Warning!

Please be advised that information on this page is not intended and MUST NOT be taken or used in any way as personal medical advice. Referral to LapSurgery Australia MUST come from your Family Doctor who is the only person qualified to advise you on the need for referral to a surgeon.

Contents

/\  Introduction

Excessive sweating and blushing are socially embarrassing conditions which can have a devastating effect on quality of life. Until recently no cure was available. Surgeons have now discovered a new surgical procedure that can cure these conditions in the majority of people with minimal pain and quick recovery .
The surgery, Endoscopic Thoracic Sympathectomy (ETS), is providing people who suffer either of these conditions not only with new hope, but in many cases with a new life.
The information below gives details of Excessive Sweating (Hyperhidrosis) and Facial Blushing and outlines the surgical procedure and how it can change your life. As with all surgery there can be failures, complications and side-effects which are discussed below.

/\  Facial Blushing (Idiopathic Cranio-facial Erythema)

Facial blushing is a common condition affecting large numbers of people. Facial blushing is due to the overactivity of involuntary nerves. The nerves control the diameter of the blood vessels and when the nerves are over-stimulated the vessels open out and colour the skin red.
Excessive blushing can occur under many circumstances including stress or embarrassment, but in many people it occurs in response to the most trivial event. Facial blushing is often accompanied by other symptoms including palpitations, feelings of excessive heat and anxiety.

/\  Excessive Sweating (Hyperhidrosis) of the Face, Scalp and Hands

Normal people sweat as a way of maintaining skin hydration and controlling body temperature. We have approximately 5 million sweat glands, many concentrated in the skin of the face, scalp and hands. Although it is not entirely understood why, some people sweat excessively due to overactive functioning of the involuntary (sympathetic) nervous system. The common places people sweat excessively are on their hands, face, scalp and armpits. ETS is highly effective at controlling excessive sweating of the hands, scalp and face.

/\  Excessive Sweating of Armpits (Axillary Hyperhidrosis)

We now have a new operation for axillary hyperhidrosis. Our surgeons have recently completed a study tour to Taiwan where the problem of axillary hyperhidrosis is very common in the population. Previously, the treatment for axillary hyperhidrosis by sympathectomy was to cut the sympathetic chain from the level of the second rib to the level of the fourth or fifth rib. Although effective, the operation often produced an unacceptable level of compensatory sweating elsewhere on the body and was used only as a resort for the very most serious cases.

The new technique involves selectively isolating only a small part of of the sympathetic nervous system between the fourth and fifth ribs. This is done by clamping the nerve with small titanium clips which stay in place permanently. (These clips are routinely inserted in the body in numerous different operations and have no known side-effects.) This technique has a high success rate in eliminating or greatly reducing axillary hyperhidrosis with a low incidence of severe compensatory sweating. In addition, there is some evidence that in those very few people in whom compensatory sweating is considered worse than the original condition, that removing the clips may reverse the operation. It must be emphasised that the possibility of reversal is theoretical and by no means guaranteed.

Other treatments are available for axillary hyperhidrosis and we recommend that some or all of these are discussed with your family doctor or dermatologist before considering sympathectomy. Other treatments include:

• Strong anti-perspirants such as Driclor. Although effective, many people find skin irritation unacceptable.
• Botox. Usually effective, but must be used repeatedly as its effect may last as little as two months. Expensive. The treatment is available through LapSurgery Australia or some dermatologists.
• Lipodermosuction. This is performed by a dermatologist, usually as a day case under local anaesthetic and with little in the way of scarring. There is a significant failure rate with this treatment.
• Surgical removal of the sweat gland bearing skin of the armpits. This is usually performed by a general or plastic surgeon and may be very effective. The disadvantages are very ugly scars in the armpits which usually preclude its use in women. LapSurgery Australia does not provide this service.

