320 Herbert Irving Pavillion,
161 Fort Washington Avenue,
New York, NY 10032
Over the past several years, several different surgical procedures have evolved to treat hyperhidrosis and eliminate or reduce the risk of compensatory sweating. Patient selection is crucial. Certain patients seem to experience worse compensatory sweating. Patients who experience excessive sweating over their entire body before ETS tend to have more severe compensatory sweating. It has been our practice to avoid ETS surgery in these patients.
The surgical technique also may have an impact on both the frequency and severity of compensatory sweating. Not all patients with hyperhidrosis are the same. Some patients have predominantly hand sweating while others may also experience severe facial sweating and blushing at the same time. Since not all patients have the same symptoms, we believe the surgical procedure must be individualized to suit the symptoms. There have been several reports involving large numbers of patients from European centers that also suggest modifying the procedure depending on the dominant symptoms.
In patients with palmar sweating we isolate the T3 ganglia. This technique is equally as effective in eliminating excessive sweating as T2 sympathectomy and reduces the chances of having severe postoperative compensatory sweating. In patients who also have facial symptoms, it is necessary to isolate the T2 ganglia, and therefore there is a higher risk of developing compensatory sweating. We however have modified the T2 sympathectomy procedure in order to reduce the risk of compensatory sweating.
Risks of Surgery
Horners Syndrome may occur if the sympathetic nerve near the T1 level is also disrupted. In patients who experience Horners Syndrome, the eyelid appears to droop slightly. The other manifestations such as absent facial sweating, or a sluggish pupil are rarely seen. The frequency of this is less than 1%, and in those who do experience it, it may resolve spontaneously. Careful dissection limited to the T2 level minimizes the risk of developing a droopy eyelid postoperatively. Since we now more frequently perform a T3 sympathectomy for palmar or axillary hyperhidrosis, the risk of a postoperative Horner's syndrome is much less.
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The Center for Hyperhidrosis at Columbia University Medical Center is located at 320 Herbert Irving Pavillion, 161 Fort Washington Avenue, New York, NY 10032. Specializing in surgical and non-surgical treatments for excessive sweating and facial blushing including miraDry and the ETS procedure. Serving the New York metropolitan area, Bronx, Brooklyn, Queens, Manhattan, Staten Island, Long Island, Nassau County, Suffolk County, Westchester County, Rockland County, Orange County, Hudson Valley, Bergen County, New Jersey, Fairfield County, Connecticut. Call 212-342-1354.
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