Background: Simple postaxial polydactyly (type B) is a common congenital hand malformation often treated by suture or clip ligation. Methods: We present a case series of patients with simple postaxial polydactyly treated by surgical excision using local anesthesia in an office setting. Results: The procedure was performed on 78 digits in 48 children with a mean age of 10.2 weeks. There were no intraoperative or early postoperative complications. A follow-up by phone interview was performed at an average of 3.2 years postoperatively. All patients were reported to be pain-free and have normal function without a perceived range of motion deficits. All parents selected the highest level of satisfaction regarding cosmetic outcomes and overall experience with the procedure. Conclusions: These results demonstrate that an office-based surgical excision is a safe, effective, and economical treatment option and has developed into our standard of care for this common condition.