Excessive sweating occurs when sweat glands in specific regions of the body become overactive. Sweat glands are responsible for secreting sweat, which helps cool the body during heat or physical activity. In individuals with hyperhidrosis, these glands become hyperactive, leading to excessive sweating even without external triggers.

Causes of Hyperhidrosis

Hyperhidrosis can be classified into primary and secondary forms, depending on the underlying cause:

1. Primary Hyperhidrosis: This is the most common form, with no underlying medical condition causing the excessive sweating. It is often genetic, meaning that individuals with a family history of hyperhidrosis are more likely to develop the condition themselves. It typically begins in childhood or adolescence and affects specific areas such as the underarms, palms, soles, or face. The overactivity of the sweat glands is usually localized, and there is no known reason why the sweat glands overproduce sweat.

2. Secondary Hyperhidrosis: This type occurs as a result of an underlying medical condition, such as obesity, menopause, thyroid problems, infections, or certain medications. In this case, sweating occurs in larger areas of the body and is often linked to an existing health issue that must be addressed first before considering treatment for hyperhidrosis.

Risk Factors for Needing Gland Resection

1. Family History: A strong genetic component exists in primary hyperhidrosis. Individuals with a family history of the condition are more likely to develop excessive sweating.

2. Anatomical Location: Areas like the underarms (axillae), palms, and soles tend to have a higher concentration of sweat glands, making these sites more prone to excessive sweating.

3. Failed Non-Surgical Treatments: For patients who have exhausted non-surgical options such as topical antiperspirants, oral medications, or Botox injections without success, surgical resection of sweat glands may become the next logical step.

4. Severe Impairment of Quality of Life: Hyperhidrosis can significantly impact a person's life, causing social embarrassment, job difficulties, and psychological distress. When the condition severely impairs daily activities or leads to skin infections or foul odor, surgery may be considered.

5. Recurrent Skin Issues: Those with hyperhidrosis may experience chronic fungal or bacterial infections due to the constant moisture in the affected areas, further exacerbating the need for gland resection.

The most notable symptom of hyperhidrosis is excessive sweating that occurs beyond the normal response to heat or physical activity. This excessive sweating can be localized to specific areas or generalized throughout the body. In cases where hyperhidrosis affects a small region, such as the underarms or palms, and significantly disrupts daily life, individuals may consider surgery.

Key Symptoms Leading to Resection Consideration

1. Excessive Sweat Production: Sweating that is disproportionate to the environment (sweating during cold weather or with minimal physical activity) is a hallmark of hyperhidrosis.

2. Visible Sweat Stains: Individuals may experience large, visible sweat stains on their clothing, often making it difficult to wear certain fabrics or colors.

3. Wet Hands and Feet: Palmar and plantar hyperhidrosis (sweaty hands and feet) are particularly challenging, as they can interfere with tasks such as writing, shaking hands, and even walking, due to slippery feet.

4. Frequent Skin Irritation: Constant sweating can lead to skin rashes, fungal infections, or odorous perspiration in the affected areas, especially in areas where sweat remains trapped, such as the underarms and groin.

5. Psychological Effects: The constant concern about sweat marks or smell can cause anxiety, embarrassment, and social withdrawal. These psychological factors can heavily influence a person's decision to pursue surgery.

6. Reduced Productivity: In severe cases, hyperhidrosis may reduce work efficiency, particularly for those who rely on their hands (e.g., in jobs that require manual dexterity or handling equipment).

When these symptoms begin to affect one's lifestyle significantly, and all other treatments fail, surgical resection of sweat glands becomes a consideration. It is important to note that resection surgery is typically recommended when the sweat production is localized (e.g., armpits, palms) and other treatments have been unsuccessful.

The process of diagnosing hyperhidrosis and evaluating whether sweat gland resection is necessary involves several steps. The diagnosis of hyperhidrosis is primarily clinical, relying on the patient's history, physical examination, and specialized tests to assess the severity and impact of the condition.