/\  Smelly Armpits (Bromihidrosis)

This distressing condition is NOT due to sympathetic nerve overactivity but is due to infection or problems with other types of glands in the armpit. ETS is usually not effective for this condition. We suggest treatment by a dermatologist.

/\  Excessive Sweating on Other Areas of the Body

ETS cannot help sweating on other areas. People suffering from this condition should have a thorough check up from their family doctor to exclude metabolic causes such as an overactive thyroid gland. Severe obesity is also a cause of excessive sweating. If this applies, you may be interested in reading the information on the Lap. Band elsewhere on this web site.

/\  Treatment Options

A range of treatment options is available. Treatment for excessive sweating and facial blushing includes: drug treatment, injections to stop the sweat glands functioning, laser treatment and hypnotherapy but surgery is the only known permanent cure.
Whilst surgery is not a new option for these conditions, surgeons have discovered a novel keyhole operation using ultra-thin microsurgery instruments. As the instruments are only three millimetres in diameter, no stitching of the skin is required resulting in smaller scars, less pain and a quicker recovery time.

/\  The Operation

ETS is performed under general anaesthetic and involves either clipping or cutting of a small segment of the involuntary (sympathetic) nerves which control the sweat glands and the size of blood vessels in the skin.

A fine, 3 mm telescope and instruments are passed into the chest through tiny incisions below the armpit.

Each lung is partially deflated, the nerve is identified and either clipped or a small segment cut out and removed.

At the end of the procedure the lungs are reinflated and a chest X-ray is performed to ensure that the lungs have reinflated fully.

/\  Cutting or Clipping of the Nerve?

We have recently researched the option of clipping rather than cutting the nerve in sympathectomy operations. Clipping involves interruption of conduction of the nerve by applying a titanium clip across the nerve but the nerve is not cut. These clips are widely used in many different operations and have no known side-effects. Our research and recent experience with the technique leads us to believe that clipping is equally as effective as cutting the nerve.

The advantage of clipping lies in the possibility of being able to remove the clip and reverse the operation in the uncommon event that side-effects of the operation are too severe. The most likely such complication is excessive compensatory sweating. There is reasonable anecdotal evidence that removing the clips reverses the operation. It must be emphasised that reversal of the operation by removal of clips has not yet been proven scientifically and cannot be guaranteed.

We now strongly recommend clipping rather than cutting because it is just as effective as cutting and has the theoretical possibility of reversibility.

/\  Hospital Stay and Recovery Time

The surgery is performed on the day of admission. The majority of patients are discharged from hospital the next day.
Most patients feel little discomfort and make a quick recovery, returning to work in 7 to 10 days.

/\  Can Anyone Have This Surgery?

Not all cases of blushing or excessive sweating are suitable for this form of treatment. In particular, people over 50 must undergo careful evaluation before being considered for surgery.
This surgery is not recommended if the risk is high due to coexisting conditions (e.g. some heart and lung conditions or previous lung surgery). The final decision as to proceed with surgery always rests with the surgeon.

/\  The Surgical Team

The Surgical team consists of three experienced specialist surgeons, Mr Chris Hensman, Mr Ray McHenry and Mr Richard Gilhome. Your operation will be performed by the surgeon to whom you are referred and one of the other two surgeons. All three surgeons perform the operation in exactly the same way to ensure consistency of results. The presence of a second surgeon adds greatly to the safety and efficiency of the operation.

/\  The Hospital

Currently all operations are performed at The Valley Private Hospital.
Although not a large hospital, The Valley Private has excellent operating facilities and equipment. Nursing staff, both in the operating theatres and the surgical wards, are highly skilled and familiar with the ETS operation.
Just as importantly, the hospital has a fully equipped and staffed Intensive Care Unit and experienced medical staff on site 24 hours per day to ensure your safety in the unlikely event of any complication of the surgery.

