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Compensatory Sweating and Quality of Life After Sympathicotomy for Hyperhidrosis and Facial Blushing

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

July 30, 2008

Sympathicotomy (Sympathetic Chain Division) For Hyperhidrosis and Facial Blushing and Postoperative Quality of Life and Likelihood of Developing Compensatory Sweating

Dr. Krasna and colleagues from the Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland have published a retrospective analysis of clinical outcomes following sympathicotomy for hyperhidrosis and facial blushing. 232 patients with at least 6 month follow-up were included in this study, published in the Annals of Thoracic Surgery, volume 85 (2008). Preoperative and postoperative quality-of-life indices (range, 0 to 3) were used to measure impact of surgery, and comparisons were indexed to preoperative symptoms. Postoperative compensatory sweating was analyzed with respect to the level(s) of sympathetic chain division. In hyperhidrosis patients, mean preoperative quality-of-life index was 2.0 and postoperative quality-of-life index was 0.4 . Facial blushers had preoperative and postoperative quality-of-life index of 2.6 and 1.0, respectively – meaning improvement. Significant compensatory sweating was seen in 33% patients overall and occurred in 29% of patients with palmar symptoms, 26% of axillary hyperhidrosis patients, and 42% of patients with facial blushing.

Dr. Krasna has concluded from this important study that “significant improvement in quality of life can result from surgery for hyperhidrosis. However, the incidence of postoperative compensatory sweating may be dependent on the level of sympathicotomy performed. The choice of sympathicotomy level(s) should be directed toward reducing the incidence of significant compensatory sweating while simultaneously ensuring relief of primary preoperative symptoms”.

Dr. Karamanoukian’s note – Compensatory sweating in this study for facial blushing and hyperhidrosis occurred in 45 % of patients and as noted was more likely the higher the level of sympathicotomy and number of levels of sympathetic chain division.

For more information about hyperhidrosis and facial blushing go to to email Dr. H Karamanoukian with questions; to contact Dr. Raffy go to


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For more information about hyperhidrosis (excessive sweating) , as well as surgical and non-surgical hyperhidrosis treatment options, contact Dr. Karamanoukian at The Center for Excessive Sweating, a National Center of Excellence for Hyperhidrosis Treatment by email or by phone at (716) 839-3638.

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