Frequently Asked Questions about Hyperhidrosis Treatment

Milder forms of Hyperhidrosis can be treated medically with moderate success. The most common nonsurgical treatments include the use of astringents, talc or starch, sedatives, antihistamine medicines or beta blocker medication. More aggressive therapy is also performed, which involves liposuction, botulinum toxin injections or iontophoresis. When these treatments fail or if a patient has moderate to severe Hyperhidrosis, surgical treatment is the most effective option.


What is the surgical treatment for Hyperhidrosis?

The most effective treatment for Hyperhidrosis is ETS (Endoscopic Thoracic Sympathectomy). This involves the use of special equipment and allows the surgeon to cut the sympathetic nerves at a precise location. The surgery takes about 40 minutes and requires two small (about 1.5 centimeters) incisions, one on each side of the chest. A camera is used to visualize the sympathetic chain and the nerves are cut as they cross the second rib. This procedure affects ONLY the nerves to the armpits and hands. The nerves to the face and feet are not treated with this surgery.

What are the results?

Symptoms improve practically the moment the patient awakens from the anesthetic. Many patients notice the difference as they are being wheeled from the operating room into the recovery area. These effects are permanent in the vast majority of patients.

What is the recovery period?

Although ETS is a minimally invasive surgical procedure, there is some pain in the postoperative period. Typically, this is localized to the incision sites and the nerves near the incisions. There is also some generalized chest discomfort that resolves in 24 to 72 hours after surgery. Most patients return to normal activity after about a week. The body continues to heal after any surgical procedure for weeks or months. In some patients, the healing process will take a little longer. People with diabetes and people who smoke tend to take longer to heal.

What kind of anesthesia is used?

General anesthetic is used for this surgery. The lungs are not completely collapsed during surgery. Most patients are discharged the same day of surgery.

What are the risks of surgery?

time an incision is made, there is a small risk of infection, bleeding or healing issues at the surgical sites. ETS is performed under general anesthesia and carries the risks associated with that. Some patients have bad reactions to medications used. Your surgeon will discuss the surgical risks in greater detail at the time of your visit.

What are side effects of surgery?

Compensatory sweating (compensatory hydrosis or reflex sweating) is the most bothersome side effect. Compensatory sweating is experienced as excessive sweating on the back, abdomen, thighs, and/or lower legs. This should be expected to a certain degree in all patients, and it ranges from mild to severe. 3% - 5% of patients will experience more severe compensatory sweating. Severe compensatory sweating or severe compensatory hyperhidrosis will make those patients unhappy. Severe compensatory sweating can be defined as very troublesome especially when it soaks through the clothing. It is a difficult situation especially in hot humid summer days. So far attempts to find a common thread among those patients who develop severe compensatory sweating has not yet yielded any concrete answers.

However, most patients who develop mild to moderate compensatory sweating say that they are not troubled by this extra perspiration and it is preferable to sweaty palms. On the other hand those patients who develop severe compensatory sweating will complain about this excessive extra sweating especially in hot humid weather or certain anxious situations. A short time after the operation, 3-1/2 to 4 days, some patients will have a temporary recurrence of sweating on their palms. This is a short-lived phenomenon that might last for half a day.

Dr. Lajam will discuss this with you before surgery. Don't be afraid to ask any questions you have.