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Hyperhidrosis Surgery: What to Know About Endoscopic Thoracic Sympathectomy (ETS)

November 16, 2020 4 min read

hyperhidrosis surgery

Treatments to stop excessive sweating, or hyperhidrosis, range from home remedies to surgery. They vastly vary many reasons, including where you sweat, why you sweat, and how you respond to specific remedies and treatment. If you’re lucky, you find relief from your symptoms with one or more treatments. But some people suffer from severe sweating that interferes with their lives. In these extreme cases, their doctors may suggest hyperhidrosis surgery.

In this article, we take a closer look at various treatments for hyperhidrosis, including surgery.

What is Hyperhidrosis?

Hyperhidrosis, or excessive sweating, is when your body sweats more than it should and without provocation. People with hyperhidrosis have overactive sweat glands that work faster and more than they need to. In fact, the health condition causes them to sweat as much as 4 to 5 times more than the average person.

There are two types of hyperhidrosis: 

  • Primary focal hyperhidrosis is when you sweat in isolated places, such as your hands, feet, and underarms. The cause is unknown, though it may be hereditary.
  • Secondary hyperhidrosis is when you sweat all over your body. It is often linked to an underlying medical issue.

Medical Treatments for Hyperhidrosis

Sometimes, hyperhidrosis requires medical treatment. Your doctor may recommend medical intervention if home remedies and over-the-counter treatments do not slow down or stop your sweating. Below are some of the common treatment options.


Botox injections are another form of medical treatment. Botox works by slowing down the sweat glands at the injection sites. It does this by interfering with the nerve singles that go to your sweat glands. It can be especially effective for people with localized sweating since injections are targeted to the area of concern. Since the effects of Botox injections are not permanent, you will likely need repeated treatments.


There are several medications that can be used to manage hyperhidrosis. Many are “off-label,” meaning their original intent is to treat a different medical condition. But they are also safe and effective options for hyperhidrosis. Typical medications used to treat hyperhidrosis are antidepressants, anticholinergics, beta blockers, and benzodiazepines.

ETS surgery

  • Antidepressants can reduce sweat gland activity and reduce anxiety that may be causing sweat.
  • Anticholinergics are drugs that target the whole body so they can be helpful for full-body excessive sweating.
  • Beta blockers and benzodiazepines are oral medications that work on your nervous system to lower anxiety.


Miradry is another medical option for treating axillary hyperhidrosis, or excessive underarm sweating. It uses thermal energy to stop your sweat glands from producing sweat. The procedure is performed in a doctor's office with a local anesthetic for numbing. The temporary side effects are typically localized swelling or soreness. Miradry is only available to treat underarm sweating, and it will not stop sweating in other parts of the body.

Endoscopic Thoracic Sypathectomy (ETS)

Hyperhidrosis surgery is another treatment option. It is usually the last type of treatment explored if no other treatments are successful. In general, it is more costly than most other treatments and is the most invasive.

Endoscopic thoracic sympathectomy (ETS surgery) is a permanent, yet risky procedure to stop sweating in the hands, feet, or underarms. ETS is often a last resort option, due to risk factors associated with the procedure as well as the potential side effects.

During this surgery, the surgeon will cut, burn, or clamp the overactive sympathetic (spinal) nerves that control sweating in particular areas of your body. In essence, it blocks the nerves that send messages to your sweat glands. There are also variations of this surgery that interrupts the signals without permanently damaging the sympathetic nerves. It is typically an outpatient procedure that only takes about an hour to perform.

ETS surgery blocks the nerves that send messages to your sweat glands.

Possible ETS surgery side effects include:

  • Compensatory sweating, or over sweating, on your legs, thighs, back, and abdomen. Sometimes, this can be worse than the original hyperhidrosis.
  • A drop in heart rate post-surgery.
  • Horner Syndrome, which causes your pupil(s) to constrict, eyelid(s) to droop, and facial sweating to decrease.

ETS Surgery Cost

Before considering this procedure, it is important to know the hyperhidrosis surgery cost. In general, the ETS surgery cost is between $10,000-$20,000. This does not always include general anesthesia and other related costs.

Hyperhidrosis surgery insurance coverage is often available when other treatments are unsuccessful. To be sure, talk with your health insurance provider about specific coverage for ETS surgery.

Opinions about hyperhidrosis surgery vary. As such, it is recommended that you thoroughly research the procedure and its potential risks and side effects. The International Hyperhidrosis Society is a great resource when starting your research.

While you work with your doctor to find ways to treat your hyperhidrosis, protect your dress shirts with an Ejis sweat proof undershirt (available in our shop or on Amazon). Our undershirts have a silent waterproof layer to prevent sweat from reaching your clothes. They also have antimicrobial technology to control odor-causing bacteria.

This article is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.

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