Hyperhidrosis treatment

Hyperhidrosis, or excessive sweating is a common and under diagnosed condition which involves the secretion of sweat that exceeds the normal production by the body. The impact on quality of life can be enormous. One of the most commonly affected sites are the armpits in both men and women. Hyperhidrosis can be classified as primary or secondary depending on if a specific cause can be found for the excessive sweating. The vast majority of cases are primary with no underlying cause. While sweating is a normal bodily function, some people will suffer excessively, and it will impact their day to day life. You may notice you have to change clothing throughout the day, or it may be impacting on your self-esteem and confidence.

Hyperhidrosis can also be categorised into focal (localised to a specific area) or more generalised affecting the whole body.

Hyperhidrosis Diagnosis Criteria (2 for a diagnosis of hyperhidrosis)

1. Excessive sweating that lasts for more than six months with frequent exacerbations
2. Excessive sweating affecting both sides of armpits
3. Family history of hyperhidrosis or excessive sweating
4. Symptoms started at a younger age (<25)
5. No significant sweating while asleep
6. Impairment of activities of daily living
7. Hyperhidrosis affecting the armpits, palms or soles

Centre for Surgery is a specialist centre for excessive armpit sweating and offer a unique multidiscplinery approach to the treatment of this condition.

• Botulinum toxin type A
• Fractional RF microneedling
• Laser ablation and suction-curettage

Expected results after excessive sweating treatment

• Significantly reduced levels of sweat production
• Improvement in confidence leading to improved personal and professional relationships

1. Over 15 years experience with all types of hyperhidrosis procedures – neuromodulator, suction-curettage and fractional RF microneedling
2. We regularly receive patients from overseas at our plastic and cosmetic surgery specialist centre
3. Our surgeons are UK trained NHS consultant plastic surgeons who live and work in London. We don’t work with ‘fly-in, fly-out’ surgeons. This is very important because whilst your surgeon takes all precautions to minimise complications, complications can and do occur and our surgeons are readily available to manage any issues if and when they arise.
4. We own and manage our own surgical facilities. Properly performed hyperhidrosis treatment takes time and should not be rushed.

• Alok Misra
• Ertan Erel
• Omar Tillo

Our surgeons are full members of:

Hyperhidrosis also known as excessive sweating is a condition of overproduction of sweat by sweat glands that is more than required to maintain the body’s normal temperature. Hyperhidrosis is not always related to being in a hot environment or exercise. Hyperhidrosis can be a very socially disabling condition with patients constantly having to change their clothing or wipe their palms dry. There is increasing awareness of hyperhidrosis as more effective treatments become available. Excessive sweating can markedly impair quality of life through interference with doing a job, personal relationships and confidence levels.

Centre for Surgery offer three highly effective treatment options for excessive sweating:

• Botulinum toxin type A (temporary treatment – non-surgical)
• Fractional RF microneedling (permanent but needs to be repeated in patients with high BMI)
• Laser ablation and suction-curettage (permanent treatment – surgical)

While sweating is a normal body physiological function, some people naturally sweat more or less than others. Those individuals who sweat excessively can cause problems and embarrassment with school, work and social situation.

Hyperhidrosis affects both males and females and can start at any age. Hyperhidrosis may be localised or generalised. Body parts such as armpits, hands, feet and groin tend to perspire more due to a high concentration of sweat glands in these areas.

If excessive sweating is limited to these areas it is called localised or primary hyperhidrosis. If the whole body perspires excessively it is called generalised or secondary hyperhidrosis, and this is usually caused by a systemic condition for example hyperthyroidism (an overactive thyroid gland). Excessive armpit sweating may also lead to a large variety of secondary medical conditions such as bacterial or fungal overgrowth, muscle cramps, eczematous dermatitis, among others. Up to two thirds of patients report a positive family history, which suggests that a genetic predisposition may exist.

Hyperhidrosis can be effectively controlled or treated now with anti-wrinkle injections as a temporary treatment required one or twice a year or with the minimally invasive procedures of RF microneedling and laser ablation.

Centre for Surgery does not offer procedures to those under the age of 18. You will need to have realistic expectations of what this procedure can achieve.

You will need to attend a consultation with one of our surgeons before undergoing this treatment. They will be able to assess whether you are a suitable candidate for this procedure. You should be in good health and for the surgical options, you will be assessed by the surgeon to make sure there no factors that could adversely impact on wound healing. This disorder can occur at any stage of life. However, the average age at the time of onset of the condition depends on the site involved. Excessive armpit sweating onset usually occurs during the teenage years.

A good candidate for hyperhidrosis treatment:

• You experience moderate to severe sweating of the armpit, palms or soles
• Deodorants or antiperspirants do not reduce the level of sweating
• You are willing to have regular injections of neuromodulator every three months to maintain the results

The starch-iodine test is an objective way to assess the extent and distribution of the disease. However, the test does not provide any indication of the severity of the condition

Deodorants and anti-perspirants are the most common solution for excessive sweating of the armpits. Deodorants are not effective for excessive sweating of the palms or soles. Even the strongest deodorants and anti-perspirants are often ineffective for excessive sweating. Deodorants and anti-perspirants are only short-acting and would need many applications throughout the day to adequately control excessive sweating.

Severe underarm sweating is a medical condition involving overactive sweat glands. While sweating is a way your body regulates your temperature, excessive sweating far exceeds the body’s need for cooling.

