Facial blushing is another manifestation of an overactive sympathetic nervous system. Often patients will have elements of facial blushing in association with hyperhidrosis but often it can occur as an isolated problem. People who experienced severe facial blushing often complain of 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. It often comes on quickly with no warning, and can be very debilitating, resulting in severe social anxiety and avoidance behavior.

Unfortunately, there are few effective therapies for patients who experience severe facial blushing. There is some controversy regarding the role of ETS for facial blushing. At the Center for hyperhidrosis at Columbia University Medical Center we have an extensive history with ETS for blushing. There is a unique subset of patients with facial blushing who 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. We make two microscopic incisions placed in the armpit, through which we place a small camera, that allows visualization of the entire chest and the sympathetic nerve. We use CO2 insufflation, which gently compresses the lung, and therefor the lung is not deflated The T2 ganglion is separated from the sympathetic trunk along the superior aspect of the second rib. At the Center for Hyperhidrosis at Columbia University, we have developed a surgical technique that avoids touching or disrupting any of the microscopic sympathetic fibres emanating from the stellate ganglia, which we believe may be responsible for autonomic innervation of the heart, and other thoracic organs. By doing so, we perform a sympathectomy that eliminates facial blushing and prevents some of the other autonomic side effects such as bradycardia or severe compensatory sweating that can be associated with T2 sympathectomy. After completing the procedure, patients are discharged home after several hours. We have recently reviewed our results of T2 sympathectomy for patients with facial blushing. With average follow-up of over one year, the results are excellent. Over 90% of patients feel that ETS-T2, has dramatically improved their blushing, and has not resulted in any side effects.

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