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Facial Blushing
Author: Rafael Reisfeld MD

Facial Sweating and Blushing:

Another manifestation of a hyperactive sympathetic system is excessive facial sweating and/or facial blushing. Such symptoms of hyperhidrosis will typically appear during mild social encounters that would otherwise not have caused facial sweating and/or blushing.

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The treatment of facial blushing and or facial sweating is a controversial subject. The uncontrolled and embarrassing situation of facial sweating and blushing was thought to be easily treated with ETS. This came about when ETS was done for patients with sweaty hands. Among those patients who also suffered from facial blushing and/or facial sweating the results were also successful at reducing facial blushing and/or sweating. However over the years two observations were made when this operation was applied only for patients with facial blushing and or facial sweating. Percentage wise these patients developed a higher rate of severe compensatory sweating. Also these patients experienced a higher degree of dissatisfaction due to the side effects. Side effects such as facial flushed feelings, loss of stamina, facial skin sensitivity, increased amount of fatigue and others led Dr. Reisfeld to the decision not to perform ETS when only facial blushing or facial sweating were involved. The clinical experience that was accumulated over the last several years is what has allowed Dr. Reisfeld to reach this assessment. More time is needed to reach a definite conclusion with regard to the most appropriate procedure for patients who suffer from only facial blushing and/or facial sweating.

Over the last few years my experience showed that patients on whom ETS was done only for facial blushing or facial sweating will show a higher degree of dissatisfaction. Many of the patients have had successful results; however, a significant percentage developed severe compensatory sweating (compensatory hydrosis or reflex sweating) which made them dissatisfied patients. This particular information came about over time after follow-up with patients. Because of the increase in dissatisfied patients Dr. Reisfeld has decided not to perform this operation when the patients only manifestation is facial blushing or facial sweating.

Possible explanation for why patients with only facial blushing and or facial sweating develop higher levels of compensatory sweating:
At this time, we know that the T2 level sympathectomy is associated with more cases of severe compensatory sweating. However, in order for the surgery to be effective in the reduction of facial blushing and/or facial sweating, this is the recommended procedure. Performing the Sympathectomy at the T2 level will bring with it a higher level of success but at the same time patients experience a much higher chance of developing severe compensatory sweating. This is the prevailing theory when the operation is done for facial sweating or facial blushing but as said before Dr. Reisfeld no longer recommends the ETS procedure to be done for people who suffer from only facial blushing and or sweating.

Surgical Summary:
In summary you may find the above paragraphs somewhat confusing but never the less it is Dr. Reisfeld's opinion that the optimal treatment for facial sweating and or facial blushing has not yet been found. Dr. Reisfeld recommends against ETS as a surgical option for facial blushing and or facial sweating.

Dr. Reisfeld at present advises all patients to try other conservative options in place of surgery. The different conservative modalities include medications such as the anticholinergic drugs Robinol, Ditropan and Propanthelin. One can also try these medications together with mild sedatives such as Xananx. Some patients will get some relief with this approach. Biofeedback may also be tried but it has not been found to be very helpful. For those patients who only have facial blushing, a medical evaluation should be carried out in order to rule out such ailments as adrenal dysfunction or overproduction of adrenaline-like materials. Dr. Reisfeld has operated on a number of patients who have experienced very good relief and positive results from the surgery, however Dr. Reisfeld no longer performs this procedure for those who suffer from only facial blushing or facial sweating. If more clinical information becomes available for those patients Dr. Reisfeld will review it and make it available through this website. Patients who are looking into this surgery, and suffer from only facial blushing or sweating, should discuss it with other surgeons.

Photo-facial treatment done with laser or other means in the past showed some degree of success. These treatment modalities were carried out mainly by dermatologists or other professionals dealing with skin treatments using different laser devices. Obviously over the years improvements have been made and there are products made by Cynosure for example, that have shown some success with the treatment of facial blushing with these new generations of laser devices.

Dr. Reisfeld is aware of the fact that some other surgeons in the U.S. as well as in Europe are performing Endoscopic Sympathectomy for patients with only Facial Blushing or Cranio-Facial Hyperhidrosis but does not share their opinion. If a patient who suffers only from facial hyperhidrosis or facil blushing and would like to know more about this controversial topic a telephone consultation or an office consultation can be obtained for a fee. For a consultation please call (310) 557-3037.

Another clinical observation which will need more time for verification is the thought that the higher failure rate of sympathectomy when ETS is done only for facial blushing has to do with the fact that when the sympathectomies were done in the past for vascular problems the success rate was very minimal. At this time we know that the higher failure rate was due to a clinical situation which we call denervation hypersensitivity. In essence the blood vessels become very sensitive to certain circulating hormones within the blood system. Dr. Reisfeld believes that the same phenomenon happens in this facial blushing presentation. More time and more clinical experience is needed before there can be a more definite conclusion.

Ask The Expert - One on one with Dr. Reisfeld Facial Blushing consultations are available. Click here to learn more.

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In contrast to those patients who suffer from excessive hand sweating the recommended approach at this stage is to perform the T2 sympathectomy.

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