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Internal ultrasound technique treats hyperhidrosis

Article-Internal ultrasound technique treats hyperhidrosis

Key iconKey Points

  • By using ultrasound, it has prevented many patients from not needing to use deodorant any longer; nor are there side effects of additional body sweating related to the procedure.
  • The procedure is performed under local anesthesia.

NEW YORK – For some folks, removing their jackets can be an anxiety-provoking experience. Or raising their arms. Or being in close quarters with other people. The culprit? Underarm perspiration and odor, or tell-tale stains on clothing.

Dr. Giese
Everyone can relate to the embarrassment that underarm sweating and odor can cause — and it's an issue not just for those who suffer from hyperhidrosis. Sharon Giese, M.D., F.A.C.S., P.C., board-certified plastic surgeon in private practice in New York, is very familiar the problem — and she has not been completely satisfied with the treatments available.

Whether the sweating is bona fide hyperhidrosis or more garden-variety underarm perspiration, it can cause odor, staining that ruins clothing and be a source of embarrassment for the patient. So, drawing on current technology, Dr. Giese has started putting the kibosh on underarm sweat via ultrasound treatment.

Intra-operative photo shows application of internal ultrasound therapy to damage the sweat glands. (Photo credit: Sharon Giese, M.D., F.A.C.S.)
STRESS THAT SHOWS Certainly, excessive perspiration is a medical condition, and Botox (Allergan) has been successfully treating the condition for some time now. But if a person doesn't have clinical hyperhidrosis, does that leave him or her out in the cold? Not as far as Dr. Giese is concerned. "Hyperhidrosis affects three to six percent of the population," she tells Cosmetic Surgery Times , "But there is a much larger group of people who are bothered by sweating and/or its odor in smaller amounts or as a result of stressful situations."

Dr. Giese is intimately familiar with the problems that this can cause, and she's very aware of how it can affect her entire patient base. "Personally, I have ruined many tops with stains and/or odor that cleaners cannot remove. Men cannot remove jackets for fear of large underarm rings and showing they are stressed."

Obviously, Botox is an option, and may be covered by insurance for those with clinical hyperhidrosis. But for those who don't actually have a medical condition, the expense comes right out of pocket. And while Botox provides an effective solution, it's not permanent. In eight or nine months, sweating starts again, and it's back to square one.

So, the serach has been on in the medical community for other alternatives, with some success — and some side effects. Dr. Giese explains, "Surgical treatments include endoscopic thoracic sympathectomy (chest surgery) with a 20 to 80 percent side effect of compensatory sweating. Others have done surgical curettage or regular liposuction to the axilla."

A SOUND APPROACH Dr. Giese says that the use of internal ultrasound was first published less than ten years ago by a clinical team in Korea. She thought it was a good study, with about 300 subjects, and it piqued her curiosity.

"I have been using internal ultrasound for liposuction for about 12 years," she notes, and making the move to the underarm area seemed logical. "This is just what I consider a new application." Dr. Giese rolls the probe under the skin in the armpit. "The ultrasonic energy presumably kills the sebaceous glands. Permanently."

Dr. Giese explains to her patients that the procedure uses technology common with "internal liposuction — it's really powerful and melts the fat. We can use it under the arm and it kills some of the sweat glands. So you don't have to wear deodorant. And you don't sweat, and you don't have any odor."

She notes that none of the women upon whom she's performed the procedure need to use deodorant any longer; nor do they have the side effects of any additional body sweating as sequela to the procedure. "One male I have done has about a 65 percent reduction of sweat, which he can now control with deodorant." When offered retreatment, the patient "declined because he is happy," although Dr. Giese says she thinks retreatment would kill more glands.

Dr. Giese performs the treatment — which has permanent effects — under local anesthesia; she says it takes about 15 minutes per armpit, so approximately half an hour total. "There is no downtime, and only minimal bruising and soreness," she says. So, how does it compare to Botox? Botox works with about 20 injections under each arm, Dr. Giese says, and the effects last about nine months. The cost is about $1,500 each treatment.

Dr. Giese's charges for the ultrasound treatments are $3,995 — more than double than that for Botox. However, because it's permanent, the long-term cost savings can be significant. And for a lot of folks, that's reason enough not to sweat the small stuff.


Dr. Giese reports no relevant financial disclosures.


Park S. Very superficial ultrasound-assisted lipoplasty for the treatment of axillary osmidrosis. Aesthetic Plast Surg. 2000 Jul-Aug;24:275-279.

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