Hyperhidrosis Surgery: Why I Regret It

Living with hyperhidrosis, or excessive sweating, can be incredibly challenging. It’s uncomfortable, embarrassing, and can impact your social life.

I’m Randy Choi, co-founder of Thompson Tee—the first patented sweat proof undershirt. My personal struggles with hyperhidrosis, along with my friend Billy Thompson, led us to create a solution for others facing the same issues.

If you suffer from hyperhidrosis, you may have considered different treatments, including endoscopic thoracic sympathectomy (ETS) surgery, also known as hyperhidrosis surgery.

In this post, I’ll share my experience with ETS surgery, explore alternative options, and reveal what I wish I’d known before making this life-altering decision.

Living With Hyperhidrosis

I first noticed my excessive sweating when I was around 12 years old. Before that, I was just a regular kid. But one experience changed everything.

I was on a bus heading to church camp, sitting next to a girl I had a crush on. We made a quick stop at a gas station, and as I stepped out of the van, I felt it—sweat covering my chest, pouring from my head. The air was cold, yet I was drenched.

I’ll never forget the looks. A few kids stared and asked, “Are you okay? What’s wrong?” I hated those questions. That was the moment I realized something wasn’t right. My body wasn’t just sweating—it was reacting to stress in a way that felt completely out of my control.

As I grew older, these episodes became more frequent. I remember another time on the school bus when a couple of cute girls sat beside me. Within minutes, a band of sweat formed around my head, dripping down to my shirt. I looked like I had just finished a marathon, but I had only been sitting there, doing nothing. The embarrassment was overwhelming.

Through high school and college, my sweating only got worse. It dictated how I dressed, where I sat in class, and how I navigated social situations. At one point, a campus physician diagnosed me with an anxiety disorder, assuming my sweating was due to panic attacks. But how could I have 5–10 panic attacks a day?

I cycled through prescriptions—Xanax, Prozac, Ativan—none of which worked. The truth was, I didn’t have an anxiety disorder. My anxiety was a response to living with cranial hyperhidrosis, not the other way around.

What I didn’t know at the time was that I wasn’t alone. Nearly 60% of people with hyperhidrosis don’t realize it’s a medical condition, and almost half don’t believe there’s a treatment that can help. For years, I was one of them—trapped in a cycle of confusion, embarrassment, and frustration, searching for answers I didn’t yet know existed.

My Journey to Getting ETS Surgery

For years, I had struggled to hide my excessive sweating, navigating social situations with constant anxiety. I had figured out ways to avoid stressful situations that triggered my sweating, but there was no real escape. Doctors had prescribed me countless anxiety medications, none of which worked. At one point, a doctor even gave me a prescription antiperspirant for my face. Nothing helped.

I didn’t even know hyperhidrosis was a medical condition.

By the time I saw a billboard advertising hyperhidrosis surgery in 2000, I was desperate for a solution. I called the number, explained my situation, and was told that there was a permanent solution: ETS surgery.

At the time, the procedure was still relatively new, and I had never heard of it before. The doctor briefly mentioned potential side effects, but I assumed they were just the standard risks that came with any surgery. More than anything, I wanted to stop feeling like I had to hide. So, without knowing what I was truly signing up for, I made the decision to go through with it—convinced I had finally found my way out.

It’s a decision I regret to this day.

What Is Endoscopic Thoracic Sympathectomy (ETS)?

Endoscopic Thoracic Sympathectomy (ETS), also known as hyperhidrosis surgery, is a procedure designed to treat severe hyperhidrosis by disrupting the nerves responsible for excessive sweating. During the procedure, a surgeon either severs or clamps the sympathetic nerves that signal the sweat glands to activate.

Unlike topical treatments or medications that aim to manage symptoms, ETS surgery directly targets the body's sweating mechanism. The goal is to stop spontaneous sweating in the affected areas, most commonly the hands, face, or underarms. However, the procedure doesn’t remove sweat glands—it interrupts the nerve pathways that trigger them.

While ETS can significantly reduce sweating in targeted areas, it’s not without risks. Many patients experience compensatory sweating—where the body redirects sweat production to other areas—along with other potential side effects. Understanding how ETS works and weighing its long-term impact is crucial before considering it as a treatment option.

The Initial Consultation Process

Walking into my first consultation, I had no idea what to expect.

Within minutes, the doctor diagnosed me with hyperhidrosis. I had never heard that word before, but hearing it felt like validation. For the first time, I understood that what I was experiencing wasn’t just in my head—it was a medical condition. It was liberating.

