Center for

Center for Excessive Sweating
5225 Sheridan Drive
Williamsville, NY 14221
(716) 839-3638

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The Center for Excessive Sweating and the Buffalo Sabres

National Center of Excellence for Hyperhidrosis Treatment


Frequently Asked Questions about Hyperhidrosis

Answers to Frequently Asked Questions about Hyperhidrosis

What is the most common type of sweating pattern in primary hyperhidrosis?

Sweating of the underarms and palms.


How long does the sympathectomy procedure take ?

The procedure takes 30-34 minutes to complete. The stay in the hospital is approximately 4 hours.


What causes sleep hyperhidrosis ?

Sleep Hyperhidrosis can be due to a variety of underlying disorders, such as:

  • febrile illness
  • diabetes insipidus (this is not diabetes mellitus)
  • Hyperthyroidism 
  • Pheochromocytoma (secretion from usually benign cells in the brain that produces excessive sweating as one of its symtoms)
  • Hypothalamic lesions in the brain
  • Epilespy
  • Cerebral and brain stem strokes
  • Cerebral palsy
  • Chronic paroxysmal hemicrania (sudden onset migrane)
  • Spinal cord infarction (sudden insufficiency in blood supply)
  • Head injury
  • Familial dysautomia (a congenital syndrome with specific disturbances of the nervous system)
  • Can occur in pregnancy and can be produced by antipyretic medications (anti-nausea)
  • Obstructive sleep apnea


What is the difference between Primary and Secondary Hyperhidrosis?

The important thing to distinguish before treatment is whether hyperhidrosis is primary or secondary.

Primary hyperhidrosis can be treated with micro ETS.

Secondary hyperhidrosis requires further medical investigation to rule out diabetes, hyperthyroidism or other disorders causing the excessive sweating.


Do we know how, why and when hyperhidrosis starts?

Most physicians think they do! As a matter of fact, until the study performed by Dr. Ramos and colleagues from the Servicio de Cirugia Toracica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain, there was no scientific data to support most assertions. Most of our observations were empiric, learned by treating patients with hyperhidrosis.

The objective of their study was to study the clinical aspects of the patients with primary hyperhidrosis. From January 1998 to October 2002, 338 patients with primary hyperhidrosis were surveyed to learn more about their presenting symptoms, signs and social indicators of their quality of life.

In 86% of patients, primary hyperhidrosis started during infancy.

The vast majority of patients (71.5%) were female with a mean age of 29 years.

In 47.9% of the patients there is family history of primary hyperhidrosis.

96% reported palmar hyperhidrosis (of the hands)

81% have plantar hyperhidrosis (of the feet)

71% reported axillary hyperhidrosis (of the underarms)

The researchers also noted that facial blushing is found in 60% of patients with primary hyperhidrosis.

Other associated conditions in primary hyperhidrosis are heart palpitations (>50%), hand tremor (32%) and headaches (31%).

The authors have come to show scientific data that reaffirms our empiric observations about patients with hyperhidrosis: that primary hyperhidrosis is especially common in the palms but is not limited to the palms, as it extends to others regions of the body with the same intensity.

Primary hyperhidrosis "can be associated with symptomatology suggestive of hyperexcitability of the sympathetic system, like facial blushing, trembling or headaches."


If you persistently have sweaty palms and feet, does this mean that you have an anxiety problem?

Probably not. Suffering from primary hyperhidrosis means that your sweat glands are being over-stimulated by the body’s nervous system for an unknown reason. You can experience sweating without feeling anxious or nervous.


Can emotions elicit sweating and facial blushing?

Absolutely, emotional sweating tends to occur on the palms, soles, and axillae (underarms). It can also cause facial blushing. For example, if you get nervous before giving a speech, you may experience sweaty palms and armpits, as well as an increased heart rate. This type of sweating is regulated by the sympathetic nervous system. Emotional facial blushing can be extreme, with an intense feeling of warmth all over the face and neck, which triggers sweating in the axillae and palms.

Emotional sweating has nothing to do with regulating body temperature. The body is not trying to cool down, but instead is reacting to nervous stimulation. In contrast, sweating produced by standing in the hot desert sun is the body’s way of trying to cool down.


Do Most Insurance Companies Pay for Endoscopic Thoracic Sympathectomy for Hyperhidrosis?

Absolutely Yes. As a matter of fact, 73/78 insurance companies we have worked with in the Northeastern United States agreed to pay for the procedure once we explained our experience with these pateints and the success rate of the operation. Among these are Blue Cross Blue Shield, Univera, Independent Health, AETNA, and United Health Care.

Hyperhidrosis is considered a medical condition. The process of obtaining approval is an art and depends on the experience of the surgeon and particular hyperhidrosis clinic. Some of these clinics in Beverly Hills, Miami and Texas are notorious for the huge amounts of money that they take from patients for elimination of hyperhidrosis. Our fees are very reasonable and we continue to serve a large number of patients with these disorders.

