Laser Sweat Ablation - FAQ's - Frequently Asked Questions

This page includes questions that patients have asked about Laser Sweat Ablation - LSA - and provides the answers to those questions.

This page will be updated as more questions are asked and as our research gives us more information about this procedure. For our latest information, keep an eye on our blog - http://lasersweatablation.blogspot.com

Does Laser Sweat Ablation increase the amount of sweating in other areas of the body?

The answer to this is yes - but to such a tiny amount that it is not noticeable. There are a couple of points that you must consider if this question interests you.....

Firstly - the total area of the armpits (axillae) is about 1-2% of the total body surface area. Therefore stopping sweating from only 1-2% and re-distributing this over 98% of the body means that the increase anywhere else is too small to notice - or measure. This is unlike the ETS (Endoscopic transthoracic sympathectomy) where 25% of the body surface area is affected - in this case about 15% of patients do get compensatory sweating elsewhere.

So it is very important not to confuse Laser Sweat Ablation (LSA) which does NOT have this problem and Endoscopic Transthoracic Sympathectomy (ETS) which may.

Secondly - if this was a problem, we would have seen this with Botox® treatments of the armpits which we have been performing since 1999. Botox® also stops sweating (although only temporarily) so if this was a problem, we would have found it in these patients already - and it hasn't been a problem.

Is it Safe to Remove the Sweat Glands?

Simply - yes it is, provided enough are left to fulfil the function of sweating - that of getting rid of excess heat from the body. Removing the sweat glands from such a tiny area as the armpits (axillae) - only 1 - 2% of the body surface area, has virtually no effect on this and so is perfectly safe.

Aren't the sweat glands needed to remove toxins from the body?

This is a very common concern from a lot of people. However, there is nothing to worry about with Laser Sweat Ablation.

Sweat is not a major way to get rid of "toxins" from the body. Most are got rid of by breathing out, metabolising them by the liver or excreting them by the kidneys. Some heavy metals are excreted by the sweat - although very few people have heavy metal toxins in their body. Urea, that is also excreted in the sweat, actually is mainly excreted by the kidneys - the sweat being a negligible amount in comparison.

In addition to the fact that sweating is not important in the removal of most toxins is the fact that, just as in the answer above, Laser Sweat Ablation (LSA) only removes sweating from about 1-2% of the surface area of the body. Therefore any toxins that might need to be removed are easily removed by the remaining 98% of the skin surface area.

If further convincing is necessary, it is interesting that in all the years that ETS (Endoscopic transthoracic sympathectomy) has been performed, which destroys sweating from 25% of the body surface area, there has not been any problem identified with "failure to get rid of toxins".

Can removing the sweat glands in the armpit (axilla) cause Breast Cancer or stop Breast Cancer being cured?

This question worries a lot of people - but fortunately it is just a misunderstanding of the word "gland".

The "glands" associated with Breast Cancer spread and treatment are not "glands" at all - they are actually Lymph Nodes. The lymph nodes lie deep in the sub-cutaneous fat, next to the major blood vessels to the arm. These are a long way away from the skin and the sweat glands. They are involved with fighting infection and cancers and hence if a cancer is spreading, the lymph nodes may be involved.

The sweat glands (eccrine glands) are actually in the skin itself. They are tiny. They secrete sweat and have nothing to do with breast cancer, spreading or fighting breast cancer and so the answer to the question is no. Removing the sweat glands from the skin of the armpit has no effect whatsoever on Breast Cancer, the spread of Breast Cancer or the cure of Breast Cancer.

Is it similar to VASER, liposuction and retrodermal currettage?

In three words, no, no and no.

VASER, despite having a name that looks similar to Laser, is actually just a vibrating tool with suction. The tool vibrated at ultrasound frequencies, which is meant to be very good to break up fat - and VASER was initially sold as a liposuction technique to get rid of fat. There is no logic or evidence yet that the vibration is particularly good at destroying sweat glands - unlike the laser which is specifically used to do so.

Several patients have contact me through the sweating website reporting failures of the VASER in removing armpit sweating - It will be interesting to wait for scientific studies to see if it can be made to work. As there is no logical or scientific reason to suppose that ultrasound vibration would kill sweat glands anywhere near as efficiently as the Nd:YAG laser, it is not something that we are aiming to study at The Whiteley Clinic.

Liposuction is the removal of fat - as the eccrine sweat glands are in the dermis and not the fat, liposuction does not have a place in the treatment of armpit sweating. Some people mean retrodermal currettage when they use the term liposuction ....

Retrodermal currettage is just like the second half of the Laser Sweat Ablation - under a local anaesthetic the doctor tries to remove the sweat glands from the dermis by scraping them off with a suction grater. However, it seems illogical to do just this when, by adding the laser treatment first, a large number of the sweat glands can be destroyed before attempting to remove them!

As the Laser will destroy many of the sweat glands - but not all - and the suction currettage will remove some but not all, anyone wanting the best chance of success would opt for both laser and currettage (ie - Laser Sweat Ablation) rather than just Retrodermal Currettage.

I am just about to, or have just had, Botox® treatment for underarm sweating - when can I have Laser Sweat Ablation?