Clinical History and Physical Examination

1. Patient History: The physician will first take a comprehensive medical history to understand the onset of sweating, its frequency, and the areas affected. They will also inquire about any triggering factors (e.g., stress, heat, exercise) and previous treatment attempts, such as antiperspirants, Botox injections, or medications.

2. Physical Examination: The physician will inspect the affected areas for signs of sweat production, irritation, or skin damage. Areas such as the axillae, palms, and soles will be closely examined to confirm the diagnosis.

Quantification of Sweat Production

In some cases, specialized tests are used to assess the severity of hyperhidrosis:

1. Gravimetric Test: This test measures the amount of sweat produced by weighing the absorbent pads placed on the affected areas.

2. Minor's Iodine-Starch Test: A solution of iodine is applied to the skin, and starch is sprinkled over it. The iodine reacts with sweat, causing areas with excessive sweating to turn dark blue.

Consideration for Surgery

After evaluating the severity of the condition and determining that non-surgical options have failed, the surgeon will discuss whether resection is appropriate. The decision will depend on:

1. The specific area affected and whether gland resection is technically feasible.

2. Patient expectations regarding cosmetic outcomes and recovery time.

3. Potential side effects, including compensatory sweating or scarring.

4. The patient's overall health, including factors like diabetes, smoking habits, or any existing conditions that may affect wound healing.

Treatment options for hyperhidrosis primarily aim to manage or reduce excessive sweating. For those who fail to respond to conservative treatments, sweat gland resection may become the best option. Several surgical methods are available, depending on the area affected, the severity of sweating, and the patient's health.

Surgical Methods for Gland Resection

1. Suction-Curettage (Liposuction-Style Removal): This method involves the use of a suction device to remove the sweat-producing glands from the skin layer. It is effective for treating localized sweating, particularly in the axillary region (underarms). This technique is minimally invasive and generally results in a shorter recovery period than more invasive procedures.

2. Excisional Removal: This method involves making small incisions in the skin and excising the sweat glands along with a margin of surrounding tissue. It is typically performed when a more significant reduction of sweat production is needed, or when the sweating is severe.

3. Laser and Microwave Treatment (MiraDry): Non-invasive laser and microwave technologies target sweat glands beneath the skin's surface. These treatments offer effective, long-term results with no need for incisions or stitches. They are often used for axillary hyperhidrosis and work by delivering focused energy to destroy the sweat glands.

4. Endoscopic Thoracic Sympathectomy (ETS): This method is used when sweating involves areas such as the hands or face. It involves cutting or clamping the sympathetic nerves that signal the sweat glands to produce sweat. While it is effective, it carries the risk of compensatory sweating elsewhere in the body.

Choosing the Right Approach

The choice of surgical technique depends on factors such as:

1. Location: Axillary sweating is typically treated with excision or suction-curettage, while palms and soles may require more invasive nerve surgery.

2. Severity: The extent of sweating will determine whether gland removal or nerve intervention is necessary.

3. Patient Preferences: Some individuals may prefer less invasive methods like laser or microwave treatment for cosmetic reasons or a quicker recovery.

Pre-Operative Considerations

Before undergoing sweat gland resection, patients should undergo a comprehensive evaluation to ensure that they are suitable candidates for surgery. This includes assessing their overall health, managing any pre-existing conditions (such as diabetes or hypertension), and discontinuing any medications that may increase the risk of bleeding. Additionally, patients should be aware of the expected recovery time and potential side effects, including scarring and compensatory sweating.

Intra-Operative Considerations

During the procedure, local anesthesia is typically used to numb the area being treated. Depending on the surgical technique, either small incisions or a suction device is used to remove the sweat glands. If sympathectomy is being performed, the patient will be under general anesthesia, and the procedure involves accessing the chest cavity through small incisions to reach the sympathetic nerves.