Needless to say, hours of work on the telephone, in some cases appealing the medical necessity of the procedure was required by my staff and/or myself.

In most cases, the insurers have come to believe that these procedures are beneficial and the sympotomatic benefit to the patient immense. These insurers include The procedure is covered by Blue Cross Blue Shield, Univera, Independent Health, AETNA, United Health Care


What can I expect from The Center for Excessive Sweating if I call for information or decide to come in for a consultation?

You will find that our office is very patient friendly. Your phone calls will be answered by Donna or Debbie or our office manager, Karen. All will try to answer any questions you might have, including recovery time, cost and financing. They will strive to give you appointments that fit your busy schedule.

Dr. Hratch Karamanoukian will provide consultation regarding hyperhidrosis on Saturdays. These consultations are given at a leisurely and unhurried pace. All consultations are complete and provided by Dr. Karamanoukian and NOT by physician assistants or nurse practitioners. Dr. Karamanoukian practices cardiothoracic surgery exclusively. He is one of the most experienced surgeons in the U.S. in the field of hyperhidrosis.

You will be examined during your consultation. Dr. Karamanoukian will explain the causes of hyperhidrosis (excessive sweating) and will answer all of your questions. When you leave the office, you will have a thorough understanding of the micro ETS procedure that you are considering and you should have all of your questions answered.

Send an email or call (716) 839-3638 to schedule a consulation with Dr. Karamanoukian at the Center for Excessive Sweating.


Can I talk to a patient who has had hyperhidrosis surgery?

If you have questions about the micro Endoscopic Thoracic Sympathectomy (ETS) procedure, we will gladly provide you the telephone numbers of patients who have consented to talk to others who are considering a cure for excessive sweating.

We will do that after we have seen you in consultation and after we get consent from our previous patients.

Read testimonials from patients of The Center for Excessive Sweating.


How long does the STITCH procedure take?

On average, it take 34 minutes with a 4 to 5 hour hospital stay.


Is ETS surgery as effective in treating plantar hyperhidrosis (of the feet) as it is for palmar hyperhydrosis (of the hand)?

Excessive sweating of the soles of the feet goes "hand in hand" with excessive sweating (hyperhidrosis) of the palms and underarms. Unlike palmar hyperhidrosis, however, plantar hyperhidrosis does not have a surgical procedure that is reliably successful.

It has been my clinical experience that plantar hyperhidrosis stays the same in one third of the patients after thoracic sympathectomy. It improves in a third of the patients and gets worse in the remaining third of patients.

Treatment options for plantar hyperhidrosis include topical agents and iontophoresis.


Is It Necessary to Deflate the Lungs During Endoscopic Thoracic Sympathectomy (ETS)?

Yes, in one way or another. Some surgeons use semantics which are confusing to lay people, claiming that they don't create a pneumothorax during ETS.

This is just a promotional tool which is medically incorrect! One way or the other, the lungs must be partly or completely deflated during ETS. I will explain below.

The Endobronchial Blocker Technique

One way the operation is done is to place an endobronchial blocker, to "block" air entry into the right lung for right sided endoscopic sympathectomy by inflating a balloon in the right bronchus of the lung, long enough to perform the procedure, such as clipping the sympathetic trunk.

This is followed by deflating the balloon on the right side once the procedure on the right side is completed to allow the right lung to expand. Once this is done, the balloon is manipulated into the left bronchus so that the left lung is deflated to enable clipping of the left thoracic sympathetic trunk (left ETS).

This could be done in reverse, that is left side first followed by the right side.

Simple Endotracheal Intubation and Carbon Dioxide Insufflation ("Iatrogenic Pneumothorax")

Alternatively, a simple endotracheal tube is used. This tube stays in the trachea and the "trick" here is to insufflate carbon dioxide into the left chest to "push" the left lung down so the back of the chest, namely the sympathetic trunk can be visualized and clipped. Once the left side is done, the carbon dioxide is suctioned out of the left chest to allow the left lung to reinflate. Next, the surgeon does the same maneuver on the right side by insufflating carbon dioxide to "push" the right lung down. Once the right trunk is clipped, the carbon dioxide is suctioned out of the right chest and the right lung inflates.

As you can see, these are semantics and in both techniques there is "pneumothorax", that is air is introduced into the chest. In one, air enters into the chest and in the other, carbon dioxide is placed into the chest to achieve the same end results. In essence, both techniques involve "collapsing" the lung and there is no difference between them.

The most experienced surgeons dealing with hyperhidrosis individualize surgical treatment to patient needs and requests. I have studied and used both techniques and use them both depending on the patient and patient wishes! In some cases, patients are very petite and the blocker is not ideal. In those cases I use carbon dioxide insufflation.


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