What criteria are used to determine the level that the miradry is set on?

Question

Hi, I'm a physician using miradry, and I was wondering the above. Do you think that the sweatglands in the skin are located at different depths? Do you think that setting the miradry on e.g. level 5, only destroys the deepest located glands and level 1 the most superficial glands? With other words, what would you advise if a normal sized person is treated with level 4-5 and has had no effect at all? And a patient with a first treatment at 3, second at 5, and is still sweating for 50%?

Stewart Wang, MD, FACS · Answer

There are several factors in deciding the Miradry treatment setting such as skin thickness, and density of sweat glands. The amount of numbing fluid used also affects the treatment setting. This is a discussion with your treating physician prior to your treatment. As a general rule we try to provide maximal energy that’s safe for your skin in order to achieve best result. Our average improvement after single treatment is about 70% reduction in sweat and/or odor.

Sincerely,
Stewart Wang, MD FACSBoard Certified Plastic SurgeonMedical Director, Wang Plastic Surgery & Med Spa

Sincerely,
Stewart Wang, MD FACSBoard Certified Plastic SurgeonMedical Director, Wang Plastic Surgery & Med Spa

Sheila S. Nazarian, MD · Answer

With the new tumescent protocol, I use Level 5 the whole time.  Have had great results and no problems.

Raffy Karamanoukian, MD, FACS · Answer

The severity of your hyperhidrosis and the amount of soft tissue in your armpit both influence the power on the Miradry treatment. Best, Dr. Karamanoukian LosAngeles

Allison Readinger, MD · Answer

We have had MiraDry almost a year.  We used to do everyone at a 3 and then based on their feedback, go up to 4 or 5 for the 2nd treatment.  Having seen that with the second treatment, most people (so far everyone) did well, we are feeling more confident with a 4 or 5 to start.  When the patient is using it for bromhidrosis/odor, we consistently do a 4 or 5 to start.  I have heard reports about more trouble with weakness or nerve issues in very slender males with a larger treatment area, so someone with very low body fat and sweating that does require the larger treatment area.  I would do a 2/3 in that patient instead of a 4 or 5 to start.

Karen Stolman, MD · Answer

We have had MiraDry for a couple years now, and now treat all patients exclusively at level 5 for both treatments.  The majority of patients have 80% improvement at this setting, and we have not had any complications.  We also use tumescent anesthesia, on which we are publishing a study for MiraMar Labs.  If your patient is having recurrence, I recommend an iodine-starch sweat test to see where the problem is exactly and then spot treating as needed.  In our first year with the device, we were more conservative and did level 3, and saw more complaints on follow up regarding efficacy.

Chase Lay, MD · Answer

that is an excellent and important question.  It really is the physician's choice.  From what I hear from our colleagues most people use treatment levels 3-5.  It is my understanding that some providers are very conservative using levels 1 and 2 making it clear to the patient's that a third treatment may be needed but there are potential for complications or prolonged healing is theoretically decreased.Best of luckChase Lay, MDDouble board-certified facial plastic surgeon

Hratch Karamanoukian, MD, FACS · Answer

I do all of my treatments with level 5 - it is physician choice. as long as they understand the local anatomy of the brachial plexus and vascular structures, level 5 is uniformly safe in experienced hands. Read the miraDry book provided on the link below.