Hyperhidrosis Surgery: Sweat Gland Removal Procedures That May Relieve Excessive Sweating

If you've tried antiperspirants, wipes, microwave therapy, and beyond, but nothing has brought you relief from sweating profusely, your healthcare provider 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, Dee Anna Glaser, MD, a dermatologist at SLUCare Physician Group, told Health. By contrast, the skin on your feet and on the palms of your hands is tough and difficult to penetrate.

Keep in mind that surgery is not a panacea. Dr. Glaser said that sweat glands are tiny and sometimes hard to detect with instruments, 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.

Local Surgeries for Sweat Gland Removal

Surgery for axillary hyperhidrosis—sweating in the armpits—requires local anesthesia and can be done in an office rather than a hospital. Your healthcare provider might recommend one or a combination of the following, said 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, told Health.

There are a few things to consider about the surgery.

Not Reversible

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

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. Here are additional considerations to think about.

Limited Data

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, said IHS. A 2018 study concluded that large, randomized trials of laser treatment for hyperhidrosis are needed. However, some healthcare providers do offer the treatment.

ETS Surgery for Sweat Gland Removal

ETS is a major surgery used to treat severe cases of hyperhidrosis in the palms and underarms, and sometimes in the face. 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. This surgery is considered to be a last resort.

Last Resort

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 said 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," said Dr. Glaser. But there's no treatment for compensatory hyperhidrosis—"and it can't be reversed."

Side Effects

ETS can cause the following side effects:

• Hyperhidrosis
• Extreme hypotension
• Arrhythmia
• Heat intolerance
• Death, in some cases

While ETS was once a good idea, Dr. Glaser said it has proven 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 Cover Hyperhidrosis Surgery?

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

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

A Quick Review

People who experience excessive sweating of the underarms, or hyperhidrosis, may be interested in exploring surgical options if all other methods to reduce sweating have failed. Among the surgical treatments for hyperhidrosis available are local surgery, laser surgery, and ETS. Each type of surgery carries different risks and benefits. You should discuss your surgical options with a healthcare provider.