Post-Operative Care

After the procedure, patients should follow wound care instructions carefully to reduce the risk of infection and promote healing. This typically involves:

1. Keeping the area clean and dry.

2. Avoiding excessive movement or strain in the treated area (e.g., no heavy lifting for a few weeks).

3. Using compression garments to reduce swelling and improve results (especially for underarm surgeries).

4. Pain management using over-the-counter medications or prescribed pain relievers.

5. Follow-up visits to monitor healing, check for complications, and assess the success of the procedure.

While sweat gland resection is a generally safe procedure, it carries risks, as with any surgery. Some of the potential complications include:

1. Scarring: The most common concern after sweat gland removal is scarring, especially if excision is performed. The appearance of the scar depends on the size of the incision, the skill of the surgeon, and the patient's skin type.

2. Compensatory Sweating: A known complication, especially following sympathectomy, is compensatory sweating, where other areas of the body (such as the back or abdomen) begin to sweat more to compensate for the treated area.

3. Infection: As with any surgical procedure, there is a small risk of infection at the incision site. Proper aftercare and hygiene are essential to minimizing this risk.

4. Nerve Damage: In rare cases, nerve damage may occur, leading to numbness or tingling in the treated area.

5. Skin Irregularities: Some patients may experience pigment changes in the treated area or skin irritation.

After sweat gland resection, most patients experience a significant reduction in sweating, leading to improved quality of life. However, there are still considerations to be aware of:

Recovery Time

Recovery times vary depending on the procedure performed. For minimally invasive techniques like laser or microwave treatment, patients can often return to their normal routine within a few days. For more invasive procedures like suction-curettage or sympathectomy, recovery may take a few weeks, with restrictions on physical activity during this period.

Ongoing Management

Post-operative care includes monitoring for potential compensatory sweating and ensuring the area heals properly. Patients should follow up with their surgeon to ensure that the sweating has been adequately reduced and to address any issues like scarring or infection.

Emotional and Psychological Impact

Hyperhidrosis can have a significant emotional and psychological impact, leading to anxiety, social withdrawal, and low self-esteem. After surgery, many patients report a profound improvement in confidence and quality of life, as they no longer need to worry about excessive sweating. However, managing expectations and understanding the possibility of residual or compensatory sweating is important for mental wellbeing.

1. What is "resection of perspiratory glands"?

Resection of perspiratory glands refers to a surgical procedure that removes or disables sweat glands in a specific area of the body, most commonly the underarms, to treat conditions of excessive sweating (also known as hyperhidrosis). The procedure may involve excision (cutting out tissue containing the glands), suction-curettage (suction plus scraping the glands), or other minimally invasive techniques to remove the sweat-gland bearing layer of skin or tissue. The goal is to reduce or stop abnormal sweating in that targeted region, improving patient comfort and quality of life.

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2. Why is this surgery performed - who is a candidate?

This surgery is generally reserved for people who experience excessive sweating in well-defined regions (for example underarms) that has not been controlled adequately by less invasive measures such as prescription antiperspirants, Botox injections, iontophoresis or other treatments. It is considered when sweating causes significant physical discomfort, skin problems (rashes, infections), or major psychosocial distress (e.g., embarrassment, social withdrawal). Prior to surgery, non-surgical therapies should typically have been attempted. A careful assessment of the medical history, location of sweating, and other health factors helps determine whether surgery is an appropriate option.

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3. What are the common techniques used in this gland-removal surgery?

There are several techniques:

1. Excision: a small piece of skin and underlying tissue containing sweat glands is removed.

2. Suction-curettage (or liposuction-type removal plus scraping): a small incision is made, the tissue is infiltrated with fluid (tumescent technique), then suction and scraping (curettage) remove or damage the glandular layer. Studies show this method can remove up to ~70-90% of the glands in the treated area.

3. Endoscopic or minimally invasive methods: in some specialized cases, small incisions and endoscopic tools may be used to access and remove or destroy glands. The choice of technique depends on the region (underarm vs palm vs feet), the extent of sweating, and the surgeon’s experience.

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4. How effective is sweat-gland removal surgery?

