I Underwent Hyperhidrosis Surgery: Here's My Advice
I’m Randy Choi, one of the co-founders of Thompson Tee. Long before I became part of a sweat proof undershirt company, I suffered from cranial hyperhidrosis. When I was a young adult, I decided to get an endoscopic thoracic sympathectomy (ETS), also known as hyperhidrosis surgery.
I want to share what I learned from that experience and talk about the facts I wish I’d known before making what I consider the worst decision of my life.
Click below to navigate to the section of this blog post you’re most interested in:
- My Experience with Hyperhidrosis
- Everything You Need to Know About ETS Hyperhidrosis Surgery
- Alternatives to ETS Surgery
My Experience With Hyperhidrosis
“Woah are you okay?!”
If you have hyperhidrosis or excessive sweating, this is the last thing you want to hear when sudden, profuse sweating strikes. But it never fails.
I remember when my friends asked me this for the first time. We were sitting on a bus about to head off to youth group camp when a couple of cute girls boarded and sat next to us. I got nervous and started to sweat.
When we stopped at a gas station and got out, everyone stared at me in absolute awe and asked me if I was ok. I had a band of sweat around my head that dripped down to my shirt. I looked as if I’d just run a marathon and had never felt more embarrassed in my life.
That was my first sweat attack. And it wasn’t the last. I didn’t know it at the time, but I had cranial hyperhidrosis — medical speak for chronic head sweat.
Living With Hyperhidrosis as a Teen
After that first time on the bus, sweat attacks came on gradually. Stress and social situations usually triggered them. By the end of junior high, I had become extremely self-conscious about my situation. I would invent excuses for my inexplicable sweat like, “I just got done skateboarding,” or “I was kicking the soccer ball around.” I even grew my hair out and doused it in gel, so it looked wet rather than sweaty. But by high school and into college, my sweating kicked into high gear.
Going to school at Cal Poly – where temperatures topped 110 degrees – didn’t help much, either. I strategically planned my walks to class based on shade and proximity to bathrooms (in case I needed to change into one of the two or three shirts I always carried around). I even only chose classes that had air conditioning .
By the end of my freshman year, I’d taken multiple trips to the campus clinic to discuss my condition with physicians. They eventually diagnosed me with an anxiety disorder, attributing my sweat events to panic attacks.
I remember thinking, “How could I have five to 10 panic attacks a day?” As a result, my doctor prescribed anti-anxiety medications and antidepressants. I tried Xanax, Prozac and just about every drug you can imagine — none worked. They only messed with my head and made me disoriented. Ultimately, I didn’t have an anxiety disorder; the anxiety was just a reaction to my excessive sweating.
Excessive head sweat affected my life on many levels. It wasn’t until a friend told me about hyperhidrosis a few years later that I understood what was going on.
Searching for a Solution to Hyperhidrosis
After learning that cranial hyperhidrosis was, in fact, a real condition, I went to a doctor who advertised a cure for "sweaty palms." That’s when he told me about endoscopic thoracic sympathectomy (ETS) surgery .
He told me that during the surgery he would open my chest cavity and slice the nerve lines around my rib cage that controlled my fight-or-flight nervous system. He explained that people with hyperhidrosis have overactive nerves which trigger unnecessary sweating.
He convinced me that the only way to stop the sweating was to destroy the nerves responsible for it. He also suggested a nonpermanent procedure which involved clamping off two to three nerves but didn’t go into detail about it.
Then he described some potential side effects of ETS surgery including:
- Horner’s Syndrome (when you have constricted pupils or droopy eyelids)
- Collapsed lungs
I didn’t like the sound of these side effects, but because he said ETS was a permanent solution, I decided to do it. I regret that decision to this day.
Undergoing ETS Surgery for Hyperhidrosis: The Aftermath
I was sweat-free for one week post-surgery. After that, all hell broke loose. Here’s what happened.
1. Compensatory Sweating
First, I experienced ghost sweat. Ghost sweat is when you feel like you’re sweating but there’s no moisture.
Then I actually started to sweat. Although I wasn’t sweating from my head anymore, I began sweating from a very defined area on my torso, front and back. I was as dry as a desert from the neck up, but swampy wet from my chest to my belly button.
