Q. What causes hyperhidrosis?
A. Secondary generalized hyperhidrosis, excessive sweating of the entire body, can be caused by a medical condition, such as menopause, an overactive thyroid, diabetes, or stroke. Medications, exercise, and heat can also cause secondary generalized hyperhidrosis. Palmar hyperhidrosis (sweaty palms), axillary hyperhidrosis (sweaty armpits), and facial hyperhidrosis are caused by heightened activity in the sympathetic chain of nerves, part of the autonomous nervous system that involuntarily controls activities in the body. The sympathetic chain of nerves is located in the chest cavity.
Q. Will hyperhidrosis improve by itself without treatment?
A. No. Hyperhidrosis tends to develop in adolescence or early adulthood. Symptoms tend to worsen over time. They do not disappear on their own. In some people, sweaty palms and facial sweating occur only under severe stress. In others, it happens all the time.
Q. Is hyperhidrosis hereditary?
A. Possibly. Although a definitive answer is not available yet, scientists believe that primary focal hyperhidrosis (excessive sweating of the palms, feet, armpits, or face) and generalized idiopathic hyperhidrosis (excessive sweating of large parts of the body) are genetically linked.
Q. What conservative treatments might help?
A. Most patients should try conservative treatments before considering surgery. Depending on the type of hyperhidrosis you suffer from, conservative treatments might include oral medications, topical agents to reduce sweating and odor, iontophoresis, Botox® (Botullinum Toxin Type A) injections, and applications of talc/baby powder.
Q. How will I be evaluated at the Hyperhidrosis Center?
A. Our medical team will provide a thorough evaluation and physical examination of you before making a diagnosis and treatment recommendations. If necessary, you may be referred to one of our dermatologists or plastic surgeons.
Q. What surgical options are available?
A. For axillary hyperhidrosis, traditional surgical removal of the sweat glands and reconstructive surgery of the skin in the armpits may be recommended. However, a newer minimally invasive surgical procedure called suction curettage might be a better option for you. Suction curettage is modified from liposuction and is performed by a dermatologist. The doctor removes the sweat glands with quick suction and scraping (curettage).
For axillary, palmar, and facial hyperhidrosis, your doctor may recommend endoscopic thoracic sympathectomy (ETS), a minimally invasive surgical procedure performed by Drs. Korst and Shapiro, in which they cut the nerves responsible for the excessive sweating.
Q. Is ETS a new procedure?
No, sympathectomy has been performed for more than 30 years. Today, thoracic surgeons can use minimally invasive techniques and special instruments inserted into the chest cavity through small keyhole incisions under the arms to perform the surgery. A tiny camera inserted into the area magnifies the sympathetic nerves, making it easier for the surgeon to precisely sever the ones needed to stop hyperhidrosis. Because there is no large chest or neck incision, patients experience less pain and infections than they would with traditional sympathectomy.
Q. Who will ETS help?
A. ETS is most successful (98%) in patients with palmar hyperhidrosis (sweaty palms), but it can be used to treat axillary and facial hyperhidrosis in conjunction with palmar hyperhidrosis.
Q. Who should not undergo ETS?
A. ETS may not recommended for patients with cardio-respiratory illness, pleural disease, untreated thyroid disease, or excessive scarring of the chest, such as what can occur from previous pneumonia that was not detected. Patients with very unusual anatomical abnormalities should not undergo the surgery, but these abnormalities are very rare. ETS is not recommended for plantar hyperhidrosis (feet).
Q. What emotional support can I expect?
A. Our dedicated Hyperhidrosis Center nurses can support you and answer any questions you might have about ETS. If you wish, we can put you in touch with former satisfied patients.
Q. Where is the surgery performed?
A. ETS is performed at The Valley Hospital in Ridgewood, New Jersey.
Q. Will I stay overnight in the hospital after ETS?
A. ETS is an outpatient procedure. The vast majority of patients will go home several hours after surgery.
Q. When will I notice results?
A. You may notice results immediately after surgery. You will wake up from surgery with dry, warm hands.
Q. Are there sutures (stitches) that need to be removed?
A. The keyhole incisions are closed with absorbable sutures that eventually dissolve. They do not need to be removed. You may shower or bathe the day after surgery.
Q. What is the recuperation period?
A. Most patients return to work and their normal activities within several days after surgery.
Q. Is follow-up required after ETS?
A. Your surgeon may advise you to come back for a follow-up appointment within several weeks after surgery.
Q. Do I have to worry about heart changes?
A The sympathetic nervous system plays a role in regulating cardiac function. Heart rate changes can happen to a very small number of people after ETS. There can be a slight reduction in heart rate. If you take part in heavy physical activity, your maximal heart rate may not reach the same level as before surgery. ETS does not cause any long-term cardiovascular malfunction. The procedure seems to benefit patients with certain arrhythmias of the heart. Competitive athletes who depend on the maximization of their heart rate need to consider this possible side effect more closely than others.
Q. Is ETS surgery covered by health care insurance in New Jersey?
A. Hyperhidrosis is considered a medical condition with serious physical and psychological complications when not treated. Therefore, ETS is usually covered by health insurance because it is considered a medical necessity not a cosmetic procedure. However, your policy may require you to try more conservative methods first, such as medications or iontophoresis. You should check with your individual health insurance coverage to determine your benefits.
Q. How do I schedule surgery?
A. Call the Hyperhidrosis Center at 201-634-5606 to schedule an appointment to meet with Robert J. Korst, M.D., or Mark Shapiro, M.D.