At the next appointment, we discussed the procedure. The doctor described it as simple: he would make small incisions in my chest cavity, cut the overactive nerve, and the surgery would take about an hour with only light anesthesia. He mentioned Horner syndrome—one of the potential risks that could cause permanent pupil dilation and droopy eyelids—but framed it as rare. And when a doctor tells you, “I can fix you,” side effects don’t seem like a big deal.

I was sold. We scheduled the surgery, and I walked away believing I was finally on my way to a sweat-free life.

What Happens During ETS Surgery?

Hyperhidrosis surgery takes approximately 40 minutes. Here’s how the procedure works:

The procedure requires general anesthesia. The surgical team inserts a tube into your trachea to help you breathe during the operation.
Two small incisions are made below one of your underarms.
One of your lungs is then deflated to give the surgeon access to your sympathetic nerve chain.
A small camera is inserted into your chest through one of the two incisions under your armpit. Tiny surgical instruments are inserted through the other incision.
The surgeon uses the camera to locate the sympathetic nerve chain responsible for sweating and guides the surgical instruments to it.
The surgeon removes the three portions of your sympathetic nerve chain that trigger sweat production.
The tools and camera are removed, and your lung is then re-inflated.
Once the surgery is complete on one side, these same steps are repeated on the other side of your body. Your incisions are then covered with small bandages, and the breathing tube is removed from your trachea.

Surgery Day: My Experience and Immediate Aftermath

Just 30 minutes after surgery, the doctor sent me home with painkillers and told me to rest. I felt groggy from the anesthesia, but what caught me off guard was the phantom sweating. I kept wiping my face, convinced it was drenched—but my skin was bone dry. It was the strangest sensation.

For the first time in my life, I wasn’t visibly sweating. I was ecstatic. After years of embarrassment and frustration, it finally seemed like I had beaten hyperhidrosis.

The first week passed in a medicated blur. The painkillers dulled any discomfort, and I didn’t question much. I focused on the fact that my sweating had stopped, ignoring the nagging feeling that something still felt off. At that moment, I believed the surgery had worked.

I had no idea what was coming next.

The Recovery Process and Early Side Effects

Eight days after the surgery, I began noticing something unsettling: sweat on my chest. I was confused—didn’t the surgery fix that? I called the doctor, and he reassured me it was just the summer heat causing the sweating. I took his word for it and tried not to worry too much.

But as the weeks went by, things only got worse. My chest sweating became more pronounced, leading to visible sweat patches across my torso. By the end of the summer, I returned to the surgeon, hoping for some answers. That’s when he mentioned compensatory sweating for the first time.

He told me that this was a rare side effect of hyperhidrosis surgery and that it shouldn’t be happening. At that point, I felt like I was living in a nightmare. After researching compensatory sweating, I realized he wasn’t being entirely truthful. It wasn’t rare—it was actually quite common among people who had undergone ETS surgery.

As the sweat continued to worsen, I found myself wearing two to three undershirts just to contain it. Even in 100-degree heat, I was layering up, desperate to hide the sweat patches that seemed to appear everywhere—across my chest, down my back, and, soon enough, even on my left shoulder blade. My doctor kept blaming it on the weather, but I knew this was more than just heat.

By the time I returned for another follow-up, I was sweating through five shirts a day. That’s when I realized that the surgery had given me an entirely new set of challenges—ones I hadn’t been prepared for.

Post-Surgery Complications

After returning to the surgeon for a third follow-up, he prescribed me Ditropan XL, a medication usually used for overactive bladder. The idea was that Ditropan XL would dry up my body entirely, including my sweat glands.

At first, it seemed promising. But the side effects quickly became unbearable. I felt dry all over—my mouth was permanently cottony, and I was constantly drowsy. Even light workouts would make me feel like I was overheating and on the verge of passing out. I developed blurry vision and headaches and had a hard time focusing on work or reading.

The side effects were so disruptive that after 2-3 months of adjusting the dosage, I decided to stop using it. It was clear that this wasn’t the solution I had hoped for.

During my next visit to the surgeon, he prescribed Drysol, a topical antiperspirant with a heavy dose of aluminum chloride. His instructions were even more outlandish: apply it to the affected areas before bed, wrap myself in Saran wrap, and let it sit overnight.

Desperation made me willing to try anything, so I followed the routine. I would shower, apply the metallic-smelling solution, and wrap my torso up like a mummy. Then, I’d try to sleep for 6-8 hours while the solution worked its “magic.”

In the morning, I had to neutralize the solution with baking soda (yes, you read that right), a process that felt more like a science experiment than a treatment. Then, I’d wash everything off and repeat the process every night.

By the third night, I started breaking out in rashes, and I realized I couldn’t keep going. The harsh chemicals were just too much for my skin. Once again, I was left searching for another solution, only to feel like I was back at square one.