For appropriate candidates, surgical removal of sweat glands can achieve a substantial and permanent reduction in sweating in the treated area. Some studies report reductions of 60-90% in the underarms following the procedure. Because the removed glands do not regenerate, the effect in the targeted area tends to persist long-term. That said, the success also depends on how thoroughly the glands are removed or disabled, the exact method used, and patient factors. It’s important to have realistic expectations: the sweating is reduced rather than always completely eliminated, and other areas may still sweat.

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5. What are the risks and possible side-effects of this surgery?

While generally safe, this surgery carries risks and potential side-effects, including:

1. Bleeding, bruising, swelling or infection at the incision site (common to many procedures).

2. Scarring or changes in skin sensation (numbness or altered feeling) in the treated region.

3. Heat intolerance in the treated area (since fewer sweat glands remain to help cool the skin).

4. Compensatory sweating: the body may increase sweating in untreated areas (for example back, chest, legs) to compensate, although this is more common when nerve-based procedures are done rather than localized gland removal.

5. In some cases, incomplete removal may lead to residual sweating with less effect.
   It is crucial to discuss with your surgeon the risk profile, site-specific concerns, and how these apply to you.

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6. What is the recovery period and what should I expect after surgery?

Recovery depends on the technique and area treated. For underarm gland removal via suction-curettage: patients typically go home the same day or after a short stay; discomfort and mild swelling or bruising may last a week; most return to usual light activities within a few days, though heavy arm activity, lifting, or strenuous exercise may be restricted for 1-2 weeks. Incision sites should be kept clean and protected. Your surgeon will advise when dressings are removed and when to resume normal activities. Final results (in terms of cooling of the area, decreased sweating) may be noticed within weeks, while full scar maturation may take months.

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7. Will the surgery leave visible scars or affect appearance?

The aim is to minimize visible scarring, but some scar or skin change is expected. Underarm procedures usually use small incisions placed discreetly in the skin crease, and many patients report minimal visible evidence of surgery after healing. However, scars may be more noticeable depending on skin type, healing tendencies (keloid/hypertrophic scars), or if more aggressive excision was done. Some sensation changes (numbness) may occur in the treated area temporarily or permanently. Your surgeon should explain the likely scar outcome based on your anatomy and the chosen procedure.

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8. Will I "lose" my ability to sweat in that area entirely, and is that safe?

In the treated area, many of the sweat glands are removed or disabled, so sweating is significantly reduced - but usually not entirely eliminated, because leaving some intact glands helps preserve normal skin physiology (cooling, moisture). Moreover, sweat glands elsewhere in the body remain unaffected, so body-wide sweating and thermoregulation are maintained. Therefore, yes - it is safe for small, localized areas. However, removing sweat glands from large body areas or doing nerve-based operations can pose greater risks of heat intolerance or compensatory mechanisms, so they are approached carefully.

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9. Are there non-surgical alternatives and when should those be tried?

Yes. Many less invasive treatments should be tried before surgery. These include prescription-strength antiperspirants, topical treatments (aluminum chloride), Botox injections to block nerve signals to sweat glands, iontophoresis (especially for hands/feet), microwave ablation or laser treatments of glands, and lifestyle measures (avoiding triggers, clothing changes). Surgery is typically considered when these therapies have been tried and insufficiently effective, and when the sweating significantly impacts daily life. The decision should involve a dermatology or plastic-surgery specialist experienced in hyperhidrosis or excessive sweating.

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10. What questions should I ask my surgeon before having this procedure?

Before proceeding with sweat gland removal surgery, it's wise to ask your surgeon:

1. What technique do you recommend for me, and why?

2. What results (percentage of sweat reduction) can I realistically expect, and in what timeframe?

3. What are the specific risks and complications for my case (given my health, skin type, area to be treated)?

4. How many procedures have you done, and what are your outcomes?

5. What will the recovery period look like? When can I return to normal activities, exercise, work?

6. What kind of scarring or skin-sensory changes should I expect?

7. Is there a possibility of needing a second procedure?

8. How will you manage aftercare, dressings, follow-up visits?

9. What is the cost, and does insurance cover it if this is considered a medical treatment (not just cosmetic)?
   Asking informed questions helps set realistic expectations and ensures you are comfortable with the treatment plan.