Below are answers to various common hyperhidrosis questions by leading expert Dr. Reisfeld. To ask a question click here. To learn more about the cure for excessive sweating visit our confidential contact form or feel free to call us at (310) 557-3037.
Hyperhidrosis & Excessive Sweating Frequently Asked Questions
Click the question to view the answer.
Interesting Cases & Questions:
Section to discuss interesting clinical situations.
- Why should I travel to Los Angeles to see Dr. Reisfeld?
- Alcohol and Hyperhidrosis do they Mix?
- What is the success rate of ETS?
- What is the recovery period for the surgery?
- Can thoracic sympathectomy and lumbar sympathectomy be done at the same time?
- What is sympathectomy vs. sympathotomy?
- What is the best procedure for my excessive foot sweating?
- Will I get more hand sweating after doing the lumbar sympathectomy procedure for my sweaty feet?
- What should I do if I have BOTH excessive foot and excessive hand sweating?
- What is the age range for patients to have the ETS procedure done?
- Is the ETS procedure right for me?
- Where is the procedure performed?
- Who performs the procedure?
- What does T level mean for ETS surgical procedure (Hand Sweating)
- What does L level mean for ELS surgical procedure (Foot Sweating)
- What about insurance?
- How much does the surgery cost?
- What if I do NOT have health insurance, what should I do?
- What if my insurance says they do not cover this particular procedure?
- Possible Insurance issues reled to the sympathectomy procedures
- How does Dr.Reisfeld determine if the surgery is right for me?
- Do the titanium clips interfere with anything?
- Is it difficult to schedule a date for the surgery?
- Does there need to be a separate ETS procedure for separate areas of excessive sweating?
- What is the possibility of recurrence?
- What is the recurrence rate after sympathectomy performed for Palmar or Plantar hyperhidrosis?
- Who is not eligible for this surgery?
- Are there cases that can not be done and why?
- What is the difference between cutting the nerve versus clipping the nerve?
- What about hand sweating and armpit sweating?
- Is the ETS procedure an option for facial sweating and facial blushing?
- Is Hyperhidrosis Hereditary?
- What are the psychological impacts of hyperhidrosis?
- What is the reversal operation?
- If I only have excessive armpit sweating, what type of procedure is right for me?
- How secure are the titanium clips?
- How do I schedule an appointment?
- What is the difference between rosacea and blushing?
- What about the Kuntz nerve?
- What is the recurrence rate / failure rate?
- Heart Rate Changes?
- Can excessive sweating be treated non-surgically?
- What happens to the rest of the sympathetic chain?
- How do I know if my sweating is excessive and considered hyperhidrosis?
- What is compensatory sweating?
- Does the clamping method guarantee reversibility of the procedure?
- Do you collapse the lungs during surgery?
- Do the clamps set off alarms in airport metal detectors?
- Discussion on the correlation between social phobias and ETS.
- Why does Dr. Reisfeld not recommend ETS for facial blushing, facial sweating and axillary sweating?
- What is the relation between Raynaud's phenomenon and hyperhidrosis?
- What should I expect immediately after the procedure
- Do warts have anything to do with hyperhidrosis?
- Is Robotic Surgery applicable to Sympathectomy?
- Can deodorant be used after axillary laser ablation - axillary suction currettage?
- Does body piercing interfere with the operation?
- Does being skinny have anything to do with hyperhidrosis?
- Does obesity have anything to do with hyperhidrosis?
- When does conversion from an endoscopic lumbar sympathectomy to open lumbar sympathectomy happen?
- Does lumbar sympathectomy affect pregnancy?
- Why are my hands cold and clammy?
- Is the anatomy of the sympathetic chain the same for everyone?
- Can I do the operation if I have scoliosis?
- Can the sympathectomy clamps move from their original position in the body?
- Palmar hyperhidrosis vs. Plantar hyperhidrosis.
- What are the heart rate changes after endoscopic thoracic sympathectomy?
- Limiting the indications for ETS
- My physician is not knowledgeable with hyperhidrosis, what shall I do?
