What you should expect: consultation, sweat test and Laser Sweat Ablation (LSA) procedure and post-op follow-up

As with all good medicine and surgery, Laser Sweat Ablation should only be offered to patients who are likely to benefit from it.

Therefore, whenever anyone considers that they might be suitable for laser sweat ablation, it is very important that we assess them fully before agreeing that it is the best thing for them.

This assessment starts with a detailed consultation and sweat test. To save time and expense for our patients, these are performed at the same visit- the sweat test being performed first and the results made available for the surgeon during the consultation.

Right Axilla (armpit) before Laser Sweat Ablation (LSA)	Left Axilla (armpit) before Laser Sweat Ablation (LSA)
Right Axilla (arm-pit) before Laser Sweat Ablation (LSA) - Iodine and Starch Test (Black shows area of sweating)	Left Axilla (arm-pit) before Laser Sweat Ablation (LSA) - Iodine and Starch Test (Black shows area of sweating)
Right Axilla (armpit) 8 weeks after Laser Sweat Ablation (LSA)	Left Axilla (armpit) 8 weeks after Laser Sweat Ablation (LSA)
Right Axilla (arm-pit) 8 weeks after Laser Sweat Ablation (LSA) - Iodine and Starch Test (No black areas showing no area of sweating)	Left Axilla (arm-pit) 8 weeks after Laser Sweat Ablation (LSA) - Iodine and Starch Test (No black areas showing no area of sweating)

Sweat test and consultation

Once you have decided to get rid of your armpit sweating for good, the first step is to book an appointment at The Whiteley Clinic.

If you state you are interested in the Laser Sweat Operation, you will be booked for a sweat test first followed by a consultation. This saves both time and money - we cannot make a decision about your suitability for Laser Sweat Ablation or other treatment without the sweat test, and so if you book a consultation only, the chances are you will need to be sent for a sweat test - and will then need a further follow-up consultation to discuss the results and the optimal treatment.

So, if you go through the system in the most efficient way, you will be given an appointment for your sweat test about an hour and a quarter before you are due to see Mr Whiteley or one of his colleagues.

You will be taken to a treatment room where one of our nursing staff will ask you some important questions. These will include which treatments you might have previously had and when you had them. The member of the nursing staff will then place some special cotton wool pads under your arms. You will be asked to return to the waiting room where you can read, have a tea or coffee or talk to anyone who has come with you.

After one hour, you will be taken back into the treatment room where the cotton wool is removed and your total hourly sweat volume is calculated. This will be noted on the form which will be sent through to the surgeon who is due to see you.

A short time later, you will be called in for your consultation. The consultant will take a full medical history - which will include:

• Where you sweat from, how it affects you, what treatments you have tried, whether it runs in your family, what other medical conditions you have or have had, what medications you are taking (if any) - and many other important questions

A brief examination will then be performed of your pulse, neck and under-arms.

Using the consultation, examination and sweat test results, your surgeon will then have formed an opinion as to what the best treatment for you. Your surgeon will then go through this in detail and go through any alternatives that might be possible for you.

The rest of this website deals with what happens if the decision is Laser Sweat Ablation. For information on other possible treatments, please go to www.sweating.co.uk.

If you are suitable for Laser Sweat Ablation, you will be taken through the pros and cons of the procedure and will go through the consent form with your surgeon. You will sign the form showing you were present and you will be sent a copy of the consent form for your records. On leaving the consultation, you will be measured by the nursing staff for your compression garment.

Laser Sweat Ablation procedure

On the day of your procedure, you will be advised to bring someone with you to drive you home. At the allotted time, you will be called to get changed in one of our changing rooms. You will change into a theatre gown and slippers, leaving you clothes in a locked locker - the key of which you keep with you.

You are taken to the operating theatre and introduced to the staff. They will check your name, consent, blood pressure and pulse. You will be given pain-killers, tablets to reduce bruising and antibiotics.

You will then be asked to lie down on the operating table. Iodine and starch will be used to find the area of maximum sweating and this will be marked on the skin. Photographs will be taken for later comparison.

Once marked using our new marking protocol, your skin will be cleaned and sterile drapes will be used to cover most of you, exposing your armpits for the procedure. The operation is then performed (please see the 'Laser Sweat Ablation - how it works' page).

At the end of the procedure, the compression garment and dressings will be in place, and you will be taken back to the changing rooms to dress.

You will be taken to our recovery area for a tea or coffee or drink of your choice and, when you are ready and our medical staff are happy with you, you will be allowed home.

Post-operative course, follow up and final sweat tests

You should wear your compression garment for 48 hours - after which most people are able to take them off. If more comfortable, you may wish to wear it for longer. Occasionally patients take some simple pain-killing tablets, although many of our patients find that they do not need to.

Most of our patients get back to almost normal life very soon after the procedure. We ask patients to come back after one week for us to check the wounds and the skin. We take photos again at this stage. It is usual at this stage for the skin to look bruised and red in areas. It may be starting to thicken and get lumpy.

Over the next few weeks, the bruising usually settles, but the skin often becomes thicker and more lumpy. It is important at this stage that the patient continues to move their arms normally, stretching the healing skin and showing it which way it should heal.

We then see our patients at six weeks after the operation by which stage the lumpy skin is usually resolving. Photographs are taken of the skin and the sweat test is repeated. Cotton wool pads are held under the armpits for one hour and the total volume of sweat is measured to be compared with the pre-operative volume.

Pre treatment iodine and starch test (left) - post treatment (right)

The iodine and starch test is also performed again, showing if any sweating is occurring at all. Photos of this test are taken for comparison with the same test performed just before the operation.

At this stage, we have so far found that our patients have a satisfactory reduction in their underarm sweating and they are discharged happy.

Ex.II Pre treatment iodine and starch test (left) - post treatment (right)

If any patients are unhappy with the result at this stage, or if the tests show the procedure has failed, then we would work with them to try to resolve the problem and to get them the result that they wish.

Finally, although this is the routine we have developed for our patients, it is important for our patients to know that not everyone follows the same path - therefore if at any stage our patients feel that things are not going according to plan, they are encouraged to contact us for advice, and to come in to the clinic for us to check them if possible.