Skip to: Palmar Hyperhidrosis | Axillary Hyperhidrosis | Facial Blushing

ETS is performed through two microscopic incisions in the armpit or axilla. The procedure is performed under general anesthesia, and local anesthetic is infiltrated into the skin and soft tissue to minimize any pain in the early post operative period. Insufflating CO2 into the chest cavity through a tiny needle displaces the lung. We than insert two small instruments into the chest cavity: a telescope attached to a magnifying camera, and a dissecting instrument. The sympathetic nerve is dissected from the surrounding tissue with the dissecting instrument as it crosses over the ribs. After we've isolated the ganglia, a 5mm clamp is placed across the nerve. The advantage of clamping is that it allows the option for reversing the procedure, should the side effects be bothersome, though this is rarely required. After completing the sympathectomy and removing the CO2 from the chest cavity, the lung re-expands, and the two incisions are closed. The procedure is completed on both the left and right side, and then the patient is awakened and moved to the recovery room. Patients generally leave the hospital within hours of completion of the operation.

Analysis of long-term follow-up data indicates that not all patients with hyperhidrosis are the same, and that surgery needs to be tailored to the individual patient. Dr. Gorenstein also believes that ETS surgery needs to be individualized to reduce the side effects of surgery.

Palmar Hyperhidrosis
The majority of patients who have disabling hyperhidrosis, complain of excessive palmar (hand) sweating, either alone or in combination with plantar (feet) sweating. ETS is the best treatment choice for this condition, when symptoms are severe, as the other treatment options cannot control symptoms in severe cases. We perform a T3 sympathectomy for palmar hyperhidrosis, which consists of placing a clamp above and below the T3 ganglia. This procedure completely eliminates excessive palmar hyperhidrosis, yet does not result in the same amount of compensatory sweating that occurs after a T2/T3 sympathectomy. Having performed only a T3 sympathectomy for palmar hyperhidrosis in several hundred patients over the past 4 years, we are very pleased with the results and patient satisfaction.

Axillary Hyperhidrosis
Some patients experience hyperhidrosis limited to the armpits (axillae). In those situations there are several treatment options, both surgical and non-surgical. We recommend patients trying a topical regimen such as drysol initially. If that fails to adequately control symptoms, then axillary Botox® can be effective.

A surgical option, when there is only axillary hyperhidrosis is surgical removal of the axillary sweat glands. Dr. Jeffrey Ascherman, a board certified plastic surgeon, performs this procedure. Through small incisions in the axillary skin crease, the dominant sweat producing areas are removed. This procedure is also done as an outpatient; there is very little discomfort aside from the incisions. In suitable candidates this can permanently and effectively reduce embarrassing sweating in the armpits.

Some patients experience severe axillary and palmar hyperhidrosis. ETS of both T3 and T4, or T3/T4 sympathectomy, is an option. The procedure is performed in the same way as T3 sympathectomy for palmar hyperhidrosis, but the lower ganglion (T4), is also blocked with a clamp.

Facial Blushing
Facial blushing is another manifestation of an overactive sympathetic nervous center. Patients complain of embarrassing blushing over their upper chest, neck, and face during stressful situations, such as public speaking or job interviews. There is some controversy regarding the benefits of ETS for facial blushing. Our experience at the Center for Hyperhidrosis at Columbia University Medical Center with ETS and facial blushing has been positive. We perform a modified T2 sympathectomy, where a block is placed only above the T2 ganglion, rather than both above and below the T2 ganglion. This technical modification of T2 sympathectomy, seems to have reduced the severity of compensatory sweating, the most common side effect that affects patients after ETS for facial blushing.

more >