Does laser for hyperhidrosis really work?

Question

Last week on the TV show The Doctors, a doctor from California appeared treating excessive under arm sweating with laser. Does this procedure really work? Does anyone know a doctor in South Florida who does this hyperhidrosis treatment?

Sheila S. Nazarian, MD · Answer

Miradry is a non-invasive way to eliminate underarm sweat and odor glands.  It is not a laser.  It is microwave technology.

Mark Berkowitz, MD · Answer

Using the newest generation of the Smart Lipo machine a laser treatment, called precision TX, can be used to markedly improve excessive sweating. I perform it in less than 30 minutes and my patients drive themselves home.

Raffy Karamanoukian, MD, FACS · Answer

The Miradry system is now FDA approved as a non-invasive therapy for underarm hyperhidrosis. I offer this procedure in my office and consider it ideal.  Raffy Karamanoukian, Los Angeles

Robert M. Lowen, MD · Answer

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.

Young R. Cho, MD, PhD · Answer

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.

Benjamin Barankin, MD, FRCPC · Answer

There are a number of treatment options for hyperhidrosis which should be reviewed with you by a dermatologist, and possible testing (e.g. blood work, chest x-ray) to make sure there is no underlying cause for your excess sweating. That said, Botox has been the gold standard treatment as far as safety and efficacy for underarm hyperhidrosis and elsewhere on the body. There is more recently the use of laser for underarm sweating which is showing some promise, but is still quite new and has no long term data on efficacy and safety, so I'd hold off on this until we have more information.

Ken Landow, MD · Answer

the miraDry machine is a microwave device that cooks the sweat glands...it received FDA approval recently for treatment of the underarm area...may prove to be valuable but it's likely to be a relatively bumpy course after the painful procedure...bruising lasts up to a month or so and sometimes issues with abnormal sensations...suggest letting some time go by as more people have the procedure and revisiting the issue in a year or so...till there's a track record I'd prefer botox...

Keith Denkler, MD · Answer

Hypersecreting sweat glands of the armpits have been treated with topical medications such as aluminum chloride.

	Other cases have been treated with BOTOX inections.  Thoracoscopic Sympathectomy involves cutting nerves in the chest that cause the excessive sweating.

	For decades surgical removal with curretage has helped those with excessive axillary sweating.

	Liposuction of the sweat glands also is effective.  The liposuction is delivered upward to the glands and not into the fat.  More recently Vaser Ultrasonic energy has also been used to diminish axillary hyperhidrosis.

	Smartlipo TriPlex&reg; Technology is a great new procedure that delivers laser energy to help vaporize the glands in the armpits.  The procedure may be performed under local with sedation and can help as more long term solution than BOTOX  or DYSPORT injections which wear off.

Hratch Karamanoukian, MD, FACS · Answer

This procedure was described recently and I consider it experimental. It has been done by doctors in the Whitely Clinic in London, and is in my opinion, not considered standard of care in the U.S. Consider it like laser liposution 5 years ago in the U.S. It was being used as a marketing tool as it is chic to use lasers for everything, sometimes even if efficacy has not been proven. There is only case reports about this treatment strategy in the scientific hyperhidrosis literature. A case report means that less than a handful of procedures have been done in a single center by a surgeon/doctor and we consider such reports to be of anecdotal experience that requires rigorous investigation before it is considered standard of care. This means that they have to be compared to traditional treatments that have been vigorously studied.
Better options at the present time are suction curettage in the office which is very effective and sympathectomy.
DO NOT rush and have these procedures done without seeing someone who is able and is capable AND trained appropriately in providing every option of care for the specific type of hyperhidrosis you have. This includes topical therapy if appropriate, medication if appropriate, Botox if appropriate, suction curettage if appropriate, surgery if appropriate. 
I believe that I have one of the best, if not the best Hperhidrosis centers in the US and as such, I follow an algorithm for proper care. This treatment algorithm has been developed over 10 years with a huge # of patients treated and is highly successful. I don't rush patients through it. You didn't develop this problem yesterday and you shouldn't have it treated tomorrow.
The prices, if you are the right candidate for them, is 6500 dollars (if you chose not to go through your insurance) for sympathectomy and $ 2400 for axillary suction curettage.
In summary, traditional suction curettage is very successful and laser curettage is associated with burn injury, is still experimental and considered a gimmick by those of us who specialize in the field. Things may change in the next several years.

David E. Berman, MD (retired) · Answer

i have been very pleased with my experience using the Cellulaze by Cynosure, as an off label procedure. it takes about 30 minutes in my office, under local. patients can return to work the next day. A single treatment can last for many years (or more. too early to tell if it will be permanent). i think in time as it becomes better known, it will become the standard of care. Select a surgeon with experience using Cellulaze or the Sidelaze.david berman mdboard certified plastic surgeon

Does laser for hyperhidrosis really work?

Answers (10)

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