Treatment for Face Sweating

Facial hyperhidrosis, or excessive sweating of the face and scalp, can be a particularly frustrating and noticeable condition. It often disrupts daily life, creating discomfort in public settings, professional environments, and during physical activity. If non-surgical treatments haven’t helped, Endoscopic Thoracic Sympathectomy (ETS) may offer a permanent solution.

ETS targets the sympathetic nerves that trigger facial sweating. Studies show the procedure significantly improves quality of life in well-informed patients. Still, 2–4% may regret the decision due to side effects.

The decision to proceed with ETS should always be made on a case-by-case basis, following a detailed medical consultation.

Conventional ETS Surgery

ETS is carried out under general anaesthetic using minimally invasive techniques. Two small incisions (0.5 cm) are made under the armpits, and the sympathetic nerve is divided. The wounds are closed with dissolvable sutures. The procedure takes around 40 minutes, followed by a chest X-ray to ensure full lung expansion.

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Contraindications to Surgery

ETS is not suitable for:

  • Elderly individuals

  • Those with cardio-respiratory disease

  • People with a history of chest disease or previous thoracic surgery

  • Patients who are obese

ETS is largely irreversible, as the sympathetic nerve does not regrow. Some techniques involve clipping or burning the nerve, but only 20–30% of cases are potentially reversible.

Post-Operative Course

Patients may experience some sharp pain around the incisions or upper back initially. Most return to work within 48 hours, although this depends on the individual. Return to sports can take up to two weeks.

Complications and Side Effects

While no life-threatening complications have occurred in our experience, ETS is performed inside the chest and may require conversion to open surgery if bleeding occurs. Occasionally, an air leak from the lungs may necessitate a suction drain.

Other risks include:

  • Arm pain or numbness (rare)

  • Horner’s syndrome (drooping eyelid and small pupil), seen in less than 1% of cases

  • Wound or chest infection (<5%)

  • Dryness of the hands

  • Compensatory sweating (most commonly on the lower body) — around 1 in 50 patients report significant impact

Some patients experience gustatory sweating (induced by taste or smell), which affects up to 30%, though few find it bothersome. A feeling of general fatigue is sometimes noted, but exercise tolerance remains unchanged, despite a small (10%) decrease in heart rate.

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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