What is the success rate of ETS?
Is ETS a new procedure?
Do I need to stay overnight in the hospital for ETS?
What are the side effects of ETS?
Does hyperhidrosis get better on its own?
Can ETS be reversed?
Who should have ETS?
If I sweat all over my body, will ETS work for me?
Is hyperhidrosis hereditary?
Are there any restrictions after ETS surgery?
Is clamping better than cutting?
Are all cutting techniques the same?
What should I do to be evaluated for ETS?
When can I return to work after ETS?
Are there sutures that need to be removed after ETS?
Is any follow up required after ETS surgery?
Will my insurance cover ETS procedure?
Can I fly after ETS?
What is the miraDry® procedure?
What is the miraDry® procedure like?
What happens after the miraDry® procedure?
What results can I expect with miraDry®?
How long will the results last with miraDry®?
Don’t I need my underarm sweat glands?
How is the miraDry® procedure different from other treatment options?
Is the miraDry® procedure right for me?
ETS is very effective in eliminating palmar hyperhidrosis. You will awaken in the recovery room with warm dry hands. Rarely will ETS fail to eliminate palmar hyperhidrosis. ETS also eliminates facial blushing and facial sweating in patients with this manifestation. In approximately 50% of patients with excessive foot sweating, that too is eliminated. Read more...
No. Surgical sympathectomy for palmar hyperhidrosis has been performed for well over 30 years. What is new is a minimally invasive approach to this very bothersome problem. Previously surgery required a large incision either in the back of the chest or in the neck to gain exposure to the sympathetic nerve. The new endoscopic approach allows surgeons to gain access to the sympathetic nerve via microscopic, painless incisions. The camera magnifies the nerve so that even the small branches are visible.
No. This is an outpatient procedure. Most patients leave the hospital several hours after completion of the procedure. Long acting local anesthesia is placed into the incision to minimize the discomfort. You will be seen by Dr. Gorenstein before being discharged from the hospital and again in the office several days later to check the incisions. Regular activity can be resumed within days of the procedure.
Compensatory sweating is the most common side effect after ETS. Most patients will exhibit this after surgery. It is usually very mild, and not bothersome considering the tremendous benefit of dry warm hands. The type of sympathectomy performed depends on the patient's symptoms. This has been shown to reduce the risk of severe compensatory sweating. Click here to learn about the other possible side effects.
No. Symptoms of palmar hyperhidrosis tend to develop in adolescence or early adulthood. Once symptoms occur they tend to worsen over time and do not spontaneously disappear. Not all patients with this problem require surgery. In some people, bothersome hand sweating only occurs under severe stress. In others it is present nearly all the time, and any stressful situation exacerbates the problem. These individuals will require surgery to alleviate the problem as no other therapy can effectively and permanently alleviate severe hyperhidrosis.
ETS should be considered a permanent procedure, and therefore is reserved for patients with severe palmar hyperhidrosis and facial blushing. The clamping technique was introduced so that if compensatory sweating is severe, the clamps can be removed and compensatory sweating eliminated. To date there has not been any large studies that prove reversibility by removing clamps. There are some encouraging case reports that suggest reversal is possible.
If you suffer from severe palmar sweating or facial blushing that has not responded to other treatments, you should consider ETS. Severe axillary (arm pit) sweating can also be cured with ETS, although this form of hyperhidrosis can also be treated with miraDry®.
ETS is intended to cure palmar hyperhidrosis and facial blushing. If you sweat profusely all over your body, you will not benefit from ETS. There could be other causes for your symptoms such as hyperthyroidism and you should consider seeking medical attention.
There may be a genetic component to hyperhidrosis. We are currently looking at first degree relatives of people with hyperhidrosis and are performing tests to see if genetics plays a role in this disorder.
There are no physical restrictions after ETS. It is usual to have some incisional pain after surgery. You may shower the next day. The sutures are beneath the skin and dissolve.
I do not believe there is any essential difference between the two techniques regarding the elimination of palmar hyperhidrosis, provided they are performed correctly. In order for the clamping technique to be effective, the nerve is clamped and permanently disrupted. Theoretically the clamp can be removed and the nerve function restored, however this has not yet been proven to work all the time. A potential problem with the clamping technique is failure to eliminate hyperhidrosis; if the clamps are incorrectly placed on the nerve or if they slip off soon after the procedure. The cutting technique is certain to stop hyperhidrosis, and there is no risk of late failures or recurrence. To date only anecdotal reports about reversal are available, but there seems to be about a 50% chance of reversing the side effects if the clamps are removed.
No. There are different ways in which the sympathetic nerve can be divided. Dr. Gorenstein uses a harmonic scalpel to divide the nerve. This instrument does not use electric current so there is less trauma to surrounding tissues and other nerves in the area of the sympathetic nerve.
If you would like to be evaluated by a physician at the Center for Hyperhidrosis at Columbia University Medical Center you may contact us by phone or by email to schedule a consultation. After a thorough examination and discussion about ETS, you can decide if you would like to proceed with ETS.
Most patients return to work within 24 to 48 hours of the procedure.
The microincisions are closed with a single absorbable suture that does not need to be removed. You can shower the day after the procedure.
Dr. Gorenstein will see you immediately after the procedure, and before you are discharged home. A follow-up appointment with the doctor is scheduled one week from surgery.
Palmar hyperhidrosis is a well-recognized medical condition with serious physical and psychological side complications when not treated. Most insurance companies and HMOs provide full coverage for ETS.
Yes. We recommend that you stay in New York until being seen by Dr. Gorenstein, and obtaining a chest X-ray to be sure there is no pneumothorax before flying.
The miraDry procedure is quick, non-invasive and provides a lasting solution for excessive underarm sweat. The handpiece from the miraDry System, when placed on the underarm, delivers precisely controlled energy to the region where the sweat glands reside and eliminates sweat glands non-invasively. The sweat glands don’t grow back once eliminated, resulting in a dramatic and lasting reduction of underarm sweat.
The procedure involves no surgical incisions or cuts. The clinician customizes treatment for each underarm area with multiple placements of the miraDry handpiece. Local anesthesia is administered to the underarms prior to the procedure to maintain comfort. Your office visit appointment will generally last about an hour. Two procedures spaced three months apart are required to maximize the results and duration.
There is minimal to no downtime following the procedure. Your doctor will likely recommend a mild over-the-counter pain medication and use of ice packs for a few days. You should be able to return to normal activities or work right after the procedure, and you can typically resume exercise within several days. Some localized soreness or swelling is normal, and typically clears within a few weeks. Some patients have short-term altered sensation in the skin of their underarms or upper arms, which gradually disappears.
Most patients report a dramatic reduction of their sweat – in a recent clinical study, the average sweat reduction was 86%. (Data on file at Miramar Labs, Inc.) You should see a reduction in sweat immediately after treatment. As with any medical procedure, results will vary by person.
The results are lasting because the sweat glands do not come back or regenerate after they have been eliminated. The miraDry procedure uses a safe, non-invasive technology that is FDA cleared to eliminate sweat glands in the underarm.
Your body contains over 4 million sweat glands, with only about 2% located in the underarms. Eliminating this 2% will not affect the body’s ability to cool itself.
Other treatment options are designed to temporarily disable the sweat glands, or involve surgery which contains inherent risks. Only the miraDry procedure provides a lasting solution with a non-invasive treatment.
If embarrassing underarm sweat outbreaks, stained clothing or frequent antiperspirant application interfere with your daily life, then you may be a good candidate for the miraDry procedure. Call our office to schedule a consultation 212-342-1354.