- What if I have only plantar hyperhidrosis (foot sweating) without any palmar hyperhidrosis (hand sweating)?
- What about the websites against the surgery?
- Can poisons or certain foods influence hyperhidrosis?
- What is the difference between "truncal sympathectomy" vs. "ramicotomy" for hyperhidrosis?
- What about Buttocks Sweating?
- What about male hyperhidrosis?
- What about female hyperhidrosis?
- Is obesity a factor in performing ETS (hands) or ELS (feet) surgery?
Why should I travel to Los Angeles to see Dr. Reisfeld?
Dr. Rafael Reisfeld, is a Board-Certified surgeon, fellow of the American College of Surgeons, diplomat of the American Board of Surgery, and known world wide as one of the very best doctors in the field of hyperhidrosis helping thousands stop sweating and start living. He has performed more ETS procedures than any other U.S. doctor. He has dedicated his entire practice to hyperhidrosis, pioneering new techniques and advancing critical research. He is the only known surgeon in the world to be an expert at all three major procedures. This gives him unparalled expertise in performing these procedures for each patient. Dr. Reisfeld has authored numerous peer reviewed medical papers and has been featured in newspapers, magazines, and television reports such as CBS, Fox News, Newsweek and others nationwide. Dr. Reisfeld takes the time to speak with each and every patient before the surgery instead of staff or personnel who are not experts in this field. We encourage you to contact our office and take the first step to stop sweating and start living!
What is the success rate of ETS?
Sweaty palms are cured in over 98% of cases. As a matter of fact after years of doing the Thoracic Sympathectomy it is becoming more evident that the success rate for plantar hyperhidrosis (foot sweating) is no more than 30%. For this reason the lumbar sympathectomy is emerging option as a excellent approach for those patients who did not get any relief with their plantar sweating after the thoracic sympathectomy or for those whom their plantar sweating is their major problem. The success rate of lumbar sympathectomy for excessive foot sweating is about 95%.
How do I know if my sweating is excessive and considered hyperhidrosis?
Simple questions that patients should ask themselves.
If the answers for those two questions are yes and conservative treatments have not helped then the available hyperhidrosis surgical procedures as a long and lasting option should be considered by the patient. You should also consult with your doctor or a medical professional in this field.
- Does my condition bother me socially or functionally?
- Do your hands drip from time to time from the sweating?
Can thoracic sympathectomy and lumbar sympathectomy be done at the same time?
So far these two procedures have not been done at the same time. There are a few reasons for this.
- We do not have the ability to judge what will be the response of the sympathetic system when two locations (thoracic and lumbar) are affected at the same time. We do not have any way to ascertain what reaction the body would have.
- Lumbar sympathectomy is usually a longer and more demanding procedure. As far as it is known so far these two procedures have never been done together. Dr. Reisfeld believes the procedures should be done separately.
- So far very limited clinical experience has been obtained in regards to doing both lumbar sympathectomy and thoracic sympathectomy at the same time. Those cases were done with one side thoracic sympathectomy and the same side lumbar sympathectomy on one day, and the other sides were done at a later date. The results were good but the final clinical recommendation at this point is not to perform both procedures at the same time because we still have some unanswered physiological questions such as blood pressure and adjustments of sympathetic system to this new approach.
- A general rule in surgery says that no two elective operations on different parts of the body should be done at the same time. This rule is based on pure logical considerations and most importantly patient safety.
What is sympathectomy vs. sympathotomy?
Basically these two definitions relate to the same thing. In both methods the sympathetic chain is rendered inactive due to interruption of the sympathetic chain either by excision or by clamping. Sympathotomy really means interruption the sympathetic chain with clamps which is the method used by Dr. Reisfeld in all of his cases. Basically sympathotomy means doing the operation with clamps compared to excision of a part of the sympathetic chain. When the sympathetic chain is excised then the word sympathectomy is the appropriate word to use.
What is the best procedure for my excessive foot sweating?
