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Hyperhidrosis FAQs

Here at North Western Vascular Surgery in Melbourne, we understand that you may have questions about our treatment options for excessive sweating or facial blushing. Our friendly and experienced team are always happy to provide the support you need, as well as answer questions regarding ETS, lumbar sympathectomy or MiraDry.

Please feel free to contact us by phone during office hours or by email. However, it is always recommended that patients see Mr Bell to discuss symptoms and best mode of treatment.

Frequently Asked Questions

  • How is a sympathectomy performed?

    There are many ways of performing a sympathectomy, including cutting the nerve, clamping the nerve, excising the nerve or ablating the nerve. I choose to ablate (by electro-cautery) the ganglia, which are the nerve cell bodies form where the nerves are derived. This guarantees that the objective of the procedure (ie dry hands or eliminate blushing) is far more likely to be achieved.

    I am not a proponent of clamping the nerve, as this results in an incomplete sympathectomy and does not result in reversal of rebound sweating with removal of the clamps.

  • What is the success rate following sympathectomy?

    The success rate varies according to the condition for which the sympathectomy is being performed.

    In those that have the procedure for sweaty hands, the success rate (ie achieve dry hands) is very close to 100%. It is important to emphasize the benefit is permanent. Some patients (less than 5%) might experience a bout of hand sweating in the first week, but this is not an indication of a poor response, and is never sustained.

    For patients undergoing a sympathectomy for facial blushing, over 90% will no longer blush after sympathectomy. The response for blushing of the neck and upper chest is a little less predictable.

    For axillary hyperhidrosis, the success rate is about 70%. This is because the sympathetic nerve supply to the axillary sweat glands, can sometimes arise form ganglia (nerve cell bodies) well down and relatively inaccessible on the sympathetic chain. For that reason I have abandoned sympathectomy for patients with axillary sweating as miraDry is a much better option for this.

  • What are the main risks of the procedure?

    The main complication is rebound sweating or compensatory hyperhidrosis. In response to ablation of the sympathetic chain, the brain sends signals to the sympathetic nerves below to work a little harder. Indeed 30 -40% of patients experience at least some degree of rebound sweating. Fortunately in most it is very mild and of no concern. However, in one in 50 patients, the rebound can be quite severe, causing spontaneous sweating on the torso, back or front. I have had patients who regret they had the procedure because of this complication, and everyone is warned of this.

    Horner’s syndrome which results in a droopy eyelid and constricted pupil, will occur if the Stellate ganglion is ablated. This occurs rarely, one in 1000 cases, usually due to misinterpretation of the anatomy by the surgeon. I believe this is far more likely to occur if the operator is inexperienced.

    Gustatory sweating, which is facial sweating following eating, particularly in response to spicy foods is a form of rebound occurring in 5% of patients.

    Chest complications such as pneumothorax or chest infections are very rare, but can occur. It is however quite common to experience heaviness in the chest and sharp pain often at the back, particularly with coughing and sneezing, referred to as pleuritic pain in the first week.

    Some patients (less than 5%) notice a marked difference in temperature between the upper torso and lower torso. In rare cases it can become somewhat disconcerting.

  • How long will I need to stay in hospital?

    Most patients stay overnight, and are discharged the following morning. If the procedure is performed early in the day, I am happy for patients to go home the same day, as long as a responsible adult is at home to care for the patient.

  • How much time off work will I require after a sympathectomy?

    I recommend a week off work, especially if the work is of a physical nature. Sharp chest and back pain is common in the first week, and often requires anti-inflammatory medications such as Nurofen to control the pain. Having said that, a number of patients return to work earlier and seem to manage quite all right.

  • How long after the sympathectomy can I fly?

    Particularly for my interstate patients, this is often asked. All patients have a post-operative Xray to exclude a pneumothorax (residual air in the chest cavity). This is rarely of any consequence and settles spontaneously but I caution patients against flying until the pneumothorax has resolved completely. Without a pneumothorax I usually recommend 4 to 5 days before flying.

  • If I get rebound sweating, can it be treated?

    Bad rebound, which fortunately is very uncommon (about one in 50 cases) is the complication I fear most for my patients, as it is out of my control.

    In most cases the rebound sweating does decrease with time, but this cannot be guaranteed for all.

    From a practical viewpoint, there is no surgical option for rebound sweating. Certain medications with anti-cholinergic properties (eg Ditropan) can be helpful in this setting.

  • Will the sympathectomy have any impact on my feet?

    It is not uncommon for patients to have the combination of sweaty hands and sweaty feet. It is more frequent for the hands to be the more problematic, though this is not always the case.

    However, almost invariably I recommend treating the hands first, as this is more often the more troublesome, but also that in two thirds of patients, there is a significant improvement in the feet following a thoracic sympathectomy.

  • Is there specific treatment for sweaty feet?

    Plantar Hyperhidrosis

    Excessive sweating of the feet can occur in isolation or in conjunction with palmar hyperhidrosis.

    This leads to excessive wear and tear on conventional footwear, an inability to wear open footwear such as sandals, and an increased incidence of infection, particularly fungal infection affecting the sole of the foot. Many patients complain of an odour associated with constantly moist feet.

    When it accompanies palmar (hand) hyperhidrosis, the most common approach is to deal with the hand sweating first by endoscopic thoracic sympathectomy (ETS), as this is usually the more dominant problem. Fortuitously, in 60% of patients, a reduction in the severity of foot sweating is noted, even though the sympathetic nerve supply to the foot remains intact.

    In cases where excessive sweating of the feet is the sole or dominant problem, a division of the sympathetic nerve supply to the lower extremities by a Lumbar Sympathectomy (LS) will dry the feet.

    Lumbar Sympathectomy (LS)

    This is performed as an open procedure under general anaesthesia. Two separate incisions are made on each side of the abdomen. The muscle fibres of the abdominal wall are split to gain access to the lumbar sympathetic nerve or chain. A short segment of the lumbar sympathetic nerve including the nerve cells (called ganglia) is excised.

    Patients are required to stay in hospital for up to 72 hours, as the abdominal incision can be painful, and regular painkillers (analgesia) are required.

    I recommend reduced activity for at least 4 weeks, and accordingly I would recommend at 3 weeks off work following this procedure.

    The results following lumbar sympathectomy are outstanding, achieving the objective of dry feet in all cases.

    Rebound sweating which can occur following ETS does not occur after LS, though some patients report an ache in the thigh in the first 6 weeks.

  • What is the cost of the sympathectomy procedure?

    This is not regarded as a cosmetic procedure and is recognised by the Medicare Benefits Schedule.

    If you have private health insurance, your hospital costs will be covered. Medicare and your health fund will cover you to the schedule fee, though there will be an out-of-pocket component call our rooms for specific costs.

    With no private health cover, it may be an expensive undertaking.

    For further information on costs incurred, download our fact sheet here.

    For more information on private health coverage, download our fact sheet here.

  • In which hospitals is the sympathectomy performed?

    Moonee Ponds

    59 Holmes Rd Moonee Ponds 3039

    Malvern

    Suite 36 Cabrini Medical Centre 183 Wattletee Road Malvern 3144

    Clayton

    Suite B Monash Medical Centre 246 Clayton Road Clayton 3168

    Gisborne

    Gisborne Medical Centre 16 Brantome Street Gisborne 3437