Take the first step towards freedom from hyperhidrosis
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Opening hours: Mon to Thurs 9am-5pm
Friday 8.30am-4.30pm

What is Hyperhidrosis

Professional hyperhidrosis treatment in Melbourne

Hyperhidrosis is the medical term for excessive sweating, resulting from excessive sympathetic nervous stimulation of the sweat glands. Everyone sweats when they are very hot, but people who have hyperhidrosis sweat profusely for no reason at all.

In virtually all cases, there is no other underlying disorder but hyperhidrosis can be distressing and have a huge impact on the sufferer’s life. Our aim at North Western Vascular Surgery in Melbourne is to help patients overcome their excessive sweating problems in commonly affected areas, such as are the palms of hands, soles of the feet and armpits.

What is Hyperhidrosis?

Sweating is a normal physiological response mediated by part of the autonomic system called the Sympathetic nervous system. It is our temperature regulator, cooling the body on hot days and when we exercise, preventing us from over-heating. The sympathetic nervous system is also called upon in times of stress, our so-called flight/fright response, so it is not unusual to break out in a cold sweat in times of stress.

For some people, this sympathetic response is exaggerated and excessive sweating may occur spontaneously, even in a cool environment, and even in the absence of any stress. When this exaggerated response occurs, we call that condition Hyperhidrosis.

It is most likely to occur in areas of the body, where the sweat (eccrine) glands are in abundance. Hence the predilection for the hands, feet, underarms (axillae) and face/scalp.

Facial blushing is also a physiological response to feeling threatened, and like sweating is mediated by the sympathetic nervous system.


The Cause

The exact cause for hyperhidrosis has not yet been identified. It is known that the anxiety experienced by sufferers can result in increased sweating, which in turn can set up a vicious cycle of further sweating and more anxiety.

The onset of this disorder is usually in adolescence and continues into adulthood (in some the onset is later). There seems to be a familiar tendency and a genetic link has been attributed to almost 50% of sufferers.
Spontaneous resolution of hyperhidrosis rarely occurs.

With the discovery that hyperhidrosis is linked to over-activity of the thoracic sympathetic nerves, surgeons have been able to focus on the relevant nerve cell bodies in the thoracic ganglia to achieve a permanent solution. It is only in the last 15 years with the advent of laparoscopic surgery that a permanent and effective treatment called Endoscopic Thoracic Sympathectomy (ETS) has been found for hyperhidrosis.

Sweaty Hands or Palmar Hyperhidrosis involves constant or excessive sweating of the palms. Wet or slippery hands are a source of discomfort and embarrassment for the sufferer, both socially and in the work environment which can lead to avoiding simple everyday activities such as shaking hands. It can also interfere with writing and gripping everyday items as well as impeding sporting activities.

Sweaty Feet or Plantar Hyperhidrosis involves constant or excessive sweating of the feet. It may cause some sufferers to change their socks several times a day and avoid removing their shoes in public for fear of foot odour. Suffers even avoid wearing sandals and thongs because their feet become too slippery.

Sweaty Armpits or Axillary Hyperhidrosis involves constant or excessive sweating of the underarms. This can lead some sufferers to shower throughout the day in an effort to avoid body odour and embarrassment. Constant wet patches under the arms often results in social avoidance and the necessity for some sufferers to frequently change their clothing.

Facial Blushing involves uncontrollable heat surges to the face and often upper chest. It may occur when attention is drawn to the sufferer. Facial blushing can happen on a daily basis with no means of control. This can lead to a lack of confidence and social avoidance.


Endoscopic Thoracic Sympathectomy (ETS)

Here at North Western Vascular Surgery, we have received many testimonials from patients who have undergone ETS in Melbourne and it is apparent that hyperhidrosis and facial blushing is a source of embarrassment that often leads to social phobia and the individual suffering in silence.

Many patients report having tried medications, acupuncture, Injections, and expensive deodorants with limited success or short-term results. There is a permanent solution and ETS has helped restore confidence and self-esteem to the many people we treat.

Frequently Asked Questions

  • What is the success rate following sympathectomy?

    The success rate varies according to the condition for which the sympathectomy is being performed.

    In those that have the procedure for sweaty hands, the success rate (ie achieve dry hands) is very close to 100%. It is important to emphasize the benefit is permanent. Some patients (less than 5%) might experience a bout of hand sweating in the first week, but this is not an indication of a poor response, and is never sustained.

    For patients undergoing a sympathectomy for facial blushing, over 90% will no longer blush after sympathectomy. The response for blushing of the neck and upper chest is a little less predictable.

    For axillary hyperhidrosis, the success rate is about 70%. This is because the sympathetic nerve supply to the axillary sweat glands, can sometimes arise form ganglia (nerve cell bodies) well down and relatively inaccessible on the sympathetic chain. For that reason I have abandoned sympathectomy for patients with axillary sweating as miraDry is a much better option for this.

  • What are the main risks of the procedure?

    The main complication is rebound sweating or compensatory hyperhidrosis. In response to ablation of the sympathetic chain, the brain sends signals to the sympathetic nerves below to work a little harder. Indeed 30 -40% of patients experience at least some degree of rebound sweating. Fortunately in most it is very mild and of no concern. However, in one in 50 patients, the rebound can be quite severe, causing spontaneous sweating on the torso, back or front. I have had patients who regret they had the procedure because of this complication, and everyone is warned of this.

    Horner’s syndrome which results in a droopy eyelid and constricted pupil, will occur if the Stellate ganglion is ablated. This occurs rarely, one in 1000 cases, usually due to misinterpretation of the anatomy by the surgeon. I believe this is far more likely to occur if the operator is inexperienced.