/\  Experience and Results

We have been performing these operations for several years and have now completed more than 500 ETS operations. No major complications have been encountered during the surgery. Very good results have been seen in the majority of patients, but there have been some failures and some people with unwanted side effects. Experiences from around the world have been analysed and published in medical journals and demonstrate a similar experience.

/\  Complications

All surgery carries some risk. Our experience, and that from around the world, has demonstrated that complications are uncommon with Endoscopic Thoracic Sympathectomy. The most common side-effect is rebound excessive sweating (compensatory hyperhidrosis) usually on the trunk and legs. Although this may be common and annoying in the early stages after the operation, only one or two percent of patients suffer severe effects in the long-term. Risks associated with general anaesthetic are rare and may be discussed with one of our experienced anaesthetists. The risks of infection and bleeding are minimal. The lungs can collapse after surgery requiring a small tube to be placed into the chest to reinflate the lung, but this happens in only a small minority of cases. Another rare complication is Horner's syndrome which is a droopy eyelid caused by damage to the sympathetic nerves to the eyelid. This is nearly always a temporary condition and has no effect on eyesight. Dryness of the hands will occur after surgery and may require moisturiser on a regular basis.

/\  More Detailed Information

If you are considering ETS surgery after reading this far you must research further. The more informed you are the more likely you will be able to make an informed decision on whether to proceed with the ETS operation. The following Adobe Acrobat downloadable documents will give much more detail on the results, possible complications and side-effects. Download the document most appropriate for your particular problem.

Facial Blushing (130kb)
Facial Sweating (131kb)
Hand Sweating (130kb)
Armpit Sweating (131kb)

These documents will open in a new browser window. If you would like to save the document onto your computer for later viewing, select the "Save" icon on the Adobe Acrobat toolbar. The toolbar will appear in the new window, above the document. If the document did not open correctly in a new window, right click the desired document link above, and select "Save Target As..." to download the document onto your computer. This may be opened with Adobe Acrobat later. If you do not have Adobe Acrobat, you may obtain it here.

/\  How to Get Treatment

The first step, if you have not already done so, is to download and carefully study the appropriate document from the More Detailed Information section above.

You should then arrange a visit to your family doctor, explain your symptoms and have a full check-up to rule out other causes of facial blushing or sweating. Many family doctors may not be familiar with the latest knowledge of the blushing and sweating syndromes or the treatment options (he/she can't be expected to know all about everything!). Your doctor may appreciate either a printout of the "Sweating and Blushing" web page or our web address. We are always delighted to discuss your condition and treatment options with your family doctor by telephone.

Ask your family doctor for a referral to The Australian Centre for Hyperhidrosis and Facial Blushing, as our surgeons cannot see you without a referral.

Click here to open the reply form. (The form is in Adobe Acrobat format.) Print out and fill in the reply form and post it to us along with your referral. We will then contact you to arrange a telephone or personal consultation as a first step towards treatment for facial blushing or hyperhidrosis.

/\  What if I Can’t Download/Print the Information and Application Forms?

If you can’t download and print out the forms for whatever reason please do one of the following:

• Telephone us on (03) 9210 7277 (9.00 am to 5.00 pm AEST, Monday to Friday) and we will post or fax the relevant information to you
• Contact us via our contact form telling us what you want sent. Please enter your fax number in the message box if you wish to have information faxed to you.

/\  Cost of Surgery and Payment

Operations are performed only in Private Hospitals. For a more information about costs please click here. (The document is in Adobe Acrobat format.)

Finance is available through Health Assist. LapSurgery Australia has no direct or indirect association with Health Assist, receives no commission and makes no warranty as to the suitability of this option for individual patients.

/\  Interstate and Overseas Patients

Travel and accommodation can be coordinated to enable assessment by the surgeon and anaesthetist so that surgery can be performed on a single visit to Melbourne.

Click here for more details of transport and accomodation.
(The document is in Adobe Acrobat format.)

/\  Useful Information Links

The Internet sites listed below provide further information on Excessive Sweating and Facial Blushing.