Excessive foot sweating or plantar hyperhidrosis usually appears together with palmar hyperhidrosis. Solitary foot sweating without excessive hand sweating can also appear but in a very low percentage of cases. We realized that the thoracic sympathectomy (ETS) does not help very much with excessive foot sweating. Since approximately 2004 Lumbar Sympathectomy has proven to be the best current option to treat patients with severe plantar hyperhidrosis (excessive foot sweating).
It still behooves patients with foot sweating to first try conservative measures before opting for a surgical solution. For more in depth information please see our foot sweating section.
Will I get more hand sweating after doing the lumbar sympathectomy procedure for my sweaty feet?
Basically the answer is no, there are some instances in which patients describe a temporary increase in their hand sweating after their lumbar sympathectomy. Those patients already had the thoracic sympathectomy for their excessive hand sweating. This temporary and short increase is unexplained so far.
What should I do if I have BOTH excessive foot and excessive hand sweating?
ETS has a much better success rate for hand sweating vs. foot sweating. Lumbar Sympathectomy is effective only for excessive foot sweating (plantar hyperhidrosis) The patient should decide which type of sweating is the most bothersome. Most patients choose to have ETS first but if their hand sweating is not as severe and their foot sweating then Lumbar Sympathectomy may be the right choice for them. As always patients must first discuss those issues with the doctor. Dr. Reisfeld is happy to discuss this with you as he is one of the only surgeons in the U.S. to be an expert in both procedures.
What is the recovery period for the surgery?
For ETS the recovery period is usually very short. After the hour-long operation, the patient spends about two hours in the recovery room and then goes home. Returning to normal life can be accomplished in a few days.
As for the lumbar sympathectomy operation the recovery is somewhat longer. This does not mean the procedure presents any additional risks. Patients stay at the hospital at least one night and rarely 2 nights. The lumbar procedure is much more demanding procedure for the doctor and the patient but recovery has proven to be relatively easy. Overweight patients pose another degree of difficulty to the surgeon. Make sure you talk with the surgeon extensively about this procedure.
Laser armpit sweat treatment patients (Armpit Sweating) do generally have a milder post operative course with regard to pain. There might be some swelling and fluid accumulation which are of a temporary nature. Patients typically leave the surgical center within a short time after the procedure.
What is compensatory sweating?
This is the common name used to the appearance of sweat in other parts of the body after the sympathectomy was done. The compensatory sweating also known as (reflex sweating or compensatory hydrosis) can appear on the lower legs, thighs, abdomen, or the back. Generally speaking everything from the nipple line up will be dry after ETS. All patients will get some sort of compensatory sweating (compensatory hydrosis or reflex sweating) which does not have necessarily any correlation to the amount of hand sweating existing before the operation. The majority of the patients will get it on a level that is acceptable by the patients, which we call mild to moderate. Between 3 to 5% of the patients will get it on a severe level which will make those patients unhappy ones. The compensatory sweating (compensatory hydrosis or reflex sweating) is a byproduct of the operation no matter what method was used. It really depends on how close the follow-up is being conducted by the different surgeons to give a definite statistical analysis of those cases.
What is the age range for patients to have the ETS procedure done?
The age range of patients for which Dr. Reisfeld performs the ETS procedure is between 10 years old and 66 years old. Dr. Reisfeld assesses each patient on a case by case basis. Generally speaking at present the recommendation for younger patients is to wait until they have gained more physiological, physical and mental maturation. This means that the potential patients should wait until the approximate age of 15 or 16. It is however recommended that Dr. Reisfeld be contacted for a much more precise assessment. Please see our section on younger age hyperhidrosis.
What happens to the rest of the sympathetic chain?
There is tremendous overlap in function within the sympathetic chain, so there are no known long-term side effects.
How much does the surgery cost?
Pricing varies depending on the type of procedure and the specific type of coverage from your health insurance provider. Our staff is very experienced in working with insurance companies and we will work closely with you to address any questions or concerns you have. The procedure is often more affordable than most people think! Please feel free to call us at (310) 557-3037.
For those patients who have no health coverage or are from out of the country we can work with you on payment options. It is highly recommended that you contact us so not only the monetary question can be answered but also so medical background can be obtained with regard to the specifics of the case while talking to Dr. Reisfeld.
