What is the success rate of ETS?

After ETS for hand sweating or palmar hyperhidrosis, the results are immediate and there will be complete elimination of hand sweating. Dr. Gorenstein has performed over a thousand ETS procedures for hyperhidrosis, and over 98% of patients claim the procedure has dramatically improved their lives.

Is ETS a new procedure?

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.

Do I need to stay overnight in the hospital for ETS?

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.

What are the side effects of ETS?

After ETS there a very few side-effects. Occasionally there is some numbness near the incisions, which is always self-limiting, and disappears. Compensatory sweating or sweating in other regions of the body is the most common side-effect after ETS. The way that Dr. Gorenstein performs ETS has been shown to limit the frequency and severity of compensatory sweating. Success rate which we measure by patient satisfaction exceeds 98% at our center.

Does hyperhidrosis get better on its own?

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.

Can ETS be reversed?

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.

Who should have ETS?

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®.

If I sweat all over my body, will ETS work for me?

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.

Is hyperhidrosis hereditary?

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.

Are there any restrictions after ETS surgery?

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.

Is clamping better than cutting?

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.

Are all cutting techniques the same?

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.

What should I do to be evaluated for ETS?

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.

When can I return to work after ETS?

After ETS there is some mild chest soreness that last between 2-5 days. Usually a mild analgesi such as Tylenol or Motrin is sufficient, and we do not routinely prescribe narcotics. The discomfort gradually disappears. Most patients can return to school or work the day after ETS. You can shower the day after surgery, and resume all normal activities depending on how you feel, there are no absolute restrictions. We recommend that you not fly for 2 days after surgery.

Are there sutures that need to be removed after ETS?

The microincisions are closed with a single absorbable suture that does not need to be removed. You can shower the day after the procedure.

Is any follow up required after ETS surgery?

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.

Will my insurance cover ETS procedure?

Most insurance plans cover ETS for palmar hyperhidrosis, and we have also been successful in obtaining coverage for patients having ETS for facial blushing. After the consultation with Dr. Gorenstein, if you decide to go ahead with ETS, our office will obtain insurance authorization on your behalf, and than schedule a surgical date. Dr. Gorenstein performs ETS at several hospitals in the tristate are, and you can select a location most convenient for yourself.

Can I fly after 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.

What is the miraDry® procedure?

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.

What is the miraDry® procedure like?

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.

What happens after the miraDry® procedure?

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.

What results can I expect with miraDry®?

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.

How long will the results last with miraDry®?

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.

Don’t I need my underarm sweat glands?

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.

How is the miraDry® procedure different from other options?

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.

Is the miraDry® procedure right for me?

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.

What is the recovery time for miraDry® procedure?

After Miradry you can return to work the next day. There will be swelling under your arms, so we recommend that you ice your underams frequently over the first 24-48 hours, and take Motrin to reduce the swelling. You should avoid strenuous exercise for the first 1-2 weeks to reduce the risk of skin irritation in your armpits.

What is the success rate of miraDry®?

After Miradry for armpit or axillary hyperhidrosis, you can expect the amount of sweating to be reduced by 80-90%. Occasionally a seconf treatment is done if patients want their sweating to be reduced even further.

What are the side effects of miraDry®?

After the miradry procedure there are very few side-effects besides for swelling. Sometimes there is numbness on the inner part of the upper arm and this will go away on its own over a few weeks. There will be some redness and sometimes bruising of the skin from the suction produced by the application wand, this too resolves on its own very quickly.

How long after procedure will they see results?

The results from ETS are immediate, after awakening in the recovery room, the hands will be dry and warm and will never sweat again!


After the miradry procedure sweating from the arm pits stops immediately. There will be some swelling for the first 2 weeks, and you should avoid using any anti-perspirant. You might want to use an anti-perspirant or a deodorant starting 2 weeks from the procedure, but most people find that anti-perspirants are no longer necessary. This will depend somewhat on the severity of your sweating before the procedure.

Facial Blushing and ETS

Certain types of facial blushing have dramatic improvement after ETS. Dr. Gorenstein will need to meet you and see the areas of your face and neck that blush, and the severity of the blushing. He performs a unique ETS procedure for patients with blushing that is very successful, and the results are often dramatic and life changing. Compensatory sweating can occur after ETS for blushing but is uncommon because of the technique of ETS performed and the fact that almost all patients with facial blushing do not have severe hyperhidrosis.

Will my insurance cover miraDry® procedure?

Miradry is not covered by any insurance plans. The cost is between $2500 and $2700 depending on the size of the armpits. Botox typically costs around $1500 for a treatment which last about 6 months. Miradry is a permanent solution to axillary hyperhidrosis.

What’s the minimum age for the procedure?

ETS can be performed on teenagers and adolescents. Dr. Gorenstein will meet and discuss the procedure with the patient to be sure they fully understand the procedure and any its possible side effects namely compensatory sweating. Providing the patient has the maturity to understand the procedure there is no absolute age restriction.


miraDry® can be performed on teenagers. The trials to obtain FDA approval for the device were performed on adults over the age of 18. Dr. Gorenstein has treated many teenagers with axillary hyperhidrosis with Miradry, and believes that the procedure is safe and does not pose any different risks in younger patients.

Payment plans?

Because ETS is covered by most insurances, a payment plan is not necessary. For those patients who need ETS but do not have insurance coverage, we can offer them a payment plan. We do accept credit cards for all charges.

ETS procedures performed?

Dr. Gorenstein has been performing ETS for 22 years, and has performed about 1000 ETS procedures over this time period. Our center has done more ETS procedures than any other in the area.


Dr. Gorenstein was one of the first doctors in the tristate are to offer Miradry. We began treating patients with Miradry one year after the treatment received FDA approval, and have treated between 150 to 200 patients since than. The interest in Miradry is increasing every year, as more people learn about the great results.

Hands modeling and feet holding flower


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