Facial Hyperhidrosis


Excessive facial sweating can result from an overactive sympathetic nervous system. Mild social stimuli with stress can cause excessive facial sweat, which can also involve the scalp, upper lip or mustache area, and the neck. This can lead to self-consciousness and low self-esteem. Because a person’s face is the first thing most people notice, someone with excessive facial sweating may withdraw from social activities.

Symptoms of facial sweating

  • Excessive forehead sweating while conducting normal activities
  • Beads of sweat pouring down at the temple area
  • Wet upper lip
  • Constant need to wipe face, even when at rest

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Treatment options for Facial hyperhidrosis

When treating any type of hyperhidrosis, it is always best to begin with the least invasive form of treatment first. Treatment options for facial hyperhidrosis can be as simple as lifestyle choices or as involved as surgery.

  1. Avoid trigger foods and beverages
  2. Some foods trigger facial sweating. Some foods/beverages to avoid are caffeine, alcohol, spicy foods, fatty foods, and foods containing MSG

  3. Topical agents (Drysol, Odaban)
  4. Treatment with topical agents should be tried as a first line defense against facial hyperhidrosis. The product should be applied only at bedtime after bathing, when relaxed, to DRY skin. The following morning the treated areas should be washed to remove any excess possibly left on the skin. Topical agents are usually ineffective against most forms of excessive facial sweating, but should be attempted.

  5. Endoscopic Thoracic Sympathectomy (ETS) 

Sympathectomy is a surgical procedure that divides nerves in the sympathetic system. It is designed to decrease excessive sweating. Although sympathectomies were considered major surgery in the past, significant advancements have been made over the past 10 years.Now sympathectomies are performed endoscopically using VATS. One or two small incisions (5 mm) are made on each side of the chest cavity through which a fiber optic camera and other instruments are inserted. These outpatient procedures result in speedy recovery and minimal scarring with immediate results.Endoscopic Thoracic Sympathectomies are best performed by a well-trained thoracic surgeon. The procedure takes place under general anesthesia,  and typically lasts 30 minutes. Once the instruments are removed, the tiny incisions are closed with glue. Sweat relief is immediately noticed by the patient upon waking up from anesthesia. Most patients can resume physical activity, and return to normal activities within 48 hours of surgery.

While endoscopic thoracic sympathectomies are extremely effective for most forms of hyperhidrosis, it was specifically designed to treat palmar hyperhidrosis or sweaty palms. Endoscopic Thoracic Sympathectomy (ETS) treatment has been proven to cure hyperhidrosis or excessive sweating in 95-99% of all cases of hand sweating.

Side Effects
Although ETS is a viable alternative for many patients, it is important to understand the potential side-effects of the surgery. In addition to the normal risks associated with most surgeries, ETS side-effects are very specific to the surgery and should be discussed in detail with your physicians. Any surgery under anesthesia carries risks from anesthetics in addition to possible local wound infections. Both are extremely rare with this minimally invasive technique for ETS.

  • Compensatory sweating
    In approximately 50% of patients who undergo ETS, a condition called compensatory sweating may occur. It is the most common side effect and is characterized by increased sweating on the back, abdomen and/or thighs. In a small number of patients, (<5%) compensatory sweating is problematic and may require oral and/or topical medication. The newer surgical technologies that we offer may reduce the incidence of compensatory sweating.
  • Horner’s Syndrome
    In rare instances (.03%), patients may experience droopy eyelids, constricted pupils, and absence of sweating in the face following ETS, and is usually temporary.
  • Gustatory Sweating
    Eating or smelling certain types of foods can cause facial sweating after ETS. This happens in a small number of patients following the operation, but usually does not appear to be a major problem.
  • Neuritis and Neuralgia
    Following surgery, a very small number of patients experience a nonspecific pain in the back between shoulder blades. It is caused by an irritation of the nerve endings and usually resolves spontaneously. It can be treated with non-steroidal anti-inflammatory drugs.
    Back to TopSide Effects
    Although ETS is a viable alternative for many patients, it is important to understand the potential side-effects of the surgery. In addition to the normal risks associated with most surgeries, ETS side-effects are very specific to the surgery and should be discussed in detail with your physicians. ETS should only be used after less invasive therapy modes have been explored. Any surgery under anesthesia carries risks from anesthetics in addition to possible local wound infections. Both are extremely rare with this minimally invasive technique for ETS.

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