What about insurance?
Most insurance companies cover the procedure because it is considered a medical necessity. We can help you with regard to your insurance. Our office, as a courtesy, will call your insurance carrier to verify benefits in the event that you chose to have the procedure. At present insurance policies are complicated and very difficult to understand. It is necessary to check each case on an individual basis. In our office we have gathered useful information about this process so those who have insurance should fax the back and front of their insurance cards.
Recently some insurance companies changed their policies with regard to the surgical treatment for hyperhidrosis. In those cases it is important for the patient to get more involved in the process and our office is happy to provide you with the necessary information. Please give us a call at (310) 557-3037.
For those who do not have health insurance see our related question. For those who do not have health insurance see our related question.
What if I do not have health insurance, what should I do?
Some patients who do not have health insurance want to purchase insurance coverage for the operation. As a rule of thumb health insurance coverage should not be obtained just for this procedure. If one gets health insurance coverage it should first be followed with conservative attempts to treat hyperhidrosis. Those attempts should be documented by health care professionals so the insurance companies will see a sincere attempt to treat it with alternative methods. To learn more visit our alternative methods to treat hyperhidrosis section.
For those patients who have no health coverage or are from out of the country we can work with you on payment options. Please contact our office at (310) 557-3037.
What if my insurance says they do not cover this particular procedure?
Lately there is a trend by some large insurance companies to exclude hyperhidrosis treatment from their policies. A similar example of this is the trial to exclude patients from getting surgical treatment for excessive obesity. In our opinion if a patient makes the effort to first try conservative measures to help their problem with no success then the surgical option should not be excluded from their policies. If a patient finds out that the surgical hyperhidrosis treatment is excluded from their policy the patient should challenge their health insurance provider. Many of our patients have successfully challenged their insurance carriers and received authorization to cover the procedure. Please feel free to contact us for more information.
Do you collapse the lungs during surgery?
No, the method that is being used by Dr. Reisfeld is a single lumen intubation which allows air to go in and out of the lungs at all times. Those surgeons that are using the double lumen technique the lung on the operated side is being collapsed.
More and more procedures have been performed as the information available on the procedure has become more accessible through the Internet and other information mediums. There has been some reluctance from the insurance companies to cover the cost. As for general information, hyperhidrosis is most likely a genetic disorder and not a cosmetic one. It is recognized by international health organizations as well as by the government as a medical entity. Obviously, the insurance industry is trying to limit the number of these operations from a purely financial perspective. We are working very hard to educate the insurance industry about this disease entity and teach them that this is a physiological ailment and not just a cosmetic or mental problem. Progress is being made in this regard especially with the amount of medical articles and clinical studies written recently by Dr. Reisfeld and other surgeons.
It is very important for patients to show any evidence that they first tried some sort of conservative treatment such as Drysol, Drionic, Robinul, etc. If insurance companies require documentation, then the patient will be provided with the appropriate documentation. In every case, our office will call the insurance company for pre-authorization. Some insurance companies will demand certain steps to be taken beforehand. In these cases, we will tell the patients exactly what is needed and guide them through the process. Some insurance companies will not respect the pre-authorizations they originally gave out earlier; however, we will do our best to follow up on that issue. Generally speaking, most of the insurance companies will cover this procedure. HMO's, in almost all cases, do not cover the procedure.
Since the insurance issue has become so important, we would like to re-emphasize that patients first try some conservative approaches to deal with their excessive sweating. Also, it is very helpful and important to keep documentation that shows such measures were taken.
For those patients who are not covered by any kind of medical insurance there is an inclusive charge that covers the facility fees, anesthesia fees, as well as the surgical fees.
For more information feel free to contact our office or call our friendly staff with no obligation and we will be happy to help you.
Phone: (310) 557-3037
How does Dr.Reisfeld determine if the surgery is right for me?
This is a very difficult question to answer since we do not have any objective measurements to find out what the "level" of hyperhidrosis is. Unfortunately, there are no x-rays, blood tests, or any other objective means by which to determine if a patient is the ideal candidate. Through discussions that Dr. Reisfeld conducts with the patient, a clinical decision is made based on many key factors. Every case is unique, and Dr. Reisfeld takes time to thoroughly assess each and every case before making his clinical decisions.
