Keyhole Operations

Sweating and Blushing ( Keyhole Operations )

Sweating and Blushing

Excessive sweating and blushing are socially embarrassing conditions which can have a devastating effect on quality of life. Until recently no cure was available.  LapSurgery Australia started performing this procedure in 2000 and to date have performed approximately 1000 cases with 80% success rate.
Surgeons have now discovered a new surgical procedure that can cure these conditions in the majority of people with minimal pain and quick recovery.


The surgery, Endoscopic Thoracic Sympathectomy (ETS), is providing people who suffer either of these conditions not only with new hope, but in many cases with a new life.

The information below gives details of Excessive Sweating (Hyperhidrosis) and Facial Blushing and outlines the surgical procedure and how it can change your life. As with all surgery there can be failures, complications and side-effects which are discussed below.

Sweating and blushing Sweating and blushing

Facial Blushing (Idiopathic Cranio-facial Erythema)

Facial blushing is a common condition affecting large numbers of people. Facial blushing is due to the overactivity of involuntary nerves. The nerves control the diameter of the blood vessels and when the nerves are over-stimulated the vessels open out and colour the skin red. Excessive blushing can occur under many circumstances including stress or embarrassment, but in many people it occurs in response to the most trivial event. Facial blushing is often accompanied by other symptoms including palpitations, feelings of excessive heat and anxiety.

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LSA Facial Blushing Brochure

Excessive Sweating (Hyperhidrosis) of the Face, Scalp and Hands

Normal people sweat as a way of maintaining skin hydration and controlling body temperature. We have approximately 5 million sweat glands, many concentrated in the skin of the face, scalp and hands. Although it is not entirely understood why, some people sweat excessively due to overactive functioning of the involuntary (sympathetic) nervous system. The common places people sweat excessively are on their hands, face, