Only after all other non-surgical treatments have been tried and proven unsuccessful (aluminium chloride antiperspirants, iontophoresis with Glycopyrronium Bromide (Robinul), Botox, oral medication) should surgery be considered for excessive sweating.
As with any surgery, it is critical to choose a skilled surgeon who has experience with this type of procedure, and to be sure you fully understand the potential risks or complications.
There are two surgical approaches for treating hyperhidrosis – removing the sweat glands under the arm, or dividing the sympathetic nerves which lie along the sympathetic ganglion chain beside the spinal cord, a procedure called Endoscopic Transthoracic Sympathectomy. The latter is major surgery performed under a general anaesthetic.
This surgery can be performed under local anaesthetic as an out-patient procedure and patients can return home immediately after the surgery. Most return to work the next day.
A small incision is made in the axillae (armpits) and the sweat glands are literally scraped away. Antibiotic ointment is introduced into the puncture wound which is not sutured (stitched), and a wad of gauze is taped into the axillae.
Sweating ceases at once and as early as 4-6 weeks, and the puncture incisions are almost invisible. By 4-6 months postoperatively, physiological sweating returns, but in most cases the hyperhidrosis does not return.
A single treatment usually induces permanent improvement in most patients, but is not successful for everyone.
There are currently only 3 practitioners of this surgery in the UK. as far as we are aware. If your GP cannot locate a surgeon who carries out the procedure please contact us for further information.
It is likely to cost you around £1000 for treatment privately on your underarms in the UK.
We would be most grateful if all practitioners of this surgery would contact us so that we are able to pass on this information to patients that are interested
Mr McCleary (Vascular Surgeon) York hospital. NHS & Private
Mr Darryl Baker (Vascular Surgeon) The Royal Free hospital. NHS
Dr Rowland-Payne (Dermatologist) The London Clinic. Private
Mr Addison (Plastic Surgeon) Edinburgh (Bilateral Axillae aspiration with Lipolyis) NHS
Mr Simon Lee (Plastic Surgeon) Frenchay Hospital, Bristol. (Subdermal Liposuction)
Mr George Cormack offers axillary subscision/subdermal curettage for axillary hyperhidrois at Addenbrookes in Cambridge on the NHS
Dr Andrew Affleck - Consultant Dermatologist does a procedure similar to the Shelley's procedure. Results are variable, but side effects are minimal
A very new treatment, performed in the UK for the first time in March 2009 by Mr Mark Whiteley at the Whiteley Clinic in Guildford www.armpit-sweating.co.uk, this is a local anaesthetic procedure that only takes about an hour to perform in most people. The procedure starts with an iodine test to show the exact areas of sweating in the armpit, which are then marked.
A local anaesthetic is injected into each side. A 3mm incision is made through which the operation is performed - if the area to be treated is very large, 2 incisions might be made. After loosening the skin of the armpit, a laser is then put inside the skin. This is fired, destroying the sweat glands. Once destroyed, the sweat glands are removed by suction.
The wound is too small for stitches and so a dressing is put on the whole of the area and a compression garment is worn like a jacket. After 2 days and nights the dressings can be removed. All wounds should be healed in 3 - 5 days.
Most people are able to live quite normally after the surgery, although it takes about 2 weeks to get back to exercise or heavy physical activity.
Ultrasound Liposuction Curettage (Vaser)
VASER® Hyperhidrosis Therapy is a minimally-invasive surgical procedure that can be performed under local anaesthesia. Through a small incision into the skin of the armpit local anaesthesic is infused. Then, using an ultrasonic liposuction device, a thin wand is passed to heat the under surface of the axillary skin where the sweat glands are. A simple bandage is placed and the patient goes home. Recovery is minimal with a return to work and play within 24 hours. A permanent reduction in sweating is achieved immediately and the risks are minimal to none.
Bilateral Axillae Aspiration
is an operation where some of the sweat glands are removed by aspiration, rather than by liposuction as the fat is not targeted. It could be described as minimally invasive Retrodermal Curettage. The procedure is done under general anaesthetic and takes about 45 minutes. So far there have been no complications and the results have been very favourable. Currently this is performed only by a surgeon in Edinburgh.
This is removal of the sweat glands. It is not commonly practiced as problems include incomplete removal and poor healing.
This operation cuts away at the skin and can cause large scars. There is also a risk that the wound will not heal well. It is not commonly practiced today.
As a last resort and only in extreme cases, if all other treatments have failed to reduce the excessive sweating sufficiently to allow an acceptable quality of life, this major surgery might be considered. It can have a good outcome, but in far too many cases the side effects, such as compensatory sweating, leave the patient worse off than before. Generally used to treat palmar (hands) or sometimes facial hyperhidrosis, anyone considering this option should carefully research both the potential outcomes and the experience of their chosen surgeon.
The surgery aims to interrupt the transmission of nerve signals from the spinal column, to prevent these nerve signals from "turning on" the sweat glands. The surgeon cuts or clamps the overactive sympathetic nerves which cause the excessive perspiration, where they run along the side of the spine. The procedure is permanent, and there is no guaranteed reversal technique.
Diagram courtesy of Mr Mark Whiteley
The patient is placed under general anaesthesia throughout the surgery, which lasts less than an hour. Recovery is also achieved in a short time, ranging from a day to a few days. Most people are able to return to work in week or two, depending on their individual comfort level.
Patients are not eligible for this surgery if they suffer from severe cardio-respiratory illness, pleural disease or untreated thyroid diseases.
Below is a more detailed look at the surgery itself:
Any surgery has possible side effects; this is why most patients would prefer a course of Iontophoresis for palmar and plantar hyperhidrosis and Botox or iontophoresis for axillary hyperhidrosis, before undertaking such an operation.
Compensatory sweating is the most common side effect and occurs in a high proportion of cases, causing sweating on areas such as the chest, back, thighs and groin. It is by no means uncommon for patients to find the compensatory sweating leaves them worse off than before the surgery, and unfortunately the procedure is not guaranteed to be reversible.
Another side effect, gustatory sweating, can occur. With this condition, patients notice that they tend to sweat while eating or smelling certain foods.
Complications are not common for this surgery, but they may include the following: