Endoscopic Thoracic Sympathectomy (ETS)

  • The most effective and permanent solution to excessive sweating is surgery (Endoscopic thoracic sympathectomy or ETS): Small portion of the select  sympathetic nerve in the chest are either cut with harmonic scalpel or electrocautery, or they may be divided by clamping with titanium clips (potentially allowing for the reversal of the procedure). This is done as an outpatient procedure (lasting less than an hour), with return home the same day. Incisions are small, and the discomfort is minimal.

The major drawback to the procedure is incidence of compensatory sweating experienced in most patients in other areas of the body such as lower back or thighs. This side-effect occurs on in most patients, but luckily occurs in times of exertion and hot weather.

Prior to considering surgery, all patients should be tried on some of the following treatments:

  • Aluminum chloride (Xerac, Maxim) solution. Aluminum chloride is used in regular antiperspirants, but excessive sweating sufferers need a much higher concentration. It usually takes about a week of nightly use to reduce the sweating. An aluminum chloride solution can be effective; some people, however, cannot tolerate the irritation that it can cause.


  •  Botulinum toxin type A (trademarked as Botox): Injections of the botulinum toxin are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. With proper anesthesia the hand and foot injections are less painful. The procedure when used for underarm sweating has been approved by FDA, and now some insurance companies pay partially for the treatments.


  • Iontophoresis: The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. A common brand of tap water iontophoresis device is the Drionic, Idrostar or MD1 Fischer. Some people have seen great results while others see no effect. However, since the device can be painful to some and a great deal of time is required, no cessation of sweating in some people may be the result of not using the device as required. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area as well.


  • Oral medication: There are several drugs available with varying degrees of success.        Aanticholinergic drugs are available that have shown to reduce excessive sweating. Ditropan (generic name: oxybutynin) is one that has been the most promising. For some people, however, the drowsiness and dry-mouth associated with the drug cannot be tolerated.  Robinul (generic name: glycopyrrolate) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin, with similar side-effects. Other less effective anticholinergic agents that have been tried include propantheline bromide (Probanthine) and benztropine (Cogentin). A different class of drugs known as beta-blockers has also been tried, but don’t seem to be nearly as effective. Beta-blockers may reduce facial blushing.

less effective options

  • Weight-Loss: Excessive sweating can be aggravated by obesity, so weight-loss can help. However, most people with excessive sweating do not sweat excessively due to obesity.
  • Relaxation and meditation: Relaxation techniques have been tried with limited success.
  • Hypnosis: Hypnosis has been used with limited success.


Dr. Konecny has been treating excessive sweating of hands, underarm and feet, in addition of facial blushing. His preferred method of definitive control of hand sweating and facial blushing is Endoscopic Thoracic Sympathectomy by division of the sympathetic chain with harmonic scalpel or clipping. For the underarm sweating, we prefer local treatment with gland scraping or skin excision.

Dr. Konecny has lectured in numerous California forums and on the national level conference (American College of Osteopathic Surgeons) on the subject of control of Hyperhidrosis. If you have excessive sweating problem, please contact us in Long Beach, California, for your excessive sweating treatment.

Book Appointment

  • Please include non-medical questions and correspondence only.
  • This field is for validation purposes and should be left unchanged.