Does laser for hyperhidrosis really work?

Because hyperhidrosis is such a problem for many people, all sorts of surgical treatments have been tried. These early surgical efforts used the only methods available. They included removal of the axillary skin and skin grafting!, and attempts to destroy the sweat glands by scraping under the skin (curettage), use of vaser ultrasound, 1064 YAG laser, and most recently Smartlipo Triplex/SideLaze 1440 laser.

While there is novelty to the idea of using a laser to remove sweat glands, there is certainly no widely accepted surgical standard of care. Hence most people are using chemical methods, such as Botox.

In our clinic, we use the SmartLipo Triplex/SideLaze to effectively reduce or eliminate under arm sweating. This is done under local anesthesia in the office setting, after mapping out the distribution of sweat glands with starch/iodine. 

There will undoubtedly be more literature on this method published in the next few years.  As yet it appears that only a handful of doctors are offering laser sweat gland ablation.

To address the safety question, readers should know that the SmartLipo Triplex device has computer controlled thermal sensing, with a thermistor at the tip of the laser cannula that senses the exact subcutaneous temperature. It is set at a level that will not burn the skin and the laser computer will turn off the laser energy if a safe temperature is exceeded.

There have been reports that ultrasound or laser can help hyperhidrosis.  The challenge i see for both techniques is that you have be able to provide selective injury to the undersurface of the skin without causing a full-thickness injury.  Axillary shaving where you physically excise and remove the sweat glands without injuring the skin has been shown to be highly effective in providing a permanent reduction to armpit sweating.