Does the clamping method guarantee reversibility of the procedure?
The clamping method, which originated in Taiwan, gives a much better option for those patients who are unhappy with the outcome of the surgery and are seeking to do the reversal. Before the clamping method was introduced, the only option that was viable for the patients was the nerve graft reversal. Having the clamps applied gives the patient as well as the surgeon a much easier approach to provide a possibility for reversal. Dr. Reisfeld has performed so far several clamp reversals and the statistical numbers are indicating some degree of reversibility which manifests itself with return of sweat to the upper parts of the body, some recurrence of hand sweating, better heat tolerance etc. Obviously the degree of reversibility varies among patients and we need to do more cases in order to establish more precise statistical data on this.
Do the titanium clips interfere with anything?
Titanium clips are entirely safe for the long and short-term and do not "interfere" with medical examinations such as x-rays, MRI scans, etc.
Is it difficult to schedule a date for the surgery?
Scheduling a visit is very easy and simple. Because the operation will not require excessive time away from work (usually less than one week), you can schedule the surgery at your convenience. A consultation and examination with the doctor are required beforehand. The procedure itself will take only about an hour.
Is there a need for separate procedures to treat different areas of excessive sweating?
What is the possibility of recurrence?
Sympathetic surgery has developed and improved over the last several years. As stated in other parts of this website, excessive hand sweating is best treated with ETS, which might also help with excessive armpit sweating. Unfortunately sweaty feet (plantar hyperhidrosis) is not improved as much with ETS. For sweaty feet the appropriate procedure today is lumbar sympathectomy. For isolated excessive armpit sweating laser ablation of the sweat glands is now the treatment of choice.
Please view our section on recurrence.
What is the recurrence rate after sympathectomy performed for Palmar or Plantar hyperhidrosis?
Please view our recurrence rate page.
Who is not eligible for this surgery?
You are not a candidate for the procedure if you suffer from severe cardio-respiratory illness, pleural disease, or untreated thyroid diseases. Dr. Reisfeld takes the time to personally communicate with people and determine if the surgery is right for them after reviewing several factors of their unique situation. The benefit to this is that you speak directly with Dr. Reisfeld who is an expert in the field, as opposed to staff or personnel who are not.
Are there cases that can not be done and why?
In certain cases some old scarring can prevent performing the operation in a safe manner. This type of scarring can be the result of previous pneumonia that was not necessarily clinically obvious. Chest Trauma can result in internal scarring (adhesions) that can prevent safe performance. Some very unusual anatomical abnormalities can also prevent doing the operation in a safe manner. This happens in extremely rare cases.
Is the anatomy of the sympathetic chain the same for everyone?
No, although the sympathetic chain is similar in most people in some cases it may be different. Only very experienced surgeons will be able to identify the abnormality and solve any issues presented.
What is the difference between cutting the nerve versus clamping the nerve?
In the cutting method, the nerve is cut with an electric cautery or with a harmonic scalpel (an ultrasonic device). In the clamping method, titanium clips are applied on the nerve. This ceases the function of that particular nerve segment. Both methods will result in compensatory sweating (compensatory hydrosis or reflex sweating) but the clipping method allows for the possibility of reversal if the compensatory sweating (compensatory hydrosis or reflex sweating) becomes too severe. To learn more about reversal see the reversal section below.
What about hand sweating and armpit sweating?
Many patients will have the combination of hand sweating and armpit sweating (axillary). When the ETS procedure is being done for the hand sweating, about 85% of the patients will see excellent results with regard to their armpit sweating. This is especially true since Dr. Reisfeld will apply clips on the lower levels of the sympathetic chain. In normal cases the method used is clamps on the levels T3 to T4. In cases where axillary hyperhidrosis is very severe then a clamp will be applied also on T5 in order to get improved results for severe armpit sweating.
Is the ETS procedure an option for facial sweating and facial blushing?
For more information on this please click here.
Is Hyperhidrosis hereditary?
