Working up a sweat—whether because it’s hot and muggy outside or because you’re exercising—is both natural and healthy. It’s the body’s way of cooling itself down. But if you find yourself sweating excessively and unpredictably, without knowing why, you may have a medical condition called hyperhidrosis.
If you have hyperhidrosis, the body’s eccrine sweat glands are overactive and cause excessive sweating, which can result in embarrassment, discomfort and can even interfere with daily life. The good news? There are a number of treatments available for hyperhidrosis, including surgery, though most people living with hyperhidrosis consider surgery only after other treatment methods have failed. But surgery comes with its own set of risks and complications, so it’s important to understand all your options before making a treatment choice that’s right for you.
Types of Hyperhidrosis Surgery
There are two types of surgery for treating hyperhidrosis: endoscopic thoracic sympathectomy, or ETS, and sweat gland removal.
Endoscopic Thoracic Sympathectomy (ETS)
Endoscopic thoracic sympathectomy is a procedure most commonly performed when other types of treatments for hyperhidrosis have failed. Typically, ETS surgery is performed to treat local hyperhidrosis, which is when excessive sweating occurs only in certain areas of the body, as opposed to all over. The most commonly treated areas are the palms of the hands (palmar hyperhidrosis), underarms (axillary hyperhidrosis), and sometimes facial blushing. The procedure is less commonly performed for plantar hyperhidrosis (excessive sweating of the feet), as it tends to be less effective for this area.
During ETS surgery, a thoracic surgeon either cuts, clamps, or otherwise destroys the sympathetic nerves that control sweating in the problem area. After the patient is put under general anesthesia, the surgeon will make two or three small incisions under the armpit, on the side where excessive sweating occurs. The lung on that side of the body will be deflated, or collapsed, so that the surgeon has more room to work. A small telescope with a camera, known as an endoscope, is inserted through one of the small incisions in the chest in order to magnify the area being operated on. Other small tools are inserted as well, and the surgeon will use these tools to find and cut or clamp the nerves that control sweating. During the cutting method, the nerve is cut with an electric cautery or with a harmonic scalpel (an ultrasonic device). In the clamping method, titanium clips are applied to the nerve to cease function of that particular nerve segment.
Afterwards, the lung is reinflated, the cuts are closed with stitches, and a small drainage tube may be left in the chest for a day or so. ETS is an outpatient procedure that takes somewhere between one to three hours, and recovery time is usually one to two weeks.
Sweat Gland Removal
While ETS is the most common type of surgical treatment for hyperhidrosis, it’s not the only one available. In fact, there are a number of other procedures that can address excessive sweating symptoms. Unlike ETS, which works by cutting or clipping the nerves responsible for excessive sweating, these other surgical procedures work by removing or destroying the overactive sweat glands in the problem area. Let’s take a closer look.
Axillary Curettage: You might remember that axillary hyperhidrosis is what we call excessive armpit sweating. Axillary curettage is a surgical technique that treats excessive sweating in this specific area of the body. A surgeon will scrape out the sweat glands from the underarm area. While the procedure is considered to be fairly effective for treating underarm sweating, it’s generally considered a pretty invasive surgery and carries the risk of scarring and nerve damage.
Laser Sweat Ablation: Laser sweat ablation is another treatment for underarm sweating. It uses a laser to destroy sweat glands in the underarms. Considered minimally invasive, laser sweat ablation can still cause pain and swelling. Lastly, results tend to vary from person to person, and it may not be totally effective for every patient.
Subcutaneous Sweat Gland Removal: Just like it sounds, subcutaneous sweat gland removal involves removing the sweat glands beneath the skin, often in the underarms. This procedure comes with a high risk of complications, including infection, scarring, and nerve damage.
How Effective is Hyperhidrosis Surgery?
The results of ETS surgery are typically immediate; many patients report waking up from anesthesia with dry, warm palms. It’s generally considered to be a very effective treatment, though success rates vary based on the area being treated.
Palmar Hyperhidrosis (Hands): ETS surgery is considered highly effective for treating palmar hyperhidrosis. In fact, most studies report success rates exceeding 95%, which means the majority of patients experience significant relief from sweating after the procedure.
