the market are FDA approved for toenail fungus treatment are approved for the temporary clearing of the nail. This means that the fungus may or may not come back. Some people will see significant changes in their nail with improved color and consistency. In areas that are unattached attachment of the nail may occur. It may be necessary to have periodic treatments to maintain results similar to having one's teeth whitened.

Even the strongest oral medications only clear up 80% of the cases of infected toenails with a 50% reoccurrence rate within 3 years after oral treatment. Currently, there are no long term studies with laser treatment.

Are additional treatments necessary?

Typically with the start of laser treatment Dr. Zwiebel will recommend using a topical antifungal mediation to be applied to the nails daily. This helps to improve and maintain the results with the laser.

In severe cases Dr. Zwiebel may recommend using a special compounded topical medication and even a regimen of pulse dosing the oral medication (terbinafine HCL) to help improve results. Pulse dosing the oral medication will aide killing the nail fungus in the nail bed and root.

Pulse dosing oral medication entails taking the pill for one week at a time, every other month over the course of a year, as opposed to the traditional dosing of one pill a day for 3 months consecutively. The pulse dosing method allows us to reduce the amount of medication taken in half and the ability to treat the toenail over the entire growth cycle of the nail. (please see the attached study for pulse dosing details)

Dr. Zwiebel also recommends the Sterishoe device for shoe sterilization for those with toenail fungus and athlete's foot (tinea pedis) as to avoid reinfection.


Does insurance cover Toenail Fungus Laser Treatment?

Currently, private insurance and Medicare do not cover laser treatment of toenail fungus.

What is the cost of Laser Treatment?

The series of the first 3 treatments cost: $695 (for greater than 5 toes affected)

$495 (for 5 or less toes affected)

Additional treatments range from $95 to $150 (depending how many nails need treatment)

Does Flexible Spending (FSA) COVER Toenail Laser Treatment?

Does Health Savings Account (HSA) Cover Laser Toenail Treatment? 

In our experience most FSA and HAS programs will allow for payment of the treatment with these funds. An appropriate bill is provided with the proper diagnosis code. One should realize that we are treating an infection with a FDA approved device that is not covered by insurance or Medicare.

Is the consulation covered by insurance and medical?

A consultation regarding evaluation and treatment of toenail fungus is covered by most major insurance companies and Medicare. We are participating in-network with most major insurance companies and are a participating provider with Medicare. Please see the policy page for a complete list of insurances that we accept.


before after VariaBreeze clear nail laser treatment 2