Nails play an important esthetic and functional role in our society. Nowadays, esthetic improvements become increasingly common. Some nail dystrophies may bother patients in daily life: denial of wearing sandals, hiding a finger by keeping their hands in pockets, clenching their fists in public, etc. Physicians should be aware that some congenital and acquired nail dystrophies might benefit from surgical cures allowing a nice cosmetic outcome when performed by skilled surgeons. Here will be reviewed some of the most common nail dystrophies that may be improved by surgery: malalignment of the big toenail, trapezoidal nails, racquet thumbs, vertical implantation and duplication of the nail on the fifth toe. For more complex dysplasias and malformations, involvement of hand surgeons is recommended.