Operative Treatment for Facial Blushing

Facial blushing can be an emotionally distressing condition, especially when it occurs without warning or is triggered by common social interactions. For some, it affects professional confidence, self-esteem, and personal relationships. In cases where conventional treatments fail, Endoscopic Thoracic Sympathectomy (ETS) may offer a long-term solution.

ETS involves targeting the sympathetic nerves responsible for the blushing response. Evidence reveals that ETS, in a fully informed individual, significantly improves the quality of life in most patients. However, about 2–4% may regret the operation due to unwanted side effects.

The decision to operate for facial blushing must be weighed carefully against potential complications and side effects. This can only be determined on an individual basis during a thorough consultation.

Advanced ETS surgery

ETS is a form of “keyhole” surgery performed under general anaesthetic. Two small cuts, each about 0.5 cm in diameter, are made in the armpit. The sympathetic nerve is divided, and the wounds are closed using dissolvable sutures. Scarring is minimal. The procedure lasts approximately 40 minutes, and a post-operative chest X-ray confirms full lung expansion.

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Contraindications to Surgery

ETS is not recommended for:

  • Elderly patients

  • Individuals with significant cardio-respiratory disease

  • Those who are obese

  • Patients who have had previous chest surgery or significant chest disease

ETS is generally irreversible. The treated nerve does not re-grow. While there are techniques involving cutting, clipping, or burning the nerve, the procedure is only potentially reversible in around 20–30% of cases.

Post-Operative Course

Some patients may experience sharp pain around the wounds or upper back, which usually wears off quickly. Many return to work within 2 days, although this varies. Return to sporting activities may take up to two weeks.

Complications and Side Effects

In our centre, no life-threatening complications have occurred. However, as with any chest surgery, there is a small risk that the chest may need to be opened in the event of bleeding. Very rarely, an air leak from the lungs may require a suction drain.

Some patients report:

  • Prolonged pain or numbness in the arm (rare)

  • Temporary or, in rare cases, persistent Horner’s syndrome (less than 1%)

  • Wound or chest infection (less than 5%)

  • Excessive dryness of the hands

  • Compensatory sweating on areas such as the abdomen, legs, and feet (around 1 in 50 patients regret the operation for this reason)

Compensatory sweating is the body’s mechanism for maintaining internal temperature at 37°C. Gustatory sweating (sweating induced by smells or tastes) can occur in up to 30% of patients, though it is seldom considered a major problem.

Although some individuals report general fatigue, physical performance is not reduced. Stress testing has shown no decrease in capability, although heart rate may be reduced by 10%.

How Can Treatment Help?

These conditions can be significantly improved through highly selective nerve treatments, such as endoscopic thoracic sympathectomy (ETS). This minimally invasive procedure interrupts nerve signals responsible for blushing and sweating, reducing or stopping symptoms and improving quality of life.

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