Frequently Asked Questions 

Facial Blushing, Facial Sweating, Hand Sweating

and Armpit Sweat...

Will this procedure treat isolated underarm, armpit (axillary) sweating?
Yes, underarm sweating alone can be treated effectively with ETS. The success rate for eliminating underarm sweating is high, but individual results may vary. Underarm sweating is best treated if the patient has palmar sweating as well.

Why choose the ETS-C clamping method over the ETS cutting method?
Clamping provides a similar outcome as cutting, but offers the opportunity for reversal since the nerve causing the sweating has not been destroyed.

What is the success rate?
The success rates for palmar, facial, and underarm sweating are very good. This is also true for facial blushing. Plantar (foot sweating) may not be improved.

What is the recovery period?
Recovery from this surgical procedure is fairly quick. Patients are typically out of bed and walking very soon following surgery and may return back to the hotel within hours after the procedure. Work duties may be resumed within approximately 1-2 days and patients may engage in exercise regimens within about 7-10 days.

Does the procedure guarantee results?
A 100% success rate can never be guaranteed for any surgical procedure. However, with a very high success rate for hand sweating, facial sweating and facial blushing, the odds are very high that you will be pleased following this procedure.  There may be a decreased chance for success if the patient has had prior chest surgery or serious infections within the chest cavity, both of which may result in pleural adhesions to the chest wall which make it difficult to access the sympathetic chain. As in any surgical procedure, severe obesity may also hinder access to the target.

What are Kuntz nerves and what do they do?
Kuntz nerves are tiny accessory nerve fibers, which branch away from the main sympathetic trunk. Although many surgeons believe that these nerves are present in only 10% of the population, our surgeons have found them in approximately 70-80% of their patients. If not identified and divided, these small nerve fibers may, over time, regain the function of the clipped/severed sympathetic nerve and the patient may experience a mild to full recurrence of symptoms (i.e., sweating and/or blushing). Many surgeons routinely divide multiple levels of the sympathetic nerve trunk, which can result in bothersome to severe compensatory sweating. It is our belief that by dividing only the necessary nerve levels and any present Kuntz nerves, patients are at a decreased risk for a return of sweating, and compensatory sweating should be minimal.

Is part of the sympathetic chain removed during ETS-C surgery?
No, and this is where the term "sympathectomy" is a very common misnomer on the websites of some surgeons. In medical terms, "ectomy" refers to the actual removal of tissue from the body, for example, as in "tonsilectomy" or "appendectomy." The appropriate word is "sympathicotomy" since "tomy" refers to the division or separation of tissue. Thus, the term "sympathicotomy" refers to the fact that, during the ETS-C procedure, the sympathetic chain is simply cut or clamped without removing any portion of the chain of nerves.

What are the risks and side effects?
While any surgical procedure has some degree of risk associated with it, ETS-C is a  procedure with minimal side effects. The most common side effect is compensatory sweating (periodic perspiration around the lower stomach and back). This seems to be fairly well-tolerated by most patients, while 5% describe it as troublesome.  Gustatory sweating (typically isolated to a small portion of the forehead in reaction to spicy foods) has occurred in a small number of cases.  Typically, patients report feeling a sensation rather than actual perspiration. In few cases has Horner's Syndrome (slight drooping of the eyelid) occurred.  This may resolve on its own with time. This symptom is cosmetic and does not impair vision. In the rare event that the condition is permanent, it can easily be corrected with plastic surgery. Bleeding or air leaks from the lung have occurred in a small number of patients. These complications are rare and can be easily treated.

What is Botox and is it a good alternative to surgery?
Botox (botulinum toxin A) is a poison that has been used for several years to smooth out age-related wrinkles. Thus, its traditional use has been in cosmetic surgery as an alternative to more invasive procedures such as facelifts, etc. The poison acts by paralyzing the nerves that project to either facial muscles (i.e., in treating age-related wrinkles) or to sweat glands (i.e., for treating hyperhidrosis). Only recently has Botox been used to treat hyperhidrosis and the results are not altogether impressive. For palmar and/or axillary hyperhidrosis, numerous injections must be made and most patients have reported these to be extremely painful. In addition, sweating has only been marginally reduced and a full return of sweating will occur approximately six months following the injections. In addition, numerous patients have reported significant loss of grip strength following Botox injections into the hand region. It is important to note that we have performed ETS-C on several patients who were treated unsuccessfully with Botox injections.

Will health insurance cover the cost of this procedure?
Since the surgery is FDA approved and performed in the U.S., many health insurance companies will pay for the procedure. Our office will contact your particular health insurance company and make necessary arrangements for you.

When can I have ETS?
Since many people travel from the U.S. and Canada each year to have ETS-C with us, it is highly recommended that individuals who wish to schedule an appointment give two to three weeks time for surgery confirmation. However, if a particular date is requested, we will do our best to accommodate this request. Our surgeons perform ETS on Mondays, Wednesdays and Fridays, but special arrangements can be made if necessary. Many people have chosen to extend their stay in Miami for one or two weeks in order to make their trip into a vacation. The beautiful Florida Keys, Everglades, Fort Lauderdale, South Beach etc. are all within easy driving distance.

Can I go by myself or should I bring a companion?
No one has to accompany you, but many people bring along family members, friends, etc.  They will be responsible for their own hotel/travel costs.

Can I speak with other patients who have had the ETS procedure?
Absolutely. Please contact our office and we will kindly provide you with a list of our former patients.