Hyperhidrosis seems like an uncommon medical problem to be treated by plastic surgeons. It is an aggravating condition which is seen as too much sweating, usually from the armpits, in an effort to regulate body temperature. For those afflicted it is an issue of inconvenience and embarrassment with the frequent need for clothing changes and unsightly wet rings on clothes in the armpits.
It has reached awareness as a plastic surgery treatment because of its successful management with Botox injections. Botox works for hyperhidrosis by blocking the nerve connection that stimulates the sweat glands. While not permanent and expensive over the long haul, it is effective for those hyperhidrosis patients who can not be adequately treated by topical anti-perspirants.
Both before Botox became popular as a hyperhidrosis treatment and, even now, efforts to come up with an effective surgical solution that would be longer-lasting have been pursued. Many surgical techniques have been tried, most of which aim to remove or destroy the apocrine glands and ducts that lie right below the skin. These are not to be confused with the eccrine glands which lies within the skin.
One of the interesting surgical methods for treating hyperhidrosis is a modification of liposuction. Liposuction uses blunt instruments to remove fat in an effort to not damage surrounding tissues. In the treatment of hyperhidrosis, however, a modified cannula is used with sharp edges in a deliberate effort to create damage, in this case to scrape the underside of the skin where the apocrine glands reside. This can remove some of them and disrupt the duct connections in others.
Like liposuction, it is fairly simple to do and is done in a similar fashion. A small incision is made just at the front edge of a skin crease in the arm pit and the armpit is infused with tumescent solution. Once numb, the sharp cannula is used to scrape the undersurface of the armpit. The zone of treatment is where hair is located as this will have the highest concentration of sweat glands.It is hard to know when the maximum effect has been obtained so it is done to the point of ‘overtreatment’ with many passes back and forth. At the end, I will add a heat treatment (Smartlipo) to the undersurface of the skin in an effort to ensure the maximum amount of gland destruction. One has to be careful, however, to not burn the skin. This is a procedure which can easily be done under local anesthesia which can be supplemented with some intravenous sedation medication.
One of the other potential benefits with this treatment is in control of a potential companion condition known as bromhidrosis. This is an extension of hyperhidrosis in which the additional problem of a foul odor occurs which results from the action of bacteria on the skin. By definition, reduction of excess sweating should also help cut down or eliminate an odor problem as well. One other potential benefit is a reduction in armpit hair. Hair follicles are very hardy so they are hard to eliminate but a more sparse hair density is possible afterwards.
This is a treatment for those who have abnormal sweating, not for those who sweat a lot when working out or out in hot weather. Hyperhidrosis is when you excessively sweat in non-stressful situations. How much sweating reduction is possible? Reports have it as anywhere from 50% to 80%. Patients should not expect a total cure but significant reduction is possible with no known risks other than some temporary bruising, tenderness and skin stiffness. Because this is a modification of liposuction, this treatment has become known as Sweatlipo.
Dr. Barry Eppley