Hyperhidrosis Surgery Side Effects

Along with compensatory sweating, I experienced several other side effects after my ETS surgery that I hadn’t been prepared for.

Skin Problems

The surgery had an unexpected impact on my skin. My face fluctuated between being dry and oily, which led to acne for the first time in my life. The dryness eventually spread to my hands and scalp, leaving them rough and flaky. This was a harsh reminder that the procedure had altered more than just my sweat levels.

Psychological Fatigue

The mental toll was just as jarring. I found myself drained of energy, struggling to make even the simplest decisions, like choosing a brand of shampoo. My usual assertiveness seemed to vanish, and I felt sluggish, disconnected from my own body. The surgery had affected my autonomic nervous system, which controls vital functions like the fight-or-flight response, leaving me feeling numb and lifeless in situations that should have been routine.

Slowed Metabolism

I also noticed a significant change in my metabolism. I wasn’t digesting food as efficiently as before, which led to weight gain. My body wasn’t functioning the way it used to, and it felt like everything had slowed down.

As I tried to navigate these side effects, I realized my doctor had not been upfront with me about the potential risks. Feeling frustrated and alone, I reached out to other ETS patients and discovered they, too, were struggling. Many shared the same anger and disappointment toward their doctors and the procedure’s outcome.

In addition to the side effects I experienced, there are other common ones that people who undergo ETS surgery may face:

Horner’s Syndrome: This includes droopy eyelids, a decreased pupil size, or an overall sunken appearance of the eyes
Gustatory Sweating (Frey’s Syndrome): This is characterized by sweating on the forehead, scalp, neck, and upper lip triggered by eating, speaking, or even thinking about food.
Neuritis and Neuralgia: Numbness, tingling, weakness, or even paralysis caused by nerve pain and inflammation.
Brachial Plexus Injury: Weakness, loss of feeling, or loss of movement resulting from nerve damage.
Decreased Heart Rate: A slower heart rate due to the severed connection of upper thoracic ganglions from the heart.

These side effects are far more common than I had been led to believe, and they have left me questioning whether the surgery was truly worth it.

Should You Get Hyperhidrosis Surgery?

Looking back, if I had known that I'd be dealing with a new, more frustrating sweat issue post-surgery and would end up back on prescription medications, I wouldn’t have gone through with it. While hyperhidrosis surgery has likely advanced since then, it’s still a major, life-altering decision.

Here’s what you should do before considering ETS surgery:

Meet With a Dermatologist

Dermatologists are specialists in diagnosing hyperhidrosis and will be able to confirm whether your condition is actually hyperhidrosis rather than something psychological. If you’re thinking about surgery, start with a dermatologist rather than a general practitioner to get the most accurate diagnosis.

Do Your Research and Consider Alternatives

Before jumping to an invasive and irreversible procedure like ETS surgery, it’s important to educate yourself about other treatment options for hyperhidrosis. There are less drastic alternatives that may suit your needs, and knowing all your options is crucial. Find out more here:

Ask Questions and Get Multiple Referrals

Not every doctor who performs ETS surgery is an expert on hyperhidrosis. It’s essential to visit multiple specialists, ask questions, and compare their approaches. Be sure to speak with patients who’ve undergone the procedure, especially those who had it done more than two years ago, as some complications don’t become apparent until much later.

Know What Outcomes to Expect

Both the National Center for Biotechnology Information (NCBI) and the Journal of Thoracic and Cardiovascular Surgery (JTCS) report similar success rates for axillary ETS surgery—88% and 83%, respectively. However, both studies define “success” as immediate dryness, not sustained dryness. High rates of compensatory sweating were also found in both studies. In one NCBI survey, 68% of patients experienced increased sweating in new areas after the surgery, and 60% of patients in the JTCS study faced the same issue.

Ask How Much ETS Surgery Will Cost

ETS surgery costs vary widely based on factors such as location, healthcare provider, and individual patient needs. On average, the procedure ranges from $8,000 to $10,000. However, total expenses can escalate to $20,000 or more when accounting for additional costs like anesthesia, operating room fees, and post-operative care. It's essential to consult with healthcare providers to obtain personalized estimates and verify insurance coverage, as some plans may partially or fully cover the procedure if deemed medically necessary.

Find Out If Your Insurance Will Cover ETS Surgery

ETS surgery is generally considered medically necessary, not elective, so it’s often covered by health insurance. However, you should confirm this with your insurance provider to ensure the surgery and any potential alternative treatments are included in your coverage.

If you’re considering hyperhidrosis surgery, take these steps to make a well-informed decision. It’s not a quick fix, and the potential risks and side effects should be thoroughly understood before you move forward.

