Quick Look: Key Points

Common Surgical Options for Hyperhidrosis

For hyperhidrosis, or excessive sweating, surgical procedures can offer a lasting solution. However, these are generally considered a last resort due to potential risks and side effects.

Written by: Brice Ulich

What Surgical Options Are There for Hyperhidrosis?

If you have really severe primary hyperhidrosis (that's the kind that's not caused by another medical condition), surgery might be an option. The goal is to fix the problem permanently by either removing the sweat glands or cutting the nerves that control them. But, it's a bigger deal than other treatments, with potential risks and higher costs.

Excision - Sweat Gland Removal

Types of Procedures:

Suction Curettage: They use a special tube to suck out the sweat glands.
Laser Coagulation: They use a laser to zap the sweat glands.

The classic surgical way to treat underarm sweating is excision. That's where they cut out the whole area of skin where the sweat glands are. This usually solves the problem for good.

The downside? It's a big surgery, so you'll have a larger wound. They'll either stitch it up or do a skin graft. This can leave bigger scars, and there's a chance of infection. Plus, your shoulder might not move as well afterward. That's why they don't do this one much anymore.

1. Suction Curettage

A newer method is suction curettage. It's kind of like liposuction for your sweat glands. They make tiny cuts and suck out the glands, and sometimes scrape a few more out with a tool.

The good thing is, you'll have smaller scars. You can usually get it done at the doctor's office with numbing medicine, and be back to work in a few days. It usually works for a long time, if not forever.

You might get some bruising and swelling, and rarely, an infection. It takes a few weeks to see the full results. This method only works for underarms.

Suction curettage has gotten even better in recent years. They've improved the tools and techniques, so there are fewer problems and it's less likely you'll need another surgery. They use special numbing medicine to make it comfortable, and you'll just have a couple of tiny stitches. The swelling goes down pretty quickly.

You can usually get back to your normal activities right away, but it's a good idea to take it easy for a day or two. Your underarms will be pretty dry after the surgery, and the sweat glands don't grow back. You won't start sweating more in other places either. Sometimes, a few sweat glands might start working again over time. If antiperspirants and other treatments aren't enough, this could be a good option.

2. Laser Treatment

Laser treatment is a newer approach. They don't remove the sweat glands, but use microwaves to destroy them. It only works for underarm sweat glands. They numb the area, then use a device like Miradry to heat up the glands while cooling the skin. It destroys most of the sweat glands. You might have some soreness and swelling for a few weeks. For best results, you'll probably need two treatments, three months apart.

The good thing is, it's less risky than surgery and the results are long-lasting. Some people also like that it reduces underarm hair. There's no downtime either. The bad thing is, it's still pretty expensive and you can only get it at certain clinics. Plus, it's only for underarms, and we don't know the long-term effects yet.

Sympathectomy - Nerve Block

Types of Procedures:

Thoracoscopic Sympathectomy: They make small cuts in your chest and cut the nerves.
Endoscopic Sympathectomy: Similar to the first one, but they go through your armpit.

This surgery targets the nerves that control sweating, not the sweat glands themselves. They cut or clamp the nerves. It's done in the hospital under general anesthesia, and you'll be out in a few days. It can treat sweating in different areas, especially hands. It's minimally invasive, so you'll have small scars.

They used to do a bigger surgery for foot sweating, but they don't do that anymore because it's riskier.

Like any surgery, there are risks. The most common is sweating more in other places (compensatory sweating). This happens in about half the cases. Other problems are less common. There's also a chance of Horner's syndrome (a nerve problem), heart or lung issues (especially in older people), and infections.

For underarms, they usually recommend other treatments first.

Endoscopic transthoracic sympathectomy (ETS) is an option for severe hand or face sweating that doesn't respond to other treatments. It's a minimally invasive surgery that's been improved in recent years.

If you sweat a lot in your hands and feet, this surgery might help both.
For just foot sweating, they'd have to do a bigger surgery in your abdomen, which is riskier.
This surgery doesn't work for sweating on your torso or all over your body.

It's always best to try less invasive treatments first. They might take longer or need to be used regularly, but they're usually cheaper and have fewer side effects.