Facial blushing is another manifestation of an overactive sympathetic nervous system often patients will have elements of chronic blushing in association with hyperhidrosis but often it can occur as an isolated problem. People who experienced excessive blushing often complain of seeing blushing that occurs not only on the face but also the neck and upper chest during stressful situations, such as public speaking or job interviews

There is some controversy regarding the role of ETS in treating extreme blushing. At the Center for hyperhidrosis at Columbia University Medical Center we have an extensive history of with ETS and facial blushing. There is a unique set of patients with chronic blushing do extremely well following T2 sympathectomy. A typically they have fair complexion, and exhibit patchy/blotchy erythematous patches over their upper chest neck and face which comes and goes in stressful embarrassing situations. The ETS–T2 sympathectomy is done in a similar fashion as for palmar hyperhidrosis. 2 microscopic incisions placed in the armpit are used to identify and perform the sympathectomy. The T2 ganglion is separated from the sympathetic trunk along the superior aspect of the second rib. By doing so this prevents some of the other autonomic side effects such as bradycardia or severe compensatory sweating. After completing the procedure patients are discharged home after several hours.

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