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Expert Answer: Underarm Surgery for Hyperhidrosis, Right for You?
What do you think of when you hear the word "liposuction"? Perhaps U.S television's Dr. 90210 and his Beverly Hills' clients? How about axillary hyperhidrosis? No? Well, that's about to change.
While the most commonly discussed, criticized, and arguably unethically advertised surgery for hyperhidrosis may be endoscopic thoracic sympathectomy, there are other much less risky surgical options for people who suffer from excessive sweating of the underarms.
To get answers to our questions about the pros and cons of surgeries performed in the underarms (these types of surgeries are called "local" because they are performed at the site of the sweating) we talked to Dr. Dee Anna Glaser. Dr. Glaser recently won a highly prestigious award for her work. She is the 2007 recipient of the E. Grey Dimond, MD, Take Wing Award, given to a University of Missouri-Kansas City School of Medicine alumni for excellence in his or her field and for exceeding the expectations of his or her peers in the practice of medicine, academic medicine, and research. Dr. Glaser is also one of the founding Board of Directors members of the International Hyperhidrosis Society and Professor, Vice Chairman, and Director of Cosmetic and Laser Surgery with the Department of Dermatology at the Saint Louis University School of Medicine in St. Louis, Mo.
According to Dr. Glaser, there are several different types of surgical procedures that can be performed at the underarms to remove or harm the sweat glands so that they can no longer produce perspiration. Among the techniques that dermatologists may use are liposuction to suck out the sweat glands, curettage to scrape them out, and suction-curettage to both scrape and suck them out.
"Sweat glands are located just beneath the skin, where the skin and the underlying fat meet," says Dr. Glaser, "and dermatologists can use different tools in an attempt to remove or destroy the function of these glands."
During liposuction, explains Dr. Glaser, a physician will use a small tube to suck out the superficial layer of fat in the armpit where the sweat glands are. During curettage, a special surgical tool with a circular loop on the end is used along the skin's under-surface to scrape out as many of the sweat glands as possible, or to at least injure them enough so that they no longer work. During suction-curettage the liposuction tube and the curettage scraping method are both used. Curettage and liposuction techniques are possible only in the underarms because sweat glands are fairly localized and because the underarms lend themselves to being scraped or suctioned – while hands, feet, and foreheads do not. It's important to note that another technique called excision, indicating the complete removal of underarm tissue containing sweat glands, is NO LONGER RECOMMENDED because heavy scarring can cause serious range of motion problems – even to the point where a person may not be able to move his or her shoulder normally.
"The nice thing about liposuction and curettage, on the other hand," says Dr. Glaser, "is that for whatever glands you injure or remove, you often achieve a permanent result – they will not produce any more sweat. The problem is that sweat glands are too small for us to see, even with surgical instruments, so even the most experienced dermatologist is going in blind. We don't know how many sweat glands we're removing or damaging and therefore the results can be highly variable and aren't guaranteed. And, as with any surgery, there are potential complications such as infection. We also may see bruising, swelling, loss of sensation in the underarms, and scarring depending upon the size and number of incisions that the physician uses."
"Axillary liposuction or curettage can be performed in a physician's office under local anesthesia. Recovery is no more than a couple of days although patients may feel sore for up to a week and need to limit their arm activity (sports, lifting above their heads, etc.) during that time," continues Dr. Glaser. "With Botox, on the other hand, the patient can resume nearly all normal activities right away - Botox recovery is mere minutes."
"The main problem, though, with local surgeries for underarm sweating is, as I mentioned earlier, that even after the surgery a patient may find that some sweat glands remain and that those glands are going to continue to sweat excessively. Patients may still need to use a strong antiperspirant or Botox to try and control that. Another difficulty is that health insurance organizations often do not recognize local surgeries as a treatment for hyperhidrosis and so will usually not pay for it. Botox, however, is approved by the U.S. FDA for the treatment of axillary hyperhidrosis so it's much more likely to be covered by insurance. I've found in my practice that patients who want an axillary surgery and are good candidates for it have to pay for it themselves. It may also be difficult to find a dermatologist who is experienced in doing a liposuction, curettage, or suction-curettage procedure on the underarms. These are advanced techniques for most dermatologists. So if you think this is something that may be right for you, you'll have to do some research to find the right dermatologist to perform the surgery."
"In my own personal experience," concludes Dr. Glaser, "I think I can get more consistent, reliable results with Botox for axillary hyperhidrosis than I can with liposuction-curettage. Other dermatologists may use a number of different techniques and say that they can get consistent good results, but these aren't procedures that are commonly performed and, as I already mentioned, it's difficult to predict outcomes because the dermatologist has to make a very educated guess as to where the glands are in order to remove them. Sweat glands are not like tumors or lesions that we can see and remove easily. It's not going to work for everyone."
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Find a doctor who treats excessive sweating. |
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