Laser sweat ablation can be done, even if the area has been treated with Botox® or another Botulinum Toxin.

However, as the Laser Sweat Ablation procedure involves concentrating treatment on the areas of maximum sweating, it means that Laser Sweat Ablation performed on people who currently have reduced sweating due to treatment with Botox® or another Botulinum Toxin will have sub-optimal treatment.

Without active sweating to guide the surgery by the iodine and starch test, the surgeon just has to treat the whole area - meaning that some areas are over-treated and therefore are at a higher risk of complications - or the whole area is undertreated meaning that the procedure is less likely to be successful.

Therefore if you are thinking of having Botox® and are considering Laser Sweat Ablation, it would be sensible to delay any Botox® treatment until you have had your sweat test and consultation. At that point, f you are suitable for Laser Sweat Ablation, it would be sensible to proceed with the operation and avoid the expense of the Botox® at all.

Of course there are sometimes where surgery is not possible for a few months, but the desire or requirement for treatment is strong. in such cases, it is best to have the sweat test and consultation before the Botox® - in order to plan the Laser Sweat Ablation - but ALSO to do the iodine and starch test, photograph it, and then use the photograph to guide the surgery at a later date.

For those people who have had Botox® or another botulinum toxin treatment that is working, it really is better to wait until it wears of and the sweating starts again, before booking the sweat test, consultation and laser sweat ablation procedure.

If you have any queries regarding timing, we are always happy to advise you via e-mail - info@thewhiteleyclinic.co.uk.

As there is only a 70% success rate, if it is not successful and you need repeat surgery is that a further £2990?

Although we quoted a 70% success rate when we first introduced Laser Sweat Ablation to the UK, we were quoting the success rates that had been presented from the first few doctors to do the procedure - not out own results.

At the current time, we have not had anyone who has had a failed operation, and so we have not had this situation occur yet.

However, should it occur, we would not be charging the full £2,990 which is a package price for all of the consultations, sweat tests, follow-ups etc.

If we did have to redo the procedure because it had not worked, we would do it for as little as possible - just enough to cover some of the costs of the equipment. As it is unlikely that more than just a little area would need treatment, this should be a minimal cost.

If it turns out that in the future the sweat glands grow back (which hasn't been found even after 7 years by the inventor of the operation) then this would not be a failure of the operation, and so we would need to charge a reasonable amount for a redo. however, all the evidence seems to point towards this not occurring.

How much more do people with axillary hyperhidrosis sweat compared with the average human?

This isn't known for sure as the research hasn't been done. There will be some who sweat the same as most other people but just mainly from their axillae (arm-pits); however there are others who will sweat more than most people and in whom it shows in the arm-pits first or the arm-pits as well as elsewhere on the body.

In addition, there is a large psychological component to hyperhidrosis. Anyone who
gets anxious about a little underarm sweating will drive their sympathetic nervous system and adrenaline, and will get a huge surge of sweating as part of their anxiety.

As such, it is very hard to be able to answer the question with a simple statistic. This is one of the reasons we have to consult and test each patient, to get to the bottom of each individual and sort out the best treatment for them.

Could you describe (as simply as possible) how the operation works? Do you simply laser away the sweat glands?

The laser sweat ablation (LSA) operation in simple terms – 1] local anaesthetic to numb 2] a blunt separation of the skin from the underlying fat and tissues 3] laser destruction of the sweat glands from beneath 4] removal of the dead sweat glands 5] compression dressing for 2-3 days.

This procedure originated in Argentina. are you the first to  bring it over to the UK? Were other consultants not aware of it?

It originated in Buenos Aries by Dr Blugerman who I went over to train with in December 2008.

I performed the first in the UK on 5th March 2009. At that stage, the only other person in Europe doing the procedure was a surgeon in Croatia. I got to hear of it as I am part of the Laser and Heath Academy (LAHA) run by the Laser company called Fotona, in Slovenia. I saw a presentation of it last September at one of the research meetings they held in Slovenia.

There are no other UK doctors on the LAHA and so they probably hadn’t heard of it at that time. Since I popularized it, there have been several people offering it – none have been to either myself nor Dr Blugerman for training. I am not sure where, or if, they are actually trained in the techniques.

There are some other Non-Laser techniques – such as liposuction or ultrasound-vibration liposuction. As these don’t destroy the sweat glands as the laser does, it will be very interesting to see the results if any of the practitioners publish them.

What are the Side Effects and the Recovery Time from Laser Sweat Ablation?

The results and side effects are on my blog – http://markwhiteley.blogspot.com andthen latterly on the new blog http://lasersweatablation.blogspot.com.

In a nutshell - the first patient had some breakdown of his skin, but healed well with a fair result. The second had breakdown of the skin and tightness of the scar tissue. She had pain afterwards but this wasn’t helped by the fact she pulled a muscle in her arm during the recovery phase.

We then changed some of the technique and the subsequent patients to date have all done very well with no complications found so far.

The first patient and last 3 have all gone back to work within 3 days – the second patient who had more pain took longer. Most of the subsequent patients have been back to normal life in 2-7 days.