Is the ETS surgical procedure appropriate for facial sweating and facial blushing?
In the early 90’s ETS was thought to be an answer for patients who suffer from facial blushing and or facial hyperhidrosis. The basis for this was the fact that patients who had facial blushing and or facial hyperhidrosis together with palmar hyperhidrosis (excessive hand sweating) showed an initial improvement of the symptoms in the head area. That lead to the assumption that ETS would help patients who suffer from only facial sweating and or facial hyperhidrosis. It was then adopted by surgeons in Europe and the Far East to offer ETS as a solution for the facial manifestations. As more information was accumulated it was shown that patients who had the operation for the facial presentations developed more severe side effects with regard to compensatory sweating, gustatory sweating and hair loss. After reviewing those cases it was a decision made by Dr. Reisfeld not to offer ETS for those two isolated types of facial hyperhidrosis. The theoretical explanation for that lies in the fact that while performing ETS for facial problems the surgeon must be high in the sympathetic chain causing less sympathetic ganglia innervating the head region.
By doing ETS on lower levels of the sympathetic chain (T3 to T4) you allow the head area to get more in-tact sympathetic innervation which somehow helps with the side effects.