Risks and complications Laser Sweat Ablation (LSA) procedure and post-op follow-up
As with all medical and surgical treatments, there is always a small risk of something going wrong, or not going according to plan. This is rarely due to any mistake being made - but is more usually a combination of events and factors - some related to the patient and some related to the equipment or doctor.
At The Whiteley Clinic, we have built our reputation for innovation and excellence by continually looking for new and better ways to treat our patients, and then auditing our results and performing research to keep improving our techniques and protocols.
Our introduction of Laser Sweat Ablation to the UK is an example of how we work to reduce the risks and complications of all of the procedures that we offer.
Having identified the need for a local anaesthetic operation to permanently reduce armpit sweating (axillary hyperhidrosis) Mark Whiteley visited the person who developed the procedure and underwent formal training.
Having gone through all of the necessary regulatory procedures to perform the procedure in the UK, Mark Whiteley and his team have continued to modify and improve the Laser Sweat Ablation procedure as they monitor and audit their results.
Although we have taken steps to reduce all of the possible risks, it is still possible that complications or adverse events can happen - even if very uncommon.
The possible risks of Laser Sweat Ablation are listed below - with explanations of what we have done to help reduce each risk:
- The procedure not working - This would happen if the patient found no reduction of their armpit sweating at the 6 week follow-up, and if the tests confirmed this to be the case. Using the protocols that we have introduced, we have not had this problem to date, but there is always a chance that someone will be our first failure.
- Infection - Any operation which goes across the skin can get infected. To keep this risk to a minimum, we use a sterile operating theatre to perform all of these procedures and we cover our operation with antibiotics. Initially we used one doseof antibiotics at the time of surgery, but are moving to giving a few doses to go home with as a precaution. So far we have not had any proven infections - our second patient was certain that she had an infection, but when examined by Mr Whiteley, there was no sign of infection.
- Breakdown of the skin (skin ulcers) / Skin burns - our first 2 patients had some breakdown of the skin in the middle of the armpit between weeks 1 and 4, probably due to a combination of burns from the laser and too much removal of the dermis affecting the skin blood supply. Both healed - however this was deemed to be an unsatisfactory event for our patients. Hence we stopped performing Laser Sweat Ablation and completely changed our protocols and procedure - and we have not had this complication since. Details of these changes can be seen on this website on History and development of Laser Sweat Ablation or you can see how it developed as it happened on the blog http://markwhiteley.blogspot.com.
- Numbness - loss or reduction of sensation - The skin of the axilla is very sensitive in many people (hence when we are children adults often 'tickle under the arms'). During the process of Laser Sweat Ablation, some of the sensory nerves can be bruised or destroyed. Some of our patients have noticed a decrease in sensation under the arms for the first few weeks after the procedure - although they report it does affect or worry them at all. We will be measuring this and publishing whether this is a permanent feature or whether it resolves.
- Pain - All surgery has some pain associated with it. Since we have changed our protocol, almost all of our patients have said there is a little discomfort at worst - few even need painkillers after the operation.
- Bruising / Haematoma - Everyone will have some bruising as they are having a surgical procedure. However, we give our patients a tablet to reduce bruising before the surgery, use adrenaline with our local anaesthetic which reduces bruising, use an Nd:YAG laser that seals broken blood vessels and put pressure on the area with the compression garment to reduce any bruising or collection of blood (haematoma) even further. So far, this has not proven to be a problem for our patients.
- Lymphocele - Fluid collection of lymph - Any cut across the skin can rupture the little lymph vessels and cause a collection of lymph fluid. However, it is a rare condition and so far we have not seen it in any of our patients.
- Hair loss - Hair contains the pigment melanin, and this picks up the laser light from an Nd:YAG laser - in fact this laser is commonly used for Laser Hair Removal!! Therefore theoretically, the Nd:YAG laser from under the skin could destroy the hair and stop it growing. Most of our female patients would love this, but our male patients are not so keen. However, so far we have not found the hair to be affected in any of our patients and so this does not seem to be a major problem.
- Pigment loss of the skin in dark skins - The same as with hair loss above, the melanin pigment in dark skins could theoretically be affected by the Nd:YAG laser. However, whether this actually turns out to be a problem remains to be seen.
- Scars - When we first started. there were 2 - 3 scars about 1 cm each. Now, we generally make 2 small scars on each side, about 3 mm long. They are almost invisible when fully healed. Lumpy scar tissue under the skin seems to disappear between 6 weeks and 3 months - if it forms at all - and so scarring doesn't seem to be a major problem.
- The sweat glands growing back and the sweating returning - this is a very unlikely risk - and so far the evidence from Guillermo Blugerman sugggests that. However, we do not know whether in 10 or 20 years time, there might be some recurrence of the sweating - although the science suggests that it is highly unlikely.
So in conclusion, as with any medical intervention there are possible risks with having Laser Sweat Ablation. However, we have reduced these risks to a minimum and are continuing to monitor our patients to see if we need to improve things further.
When consenting to the procedure, both the doctor and the patient need to be convinced that the probable benefits of the Laser Sweat Ablation procedure outweigh any possible side-effects or complications. In people who have positive sweat tests, this is almost always the case.
Although "Laser Sweat Ablation" or "LSA" has been advertised elsewhere in the UK, the actual Laser Sweat Ablation procedure has only been developed by Mark Whiteley of The Whiteley Clinic. This is being continuously improved and modified on the results of The Whiteley Clinic’s on-going audit and research. To date, no UK doctor has been on the Whiteley Clinic LSA course to learn this technique. Hence any other individual, clinic or hospital in the UK offering "Laser Sweat Ablation" or "LSA" is not using the Whiteley Technique and has not been trained in the settings and techniques that The Whiteley Clinic has shown to be optimal by it’s research.