What Is ETS Surgery? An Inside Look at Hyperhidrosis Surgery

If you have hyperhidrosis like myself, you might be exploring endoscopic thoracic sympathectomy (ETS) surgery as a solution. ETS surgery involves opening the chest cavity and slicing the nerve lines that control a person’s sweating response.

After being diagnosed with cranial hyperhidrosis, I underwent ETS surgery to stop sweating.

Today, I’ll share my experience with ETS surgery, alternatives and what I wish I’d known before making what I consider the worst decision of my life.

  1. Living With Hyperhidrosis as a Teen
  2. ETS Surgery a Solution to Hyperhidrosis
  3. The Effects of ETS Surgery for Hyperhidrosis
  4. ETS Surgery FAQs
  5. Alternatives to ETS Surgery


I experienced my first sweat event as an early teen, when a couple of cute girls sat next to me on the bus.

A band of sweat formed 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.

I didn’t know it at the time, but I had cranial hyperhidrosis — the medical term for chronic head sweat.

I became extremely self-conscious about my excessive sweating, which worsened into high school and college.

In college, the campus physician diagnosed me with an anxiety disorder, attributing my sweat events to panic attacks.

I didn’t understand how I could have 5-10 panic attacks a day.

The doctor prescribed anti-anxiety medications and antidepressants, includingXanax, Prozac and virtually every other, but none worked.

Ultimately, I didn’t have an anxiety disorder; the anxiety was just a reaction to my excessive sweating.

And I wasn’t alone in my confusion. 60% of people with hyperhidrosis don’t know it’s a medical condition, and 47% don’t believe a treatment exists that could help.


Years later, I learned about cranial hyperhidrosis and visited a doctor who advertised a cure for "sweaty palms."

The doctor told me that people with hyperhidrosis have overactive nerves that trigger unnecessary sweating, and that ETS surgery was an option.

He convinced me that cutting these nerves would end my exaggerated sweat response to stressful situations.

ETS surgery was supposed to be a permanent solution, so I decided to do it — a decision I regret to this day.


I was sweat-free for one week post-surgery. Here are the side effects of hyperhidrosis surgery that I quickly discovered:


My first reaction to ETS surgery was ghost sweat, where you feel like you’re sweating, but there’s no moisture.

Not soon after, I began to actually sweat 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 see what was wrong. That’s when he told me about compensatory sweating, or profuse sweating from areas of your body previously unaffected by hyperhidrosis.

My sweat continued to worsen. Soon, I had to wear 2-3 undershirts daily to contain my chest and back sweat and suddenly began sweating on my left shoulder blade.

My doctor blamed my excess sweating on the heat. But I knew it was more than that. The next time I returned, I was sweating through 5 shirts a day.


The side effects of ETS surgery didn’t stop at compensatory sweating. I experienced a noticeable lack of energy and had difficulty making simple decisions like choosing a brand of shampoo.

My natural feelings of assertiveness also diminished. ETS surgery affected my autonomic nervous system, which impaired my fight-or-flight response and made me feel dull and lifeless.


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.


I felt like my metabolism slowed drastically after surgery. I wasn’t digesting food as quickly as before and gained weight.

In 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 procedure’s results as well.


Knowing what I know now, here are the questions I wish I’d asked before undergoing hyperhidrosis 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%, 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% experienced increased sweating in new places on their body post-operation. Of the 15 patients tested in the JTCS study, 60% experienced compensatory sweating.


ETS surgery costs vary widely. It is impossible to state the exact cost of hyperhidrosis surgery, but in the U.S., it’s reported to be in the range of $5,000-$10,000. Talk to your doctor or insurance company to get a more exact estimate.


ETS surgery is usually covered by health insurance. Because the condition affects a person’s quality of life, it’s considered a necessity rather than an elective or cosmetic procedure. Check with your insurance provider to see if ETS surgery or alternative treatments are included in your coverage.


Before you decide to have ETS surgery, make sure you’re aware of the potential side effects. Here are seven ETS 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 surgery before deciding to proceed.


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

  1. General anesthesia is required for the procedure. A tube is inserted into your trachea to help you breathe during the operation.
  2. Two small incisions are made below one of your underarms.
  3. One of your lungs is then deflated to give the surgeon access to your sympathetic nerve chain.
  4. A small camera is inserted into your chest through one of the two incisions under your armpit.
  5. Tiny surgical instruments are inserted through the other incision.
  6. The surgeon uses the camera to locate the sympathetic nerve chain responsible for sweating and guides the surgical instruments to this location.
  7. The three portions of your sympathetic nerve chain that cause sweat are removed.
  8. The tools and camera are removed.
  9. 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.

When ETS surgery is complete, a tiny chest tube is inserted through one of the incisions on each side of your torso, helping your lungs reopen. Then, they cover the other incisions with small bandages and remove the breathing tube from your trachea.


Once the procedure is complete, you’re moved to the recovery room. When you wake up, nurses remove one of the small chest tubes. You will remain in the recovery room for about two hours before moving to a standard hospital room.

Shortly after arriving at your hospital room, nurses remove the second chest tube, ending the procedure. ETS surgery is an outpatient procedure, so you can expect to return home the same day. If you have trouble waking up from anesthesia, you may need to stay in the hospital overnight.

It’s normal to have some pain around the incision sites. Your doctor will give you oral pain medication like acetaminophen to take for 7-10 days after the surgery. You should be able to return to work within one week.

After one week, you’ll return for a follow-up visit. During this appointment, the doctor will remove any remaining sutures and inquire about side-effects.


I fully regret getting ETS surgery and wouldn’t wish my experience upon anyone. But when you’re young, desperate and confused about excessive sweating, you don’t question your doctor.

If you decide not to go through with hyperhidrosis surgery, there are other ways to cope. Here are some tactics I use that help keep my sweating dormant:

  • Keep fans on at home and work to keep air circulating
  • Drink plenty of water
  • Limit your stimulant intake (sugar, caffeine, etc.)
  • Practice deep breathing and mindfulness when you feel anxiety coming on
  • Wear a sweat proof undershirt daily

Looking for more organic approaches? Read 13 Natural Ways to Stop Sweating

I do not recommend ETS surgery for hyperhidrosis, but if you do decide to have the procedure, here are some steps you should take first:

  • Meet with a dermatologist first. Dermatologists specialize in diagnosing hyperhidrosis, so they know it’s not a psychological condition. Start your search here rather than with a general practitioner.
  • Do your research and consider all alternatives. Knowledge is power. When you’re uneducated about a problem, it’s easy to make rash decisions. Always do extensive research before resorting to an invasive, irreversible procedure like ETS surgery.
  • 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 several 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 surgery.
  • 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.


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 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 live confidently.

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.

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.