Naturally, I went back to the doctor to ask him what was wrong. That was when he told me about compensatory sweating, or when you sweat profusely from areas of your body previously unaffected by hyperhidrosis.
As each day passed, it only got worse. By the end of summer, I had to wear two to three undershirts to contain my chest and back sweat . Then, out of nowhere, the sweating appeared on my left shoulder blade.
Each time I went back to my doctor to report more sweat, he blamed it on the heat. I knew it was more than that since by the second time I returned, I was sweating through five shirts a day.
2. Psychological Fatigue
The side effects of ETS didn’t stop at sweating. I experienced a noticeable lack of energy and difficulty making simple decisions like choosing a brand shampoo.
My natural feelings of assertiveness also diminished. Only later did I learn that these psychological changes were a result of ETS surgery which impaired my fight-or-flight response.
3. Skin Problems
The operation also made my face alter between dry and oily. As a result, I got acne for the first time. Eventually, the effects spread to my hands and scalp which also dried up badly.
4. Slowed Metabolism
I also felt like my metabolism slowed drastically post hyperhidrosis surgery. I wasn’t digesting food as quickly as before and gained weight.
After dealing with all of these side effects, I realized that my doctor hadn’t been transparent with me. I reached out to other ETS patients to find solace. I found that all of them were furious with their doctors and the results of the procedure as well.
Everything You Need to Know about ETS Surgery
Knowing what I know now, here are the questions I wish I’d asked before undergoing hyperhidrosis surgery.
What is the Success Rate of ETS Surgery?
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 percent respectively.
Both studies define “success” as immediate dryness post-operation, not sustained dryness.
Rates of compensatory sweating post-operation were high in both studies. In NCBI’s study of 73 patients, 68 percent experienced increased sweating in new places on their body post-operation. Of the 15 patients tested in the JTCS study, 60 percent experienced compensatory sweating.
How is the Procedure Performed?
ETS surgery takes approximately 40 minutes. Here’s how the procedure works:
- The anesthesiologist administers general anesthetic. Then he or she inserts a tube into your trachea to help you breathe during the operation.
- The surgeon makes two small incisions below your underarm.
- The anesthesiologist deflates your lung to give the surgeon access to your sympathetic nerve chain.
- The surgeon inserts a small camera into your chest through one of the two incisions under your armpit.
- The surgeon inserts tiny surgical instruments through the other incision.
- The surgeon uses the camera to locate the sympathetic nerve chain responsible for sweating and guide the surgical instruments to this location.
- The surgeon removes three portions of your sympathetic nerve chain that cause sweat.
- The surgeon removes their tools and camera.
- The anesthesiologist reflates your lung.
Once the doctors complete surgery on one side, they perform these nine steps on the other side of your body.
When the surgery is complete, the doctors insert a tiny chest tube through one of the incisions on each side of your torso to help the lung reopen. Then, they cover the other incisions with small bandages and remove the breathing tube from your trachea.
How is the Recovery Process for Hyperhidrosis Surgery?
Once the procedure is complete, they move you to the recovery room. When you wake up, nurses will remove one of the small tubes from your chest. You will remain in the recovery room for two hours before being moved to a standard hospital room.
Shortly after arriving at your hospital room nurses will remove the second chest tube.
You can expect to return home within 24 hours of ETS surgery. If you have trouble waking up from anesthesia, you may need to stay overnight.
Doctors will require you to take oral pain medication like acetaminophen for seven to 10 days after the surgery as it’s normal to have some pain around the incision sites. You should be able to return to work within one week.
After one week, your doctor will have you back in their office for a follow-up. During this appointment, the doctor will remove any remaining sutures and inquire about side-effects.
What are the Potential Side Effects of Hyperhidrosis Surgery?