Yes, Dr. Reisfeld believes there is a genetic correlation in hyperhidrosis. To see Dr. Reisfeld's thoughts on this topic. Click Here.
What are the psychological impacts of hyperhidrosis?
Please read our article that goes into the psychological impacts of hyperhidrosis.
What is the reversal operation?
In the event that a patient is not satisfied with the procedure due to some side effects (compensatory sweating), reversal of the operation can be offered. For more specific information, see our reversal section. For those patients who had the cutting method performed and suffer from severe compensatory sweating, reversal is a possibility that involves a complicated procedure. In this instance, a nerve graft from the ankle is used to bridge the gap in the nerve segment. Over the last two years, Dr. Reisfeld has performed several of the nerve graft reversal operations. The data that was accumulated from those cases shows that at least 60% of the patients will benefit from this procedure in a few aspects. Their compensatory sweating decreases and they start sweating over the upper shoulders, neck, and facial areas. The theory is that once the upper body areas start to sweat the evaporation process causes cooling of the head area. From that location, signals are transmitted to the brain indicating a cooler temperature. The return of upper body sweating could explain the lessening of compensatory sweating and the better ability to tolerate heat. For this rare and unique procedure, please talk to your surgeon.
Recently questions were asked with regard to the use of nerve guides made out of collagen. These nerve guides are used mainly in peripheral nerve repair where there is no gap between the cut ends of the nerve. The nerve tube serves as a protective conduit and supposedly enhances axonal regrowth across a nerve gap. Again, this is only done in peripheral nerve repair. This tube dissolves with time. Other patients ask about the use of schwann cell cultures which, at present, are in the experimental stage and have not yet been used in any clinical cases.
Dr. Reisfeld only performs the clipping/clamping procedure due to the fact that it is much easier to remove the titanium clips than it is to perform a nerve graft reversal in the rare event that it is requested. A nerve graft procedure would be performed for those cases where the cutting method was applied. Dr. Reisfeld does not perform the cutting method because he believes that the clipping/clamping method is a better choice. Statistical data is not yet established for either the clip removal or the nerve graft method. As far as experience shows, after a reversal procedure patients will start getting sweat back on their upper body areas (head and shoulders) and, as a result, compensatory sweating (compensatory hydrosis or reflex sweating) will be reduced. This process might take up to a year.
With the clipping/clamping method, the amount of nerve destroyed is much less than with the cutting method. With less nerve destroyed one can assume that recovery after clip removal would be easier and more effective. In either event, it is very important to discuss these issues, should they arise, with your surgeon.
If I only have excessive armpit sweating, what type of procedure is right for me?
With regard to the presentation of only excessive armpit sweating, sympathectomy does not offer the same high success rate as it does for hand sweating. For that reason, Dr. Reisfeld does not perform ETS if the only complaint of the patient is excessive armpit sweating. The armpit contains two types of sweat glands, eccrine and apocrine. The eccrine glands are affected by the sympathectomy while the apocrine glands are not. Those patients who suffer only from armpit sweating should try conservative methods such as drysol, drionic, certain dry, etc. BOTOX® injections are also a viable option but the duration can be limited to anywhere from 4 to 9 months. If those methods are not helpful, the best option is to go for laser armpit sweat treatment. In this new and improved procedure the sweat glands responsible for excessive armpit sweating are destroyed by the laser technique. It is done through extremely small incisions allowing quick recovery and less tissue trauma. To learn more visit our armpit sweating page.
How secure are the titanium clips?
The clips are very secure and do not require follow up in regards to determining if they are secure or not. However, Dr. Reisfeld does follow up with each and every one of his patients individually in the post surgery phase.
How do I schedule an appointment?
It's easy! Click here to schedule an appointment as well as be sent further information about hyperhidrosis and The Center For Hyperhidrosis. You can also read first hand what Dr.Reisfeld has done for countless others by viewing our patient testimonials.
What is the difference between rosacea and blushing?