Patients with excessive sweating:

1. Change clothes frequently
2. Put absorbent material under clothing
3. Avoid certain types of fabrics and styles of clothes

Centre for Surgery in London are one of the few centres to specialise in both non-surgical and minimally invasive surgical methods to treat hyperhidrosis of the armpits. The use of neuromodulator injections for treatment of hyperhidrosis is one of the most commonly used methods as it is non-surgical in nature. Neuromodulators are also known as anti wrinkle injections and are most commonly used to treat facial lines and wrinkles. Neuromodulators act on the nerves supplying the sweat glands to reduce sweat gland production. Neuromodulator injections can result in up to six months of being symptom-free and about 50-100 units of neurotoxin are required for each armpit area. Excessive armpit treatment usually requires 2-3 sessions of neuromodulator per year.

Botulinum toxin type A

Excessive sweating, or hyperhidrosis, can be treated effectively with neuromodulator injections. The injections have been used to completely reduce or resolve excessive sweating. 

Many patients have tried prescription antiperspirants without success, and for those patients, injections are a viable treatment. Local anaesthetic numbing cream is first applied to both armpits. The injection is injected into the affected areas in a grid-like pattern and works by blocking the chemical signals from the nerves that stimulate the sweat glands. When the sweat glands don’t receive chemical signals, the severe sweating stops. Sweat does continue to be produced in other areas of your body.

In addition to the armpit area, anti-wrinkle injections can be used to treat excessive sweating in the palms and soles of the feet as well. To determine if injections are right for your type of excessive sweating, schedule a consultation with one of our surgeons.

Suction-curettage

Patients increasingly wish for a safe and robust procedure with very few side effects, lower complication rates and that keeps them the shortest possible time away from daily activities. Local surgical treatment of axillary hyperhidrosis aims at eliminating the largest possible number of sweat glands in the armpit region, while preserving, as much as possible, the normal aesthetic appearance of the armpit and mobility of the arm.

Laser ablation and suction curettage is the most invasive option for treatment of axillary hyperhidrosis. In this procedure, the sweat glands are permanently destroyed before being curetted out with a specially designed surgical curette. It is often not possible to remove 100% of the sweat glands although the amount of sweat glands surgically removed is often enough to ensure a significant and permanent reduction in sweat production. This procedure is most commonly performed under a local anaesthetic as an outpatient procedure which means you will be admitted and discharged on the same day. The procedure is very well tolerated with little to no pain or discomfort during and after the procedure and there is no requirement for general anaesthetic, but as with all procedures at Centre for Surgery, the choice of TIVA general anaesthesia is available if you feel very anxious about being aware for the procedure.

The first step involves injecting the area with a solution containing a local anaesthetic and a vasocontrictor. This minimises the risk of feeling any pain and discomfort, as well as any risk of bleeding.

Centre for Surgery uses the powerful Fotona Nd:YAG laser for hyperhidrosis therapy. This procedure involves locating where the sweat glands are. Next, an incision is made and a cannula with an optical fibre is inserted. The Nd:YAG laser is inserted and precisely ablates the sweat glands, destroying them. 

Next, small incisions are made and power-assisted liposuction is undertaken to aspirate fat globules. This method avoids any damage to the stromal network and blood vessels. A small currette shaped cannula is then used to remove the undersurface of the sweat glands. Finally, the remaining layer of fat is equalised with cannula probes to minimise any uneveness. This allows you to have a smooth appearance without any lumps or rippling skin that can occur with traditional methods of liposuction. 

This method is much gentler than traditional techniques. The scar burden is minimal scars and the recovery period is swift. You will only have to undergo one treatment, as the glands will have been physically removed.

Whilst neuromodulator injections and surgical treatment with suction-curettage are established treatments with a great record of safety and effectiveness, both treatments have their downsides. With neuromodulator injections, only a temporary effect is possible which lasts up to 6 months. Although suction-curettage is a more permanent treatment, there are risks attached as it is a more invasive surgical procedure. The most exciting prospect for hyperhidrosis treatment is the use of fractional radiofrequency microneedling. The Morpheus8 device is the latest generation of fractional RF microneedling with full control over needle depth adjustment and the level of energy delivered through the 24 precision microneedles.

The tiny pins of the morpheus8 device are able to penetrate deep enough into the skin to impart controlled thermal energy via the micropins to precisely ablate the sweat glands. The Morpheus8 procedure for excessive armpit sweating does no require any incisions and leaves no scars. The procedure can be performed effectively with the prior application of topical local anaesthetic cream to permit a pain-free procedure. Two treatments are ideal for permanent treatment effects, and in those with more severe grades of hyperhidrosis, three treatments are recommended for best results.

The recovery period will vary depending on which option you chose to undertake.

Neuromodulator injections will have no downtime. In some rare cases, you may notice some bruising or swelling at the injection site, but this will fade with time.

If you undergo Morpheus8 microneedling, you may an area of redness that will persist for a few days but again no downtime is usual.

You may notice some swelling, numbness or tenderness with laser therapy, which will last around two weeks. You can usually return to normal activities within 2-3 weeks but this will depend on the surgeons postoperative instructions.

Complications can potentially occur with any surgical procedure, suction curettage for hyperhidrosis is no different. At consultation, your surgeon will always take time to fully discuss the risks and complications associated with hyperhidrosis treatment. All risks will be outlined regardless of how rare they are. By choosing Centre for Surgery for your hyperhidrosis treatment, you can be confident in having highly experienced and expert surgeons to perform your procedure.

Although the minimally invasive suction curettage technique has shown a relatively low complication rate, a variety of mild to moderate side effects (for the most part, temporary) has been reported.

Possible complications of laser and suction curettage for hyperhidrosis include:

• Haematoma
• Ecchymosis
• Seromas
• superficial erosions of the skin
• Loss of local sensitivity
• Skin necrosis
• Infection
• Reduction in the number of hairs
• Fibrosis
• Formation of subcutaneous adherences
• Scars
• Recurrence of hyperhidrosis