    Gustatory sweating, which is facial sweating following eating, particularly in response to spicy foods is a form of rebound occurring in 5% of patients.

    Chest complications such as pneumothorax or chest infections are very rare, but can occur. It is however quite common to experience heaviness in the chest and sharp pain often at the back, particularly with coughing and sneezing, referred to as pleuritic pain in the first week.

    Some patients (less than 5%) notice a marked difference in temperature between the upper torso and lower torso. In rare cases it can become somewhat disconcerting.

  • How long will I need to stay in hospital?

    Most patients stay overnight, and are discharged the following morning. If the procedure is performed early in the day, I am happy for patients to go home the same day, as long as a responsible adult is at home to care for the patient.

  • How much time off work will I require?

    I recommend a week off work, especially if the work is of a physical nature. Sharp chest and back pain is common in the first week, and often requires anti-inflammatory medications such as Nurofen to control the pain. Having said that, a number of patients return to work earlier and seem to manage quite all right.

  • How long after the procedure can I fly?

    Particularly for my interstate patients, this is often asked. All patients have a post-operative Xray to exclude a pneumothorax (residual air in the chest cavity). This is rarely of any consequence and settles spontaneously but I caution patients against flying until the pneumothorax has resolved completely. Without a pneumothorax I usually recommend 4 to 5 days before flying.

  • If I get rebound sweating, can it be treated?

    Bad rebound, which fortunately is very uncommon (about one in 50 cases) is the complication I fear most for my patients, as it is out of my control.

    In most cases the rebound sweating does decrease with time, but this cannot be guaranteed for all.

    From a practical viewpoint, there is no surgical option for rebound sweating. Certain medications with anti-cholinergic properties (eg Ditropan) can be helpful in this setting.

  • How is the sympathectomy performed?

     

    There are many ways of performing a sympathectomy, including cutting the nerve, clamping the nerve, excising the nerve or ablating the nerve. I choose to ablate (by electro-cautery) the ganglia, which are the nerve cell bodies form where the nerves are derived. This guarantees that the objective of the procedure (ie dry hands or eliminate blushing) is far more likely to be achieved.

    I am not a proponent of clamping the nerve, as this results in an incomplete sympathectomy and does not result in reversal of rebound sweating with removal of the clamps.

  • What is the cost of the procedure?

    This is not regarded as a cosmetic procedure, and is recognised by the Medicare Benefits Schedule.

    If you have private health insurance, most of your hospital costs will be covered. Medicare and your health fund will cover you to the schedule fee, though there will be an out-of-pocket component, which does vary from fund to fund, but is in the vicinity of $1500.

    With no private health cover, it will be an expensive undertaking, costing up to $8000 out of pocket. Please download more details of prices here

  • In which hospitals is the procedure performed?

    I perform thoracic sympathectomies at 3 hospitals:

    John Fawkner Private Hospital in Moreland Road Coburg

    Monash Medical Centre (Jessie MacPherson Private Hospital)

    In Clayton Road, Clayton

    Cabrini Malvern in Wattletree Rd, Malvern

    All hospitals have State of the Art facilities with first class Nursing Care. There are minor differences with regard to fees and out-of-pocket expenses, which you should discuss with my staff.

  • Will the sympathectomy have any impact on my feet?

    It is not uncommon for patients to have the combination of sweaty hands and sweaty feet. It is more frequent for the hands to be the more problematic, though this is not always the case.

    However, almost invariably I recommend treating the hands first, as this is more often the more troublesome, but also that in two thirds of patients, there is a significant improvement in the feet following a thoracic sympathectomy.

  • Is there specific treatment for sweaty feet?

    Absolutely. A lumbar sympathectomy (performed laparoscopically or by an open procedure) will interrupt the sympathetic nerve supply to the lower limbs, thereby cutting off the nerve supply to the sweat glands in the feet. Performed as an open procedure, it involves incisions on each side of the abdomen in order to approach the sympathetic chain. The operation takes approximately one hour, is performed under general anaesthesia, requires 2 to 3 days in hospital, and a 3 to 4 week recovery. The success rate is very high (greater than 95%), and complications are rare.

Our Client Stories

I was driving home this morning feeling unimaginably happy. Choosing to have surgery was the best decision I’ve ever made. The first time I met you, I was overcome by how completely you understood what I was going through. I think what you do is unbelievably selfless and amazing. You have literally changed my life.

It isn’t even these major things that I am most grateful for. It is the much simpler things – going out to dinner without feelings of stress and anxiety, holding hands, getting my nails done… Read More

Before this operation, I wore gloves to job interviews, I skipped church to avoid the peace-be-with-yous as the thought of shaking someone’s hand made me cringe and my tops and dresses were always black to avoid stains from under my arms. This operation has changed my life forever, it has built my confidence up and has allowed me to take up new hobbies like dancing.

I just wanted to say a massive thank you to Mr Roger Bell and his team for allowing me to live my life sweat free… Read more

I was driving home this morning feeling unimaginably happy. Choosing to have surgery was the best decision I’ve ever made. The first time I met you, I was overcome by how completely you understood what I was going through. I think what you do is unbelievably selfless and amazing. You have literally changed my life.

It isn’t even these major things that I am most grateful for. It is the much simpler things – going out to dinner without feelings of stress and anxiety, holding hands, getting my nails done… Read More

Before this operation, I wore gloves to job interviews, I skipped church to avoid the peace-be-with-yous as the thought of shaking someone’s hand made me cringe and my tops and dresses were always black to avoid stains from under my arms. This operation has changed my life forever, it has built my confidence up and has allowed me to take up new hobbies like dancing.

I just wanted to say a massive thank you to Mr Roger Bell and his team for allowing me to live my life sweat free… Read more

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