Axillary Hyperhidrosis (Underarms): For armpit sweating, ETS is also considered very effective, with most studies reporting success rates exceeding 80%.
Facial Hyperhidrosis (Face and Blushing): Facial sweating, including facial blushing, responds well to ETS in most cases, though the results may not be as dramatic as those for the hands and armpits.
In most cases, ETS surgery is permanent and can’t be reversed. It’s important to make sure you understand the risks and side effects of ETS as well, as those tend to be permanent too.
Risks and Side Effects of ETS
ETS can provide real, lasting relief from excessive sweating—but it’s not without its risks and potential complications.
Compensatory Sweating: Compensatory sweating is the most common side effect of ETS, which is a medical condition where you begin sweating excessively in body parts other than the treated area—often on your back, chest, or thighs. Some studies have reported compensatory sweating ranging from mild to severe in up to 98% of people.
Nerve Damage: ETS involves cutting or clamping nerves in certain areas. In some cases, this can cause damage to the surrounding nerves as well. Though rare, some patients may even develop something known as Horner's syndrome, a condition that affects the pupil and can cause drooping eyelids, small pupils, or facial flushing. Nerve damage can also cause chronic pain or discomfort.
Pneumothorax: Because the surgeon deflates, or collapses, one or both lungs during ETS, there is a small risk that a small amount of air will be left in the chest cavity after surgery. The air is typically reabsorbed by the body within a few days, and there are rarely long-term effects.
Considering Alternatives Before Hyperhidrosis Surgery
If you’re tempted to try hyperhidrosis surgery as a first-line of treatment for your excessive sweating, you’re not alone. Hyperhidrosis can cause severe emotional distress, physical discomfort, and social anxiety. It makes sense that you would seek out both a permanent and effective solution.
But before considering surgery, you may want to take a moment to explore a number of far less invasive treatment options that are available for hyperhidrosis. Unlike surgical treatments, these treatments generally pose a low risk of complications and have minimal side effects. You might even be able to achieve the symptom relief you’re seeking—without the discomfort that comes with surgery.
Topical Medications
Topical treatments for hyperhidrosis are applied directly to the skin and work to reduce sweating by blocking or limiting the activity of sweat glands. Common topical treatments include:
Prescription-strength Antiperspirants: These contain aluminum chloride or aluminum chloride hexahydrate, which block the sweat ducts and reduce sweating. They are typically applied to the affected areas before bed and washed off in the morning.
Topical Glycopyrrolate: Though more commonly used in oral form, glycopyrrolate can also be found in some topical formulations, particularly for treating facial hyperhidrosis, where it works by blocking acetylcholine at the sweat glands.
Sofpironium bromide (Sofdra): Sofdra is an FDA-approved topical anticholinergic gel that works by blocking the action of acetylcholine, which reduces the stimulation of sweat glands.
Oral Medications
Oral medications for hyperhidrosis work by affecting the nervous system to reduce excessive sweating. Two of the most common are glycopyrrolate and oxybutynin, anticholinergic medications that work by blocking the chemical signals that activate sweat glands. These drugs are both safe and cost effective methods for treating excessive sweating, but they can come with side effects such as dry mouth, blurred vision, or urinary retention.
Botox Injections
Botulinum toxin injections can temporarily block the nerves responsible for sweating and is FDA-approved for the treatment of axillary hyperhidrosis.
Iontophoresis
This non-invasive procedure uses a mild electrical current to reduce sweating, particularly for palmar and axillary hyperhidrosis. It requires regular treatments but is generally considered to be safe and effective.
Key Takeaways
Before considering surgery, it is important to explore alternative treatments such as oral and topical medications like glycopyrrolate, Botox injections, and iontophoresis, which may provide effective solutions without the need for invasive procedures.
However, if you do feel the need to consider surgery, certain surgical procedures can offer significant relief for individuals suffering from excessive sweating in the hands, underarms, or face. While procedures like ETS can be highly effective in many cases, they also carry risks such as compensatory sweating and nerve damage. It’s important to carefully weigh the benefits and potential complications before opting for surgery.
Ready to learn more about noninvasive hyperhidrosis treatment options? Schedule an online consultation with SweatRx today.