Alternatives to ETS Surgery

If you're struggling with hyperhidrosis but aren’t sure about the risks of ETS surgery, there are several alternatives worth considering. While no treatment offers a one-size-fits-all solution, many options can help manage the condition with fewer long-term side effects.

Prescription Medications

For many, prescription antiperspirants or oral medications can be effective at managing hyperhidrosis. Topical treatments like Drysol, which contains aluminum chloride, can be applied directly to problem areas like your hands or underarms to block sweat glands. For those who need something more systemic, oral medications such as anticholinergics (e.g., Robinul) help reduce sweating by blocking the chemical signals that stimulate sweat production. While these options may require some trial and error to find the right dosage, they can offer significant relief without the permanent changes that come with surgery.

Botox Injections

Yes, Botox isn’t just for wrinkles! In fact, it’s FDA-approved for treating excessive sweating in areas like the underarms, hands, feet, and face. The botulinum toxin temporarily blocks the nerves responsible for activating sweat glands, providing relief for up to six months. Although the injections can be expensive and need to be repeated periodically, many patients find Botox to be a highly effective and non-invasive alternative to surgery.

Iontophoresis

This is a non-invasive treatment often used for excessive sweating of the hands and feet. It involves using a mild electrical current to temporarily block the sweat glands. While the process can feel uncomfortable, it’s considered safe and effective. Most people need multiple treatments to see long-lasting results, but many find Iontophoresis a convenient option for managing hyperhidrosis at home.

Microwave Therapy (MiraDry)

MiraDry is a newer, non-invasive procedure that uses microwave energy to target and destroy the sweat glands under the arms. The procedure is FDA-approved and is said to provide permanent results after just one or two treatments. While it's generally well-tolerated, some patients experience temporary swelling or tenderness. This option is especially appealing for those with severe underarm sweating who want a lasting solution without surgery.

Lifestyle Changes and Sweat-Reducing Products

For those with mild hyperhidrosis, lifestyle changes and the right products can make a big difference. Choosing moisture-wicking fabrics, using absorbent pads or sweat-proof shirts, and opting for antiperspirants with higher levels of aluminum chloride can all help reduce visible sweating. Although these methods don’t address the root cause, they can offer relief in situations where sweating is triggered by heat or stress.

Cognitive Behavioral Therapy (CBT)

If anxiety is a trigger for your sweating, you may benefit from Cognitive Behavioral Therapy (CBT). This therapeutic approach helps you address the mental and emotional triggers that exacerbate hyperhidrosis, providing strategies for managing stress and anxiety. In some cases, CBT can reduce the intensity of sweat episodes, making it a valuable option for those who struggle with sweat due to nervousness or stress.

Thompson Tee: A Sweat Proof Undershirt

I know all too well that dealing with hyperhidrosis is a lifelong struggle. When my friend Billy came to me with the idea for a sweat proof undershirt, I was all in. He knew I had experience in the apparel business but wasn’t aware of my battle with hyperhidrosis.

Although we didn’t design the product for my specific problem, I knew it would help many people avoid ETS surgery's frustrating side effects. Thompson Tee was my chance to help others avoid what I consider the biggest mistake of my life.

Today, we regularly get testimonials from customers who say they were one step away from hyperhidrosis surgery but decided against it, thanks to the Thompson Tee. Seeing the Thompson Tee sweat proof undershirt transform lives around the world has been beyond fulfilling. It’s what pushes us to keep going every day.

If you struggle with axillary hyperhidrosis, we encourage you to try a Thompson Tee risk-free before opting for expensive and invasive solutions like ETS surgery.

ETS may offer a permanent solution for some, but it’s far from the only option. Exploring these alternatives first may help you find a treatment that works for you—without the long-term consequences of surgery. Be sure to talk to a healthcare professional about your symptoms, and together, you can determine which approach is best suited for your needs.

Final Thoughts: My ETS Surgery Review

Looking back, I regret undergoing ETS surgery. At the time, I was eager for a solution, but I ended up with even more frustrating issues, including compensatory sweating and the need for prescription medications. If I had known the procedure would lead to these problems, I would never have gone through with it.

While the procedure has likely advanced, it's still a serious, life-altering decision. Do your research, consult multiple doctors, and explore all options before considering surgery. There's no turning back, especially if you undergo nerve cutting like I did, which can't be reversed.

Products like Thompson Tee have helped me and many others manage hyperhidrosis without surgery. Hyperhidrosis solutions are evolving, and with more information and support, you don’t have to settle for surgery as the only option. You're not alone in this, and there are alternatives that can improve your quality of life.