Rosacea is a skin condition characterized by blemished skin. It is also characterized with constant redness around the cheeks. Sympathetically induced blushing is characterized by facial redness initiated during certain social or functional situations. This is indicated by short bursts of facial redness that happen in conditions that otherwise will not cause facial redness. Usually it starts after puberty (20 - 30 years of age).
What about the Kuntz nerve?
Dr. Reisfeld believes that the Kuntz nerve is a misused term. In the 1920's, Doctor A. Kuntz wrote a paper regarding a nerve he found in cats. That paper was written about the high failure rates when sympathectomies were done for vascular problems with the hands. We know now that the failure rate in those types of operations are related to post-denervation hypersensitivity. In the last symposium on sympathetic surgery in Finland, the overall consensus was that the Kuntz nerve has no bearing on the failure rate of sympathectomy (the actual ETS operation).
Although the Kuntz nerve is mentioned in various publications as being somehow relevant to ETS, proof of the existence of this nerve was never proved or demonstrated. So far, there is no anatomical or physiological proof for the Kuntz nerve. When Dr. Kuntz wrote his paper he stated, "This has not been demonstrated anatomically in man, but has been demonstrated in cats by the use of experimental anatomic methods..."
For a much more in-depth explanation click here
Kuntz A: Distribution of the Sympathetic Rami to the Brachial Plexus: Its Relation to Sympathectomy Affecting the Upper Extremity. Arch. Surg., 15, 871-877, 1927.
What is the recurrence rate / failure rate?
Between 1% and 2% of the patients will develop a recurrence. The recurrence might manifest itself with mild hand sweating under certain situations such as heavy activity, hot weather, or stressful situations. In those mild cases a re-operation may not be needed. But, in those cases that the recurrence is very severe, a redo operation can be performed. So far, the recurrence rates are equal in whatever method the sympathectomy is done.
With regard to the failure rate, one must differentiate between early failure (that happens immediately after the operation) and delayed failure (recurrence that can happen within the first 2 years after the operation). Early failure can happen because of technical or anatomical problems. See our recurrence section as well.
Heart Rate Changes?
Heart rate changes can happen in a small number of cases. There can be slight reduction in heart rate which physiologically has no significance. On the other hand, if a patient is engaged in a heavy physical activity some of them will advise that their maximal heart rate did not reach the same level as before the operation. Since the conversion from the T2 to the clamping of the T3-T4 levels, there are patients who have not noticed any reduction in their heart rate and in fact their heart rate went up to 150 – 160 per minute. There is no long-term adverse effect on cardio-vascular function. To learn more about heart rate changes and sympathectomy please click here. For more information about possible side effects section. Click here
Can excessive sweating be treated non-surgically?
We wish that every medical condition could be treated with non-surgical methods. With regard to excessive sweating attempts have been made to treat it with different conservative modalities such as lotions (Drysol), oral medications, electronic devices, Botox injections, etc. So far experience has shown the medical field that none of the above conservative treatments provides long lasting solutions. Having said that this does not mean that no attempts should be made. Before any decision about surgical intervention is made one or more of the above modalities should be attempted. One is advised to keep careful records of those attempts for various reasons.
Is the ETS procedure right for me?
Yes, it may very well be. Dr. Reisfeld consults and meets with every interested patient to determine if the procedure is right for him or her. The surgical solution to end hyperhidrosis is both highly effective and extremely safe. Dr.Reisfeld is the most experienced ETS doctor in the U.S. He takes great pride in what he does and it shows time and time again. He performs this proven surgery practically on a daily basis helping those who suffer from hyperhidrosis take their lives back. Contact us and we can arrange for you to personally speak with Dr. Reisfeld and ask any specific questions you have.
Where is the procedure performed?
The procedure is performed at the Beverly Hills Center for Special Surgery, a state-of-the-art facility open since 1984. The center is California state-licensed and Medicare approved.
What does T level mean?
The "T" level means the corresponding thoracic vertebra level where the sympathectomy is carried out. This relates to the rib level where the surgery done. It gives the surgeons a way to follow-up where the sympathectomy was done so results can be compared over the years. Dr. Reisfeld carefully documents each case to the exact location of where the clamps are applied for ETS.
