Hyperhidrosis Surgery: These Procedures May Relieve Excessive Sweating When Other Treatments Fail

But it's important to exhaust less invasive options before considering surgery to remove or destroy your sweat glands.

If you've tried antiperspirants, wipes, microwave therapy and beyond, but nothing has brought you relief from sweating profusely, your doctor may recommend hyperhidrosis surgery.

Of course, whether surgery is appropriate may depend on the area of your body that's affected. A surgeon can readily access sweat glands in your armpit because they are near each other, says Dee Anna Glaser, MD, dermatologist at SLUCare Physician Group. By contrast, the skin on your feet and on the palms of hands is tough and difficult to penetrate.

Keep in mind that surgery is not a panacea. Sweat glands are tiny and sometimes hard to detect with instruments, Dr. Glaser tells Health, so it can be hard to predict the success of a surgical procedure.

So is surgery an option for you? Here's what to know about surgical treatments for hyperhidrosis.

hyperhidroisis surgery
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Local surgeries for underarm sweating

Surgery for axillary hyperhidrosis—sweating in the armpits—requires local anesthesia and can be done in an office setting rather than a hospital. You doctor might recommend one or a combination of the following, says Dr. Glaser:

  • Excision, which involves the surgeon cutting out sweat glands from your underarms.
  • Curettage, which involves the surgeon scraping out sweat glands in your armpit area.
  • Liposuction, which involves suctioning out sweat glands in the underarms.

"In each of these surgeries, the surgeon is trying to remove or injure the sweat glands, so they don't produce sweat anymore," Adam Friedman, MD, professor of dermatology at George Washington School of Medicine and Health Sciences, tells Health.

While the International Hyperhidrosis Society (IHS) states that these surgeries often have good results, it warns that they are permanent and, therefore, not reversible.

Recovery time typically takes a few days, with some soreness that can last up to a week. You may need to hold off on using your arms to lift things or engage in physical activity while you are sore.

Laser surgery for hyperhidrosis

Laser surgery is another option for treating armpit sweating. Via tiny incisions in the underarm skin, a laser is passed under the skin to heat up and destroy sweat glands, the IHS explains.

The procedure generally takes less than an hour to complete.

Data on the safety and effectiveness of laser treatment for armpit sweating is limited, consisting mostly of case reports involving a small number of patients, says IHS. A 2018 study in Lasers in Medical Science concludes that large, randomized trials of laser treatment for hyperhidrosis are needed.However, some doctors do offer the treatment.

Endoscopic thoracic sympathectomy (ETS) surgery

Used to treat severe cases of hyperhidrosis in the palms and underarms, and sometimes in the face, ETS is a major surgery. During this procedure, a surgeon attempts to cut or destroy the nerve paths on the spinal column that are connected to sweat glands in the area of your body you want to stop producing sweat, according to Dr. Glaser.

To locate the nerves to cut, the surgeon inserts a camera through the chest under the armpit. In order to destroy the nerve, your lung has to be temporarily collapsed.

The IHS states that ETS surgery should be considered with great caution and only as a last option when no other treatments provide relief and hyperhidrosis is so severe that it affects a person's ability to live their life.

Dr. Glaser says ETS can cause damaging side effects: "It can cause a major condition called compensatory hyperhidrosis, which can develop six months to 10 years after the surgery." Sweating in the treated area of the body may stop, but profuse sweating begins elsewhere, usually somewhere from the chest down.

"It can be mild, moderate, or severe," says Dr. Glaser. But there's no treatment for compensatory hyperhidrosis—"and it can't be reversed."

ETS can also cause extreme hypotension, arrhythmia, and heat intolerance, and in some cases death, the IHS notes.

While ETS was once a good idea, Dr. Glaser says it has proved to be too dangerous. She has some patients who are happy with the results and others who regret getting the surgery because they developed compensatory hyperhidrosis in the groin area, causing so much sweating that they wear a diaper to cope.

Will insurance pay for hyperhidrosis surgery?

Health insurance organizations often do not recognize surgeries as a treatment for hyperhidrosis, and therefore, usually won't pay for them, says the IHS.

Many patients pay out-of-pocket for these surgeries. But Dr. Friedman says your doctor may be able to help you navigate coverage and cost issues.

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