Before you decide to have hyperhidrosis surgery, make sure you’re aware of the potential side effects. Here are seven hyperhidrosis surgery side effects to watch out for:
- Compensatory Sweating: Increased sweating on an area of the body that was dry before surgery
- Horner’s Syndrome: Drooping of the eyelids, decreased pupil size, elevation of the lower eyelid or overall sunken appearance of the eyes
- Gustatory Sweating: Sweating after eating
- Neuritis and Neuralgia: Numbness, tingling weakness or paralysis caused by nerve pain and inflammation
- Brachial Plexus Injury: Weakness, loss of feeling or loss of movement caused by nerve damage
- Decreased Heart Rate: Slowed heart rate due to the severed connection of upper thoracic ganglions from the heart
- Dry Facial Skin: Flaking or peeling of skin from the face, neck and scalp
Once you’re aware of the side effects, I urge you to evaluate all of the alternatives to hyperhidrosis surgery before signing on the dotted line.
Alternatives to ETS Surgery for Excessive Sweating
Opting for ETS surgery was the biggest mistake of my life — an experience I wouldn’t wish upon anyone. But when you’re young, desperate and confused about what excessive sweating actually is, you don’t question your doctor.
If you decide not to go through with hyperhidrosis surgery, don’t worry, there are other ways to cope. Here are some tactics that help keep my sweating dormant and may help you:
- Keep fans on and air circulating at home and work
- Drink plenty of water
- Limit your stimulant intake (sugar, caffeine, etc.)
- Practice deep breathing and mindfulness when you feel anxiety coming on
- Never go a day without wearing a Thompson Tee sweat proof undershirt
Although I would never recommend ETS surgery for hyperhidrosis, if you do decide to have the procedure, here are some steps you should take first:
- Do your research and consider all alternatives. You don’t know how severe your hyperhidrosis is until you embrace it. Only once you fully wrap your head around it can you learn to manage it. When you’re uneducated about the problem or don’t even know what it means, it’s easy to jump to rash conclusions. The International Hyperhidrosis Society offers unbiased, comprehensive information on the procedure here. I wish I had this info back when I was considering this option. Always do extensive research before resorting to an invasive procedure like ETS. And remember: There are alternatives.
- Ask doctors how many ETS procedures they’ve successfully done and get multiple referrals. Just because one doctor can perform ETS surgery doesn’t mean he’s an expert on hyperhidrosis or knows how to treat it effectively. Visit a handful of doctors, and compare their recommendations. Ask to speak to their patients, particularly those who had the surgery at least two years prior. Some complications from this procedure do not become apparent for five to 10 years after.
- Meet with a dermatologist first. Dermatologists seem to be ones who understand hyperhidrosis the best and won’t jump to conclusions about anxiety disorders first. They realize it’s not a psychological condition. Start your search here rather than a general practitioner.
- Join online support groups. I haven’t told many people about my cranial hyperhidrosis because I know they couldn’t begin to understand it. Having a group of people who get what you’re going through and can offer support and advice is very therapeutic. I recommend checking out My Life as a Puddle, the ETS and Reversals Discussion Forum or SweatHelp.org.
- Be proactive. Make a plan to keep rags, extra shirts, water or whatever you need on hand in case a sweat attack strikes. Just having a “sweat kit” handy prepares you to handle these situations and creates a sense of relief that can keep you calm during sweat attacks, too.
Thompson Tee: A Safe and Affordable Solution to Hyperhidrosis
I know all too well that dealing with hyperhidrosis is a lifelong struggle. The condition takes a toll on your psyche. It’s something few outsiders understand.
That’s why when my friend Billy came to me with the idea for a sweat proof undershirt, I was immediately all-in. Although the product wasn’t designed for my particular problem, I knew it would help many other people avoid the frustrating side effects of ETS surgery.* 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 not to do it thanks to the Thompson Tee.
Seeing the Thompson Tee transform lives around the world has been beyond fulfilling. It’s what pushes us to keep going every day. I look forward to helping more people end their battle with axillary hyperhidrosis and excessive sweating in the future.
If you struggle with axillary hyperhidrosis, we encourage you to try a Thompson Tee risk-free before opting for expensive & invasive solutions to hyperhidrosis like ETS surgery.
What other questions do you have about ETS surgery for hyperhidrosis? Or what alternatives to ETS surgery would you recommend? We'd love to hear your stories & suggestions in the comments.
*Sidenote: I have over 20 years of experience in the domestic apparel business. Billy was not aware I had suffered from cranial hyperhidrosis when he approached me with the idea for Thompson Tee.