For lumbar sympathectomy the "L" level corresponds to the level of the lumbar vertebra where the lumbar sympathetic nerve was clamped. Learn more about the lumbar sympathectomy level.
Who performs the procedure?
Rafael Reisfeld, M.D., is a Board Certified General Surgeon, with over 16 years of experience in the field of surgery. He is an experienced endoscopic surgeon who has performed ETS on thousands of patients.
Dr.Reisfeld is featured in the "Ask The Experts" section of the EFSB Channel.
There is a great list of questions and answers to view. To view the questions and answers click the following links
Ask The Experts part 1
Ask The Experts part 2
To see other media Dr. Reisfeld was featured in, click here.
Do the clamps set off alarms in airport metal detectors?
The titanium clips are very small and will not set off any metal detectors.
What is the relation between Raynaud's phenomenon and hyperhidrosis?
A lot of patients who suffer from excessive hand and foot sweating (palmar and plantar) are sometimes mistakenly labeled as suffering from Raynaud's syndrome. Basically patients with palmar or plantar hyperhidrosis may have clammy and discolored fingers and toes because of their hyperhidrosis and not because they suffer from Raynaud's disease. This can leads to unnecessary treatments such as medications which do not serve any benefit to the patient.
What should I expect immediately after the procedure?
Please select based on your type of procedure:
Do warts have anything to do with hyperhidrosis?
It is noted that in a very small number of cases warts are seen on the fingers. There is a slight possibility that the wet condition promotes the growth of those warts. A reduction in the size in the number of the warts was noted after ETS. No definite conclusions can be made from this small number of cases.
Can deodorant be used after axillary laser ablation - axillary suction currettage?
Yes, deodorants can be used after the operation. Since no operation can eliminate underarm sweating 100% the deodorant can be used to control any minimal perspiration also to give good body odor.
Does diabetes have anything to do with hyperhidrosis?
Basically these are two different entities. There is no correlation between diabetes and hyperhidrosis but the patient who has diabetes might also have hyperhidrosis. Uncontrolled diabetes can produce generalized body hyperhidrosis which is different from focal hyperhidrosis (armpits, hands, feet).
Does body piercing interfere with the operation?
It should be noted that whoever has body piercings in different areas of the body should be aware that body piercings in odd locations may need to be removed a short time before the operation. After the operation they can be put back. This should be discussed with the surgeon prior to surgery.
When does conversion from an endoscopic lumbar sympathectomy to open lumbar sympathectomy happen?
Overweight patients or those patients who had previous operations performed in the vicinity of the lumbar region (such as c-section, hysterectomy, kidney operation) can create scar tissue that will make the endoscopic lumbar sympathectomy more difficult to perform. The option of an open procedure is always available extremely uncommon.
Can I do the operation if I have scoliosis?
Yes, but we would need to know the degree of scoliosis. In experienced hands this anatomical variation can be handled. But experience is needed to locate the nerve which could slightly be off the regular course.
Does lumbar sympathectomy affect pregnancy?
So far there is no known connection between lumbar sympathectomy and the ability to conceive. On the contrary, Dr. Reisfeld’s female patients who had this procedure have become pregnant without any issue.
My physician is not knowledgeable with hyperhidrosis, what shall I do?
Lack of knowledge about this subject is still very common within the general medical society. It is slowly becoming more acknowledged by physicians but if a response from a physician to the patient is lacking you can refer them to this site and links to all the rich information provided including the various papers written by Dr. Reisfeld in respected peer reviewed medical journals. Dr. Reisfeld is also happy to speak with any physician about it.
What if I have only plantar hyperhidrosis (foot sweating) without any palmar hyperhidrosis (hand sweating)?
We are seeing more cases where the patients only problem is plantar hyperhidrosis. It is a somewhat smaller group of patients but their foot sweating is severe enough to pose as many problems and patients that have severe hand sweating. As more cases are done with ELS (Endoscopic Lumbar Sympathectomy) more clinical data is being accumulated with regard to the success rate of this treatment. Over time we will share this data.
Do you have a question that is not answered here? Just ask and we will answer.
To ask your question click here.