unfortunately all it takes is getting it once.. not everyone gets them again though, so that's why they don't kill the root of that portion of the nail unless they have to. My brother wound up getting that surgery to remove the nail root last year for ingrown nails. I've had them for years, but they never got that bad. Unfortunately just this week though I got one that was really bad.. went to the ER Wed early morning for the pain cause it wound up getting infected.. they started me on antibiotics and pain meds. Then I went to my podiatrist later that day (strange coincidence is that I had the appointment for a month for my other foot.. talk about timing). He cut the strip of nail that was bothering me (not the root though). I hope mine heals ok. The shots of novacaine didn't bother me.. my pod. used stuff to freeze the skin so I wouldn't feel the needle. I always heard horror stories of docs putting needles through the toenail, but thankfully he just stuck me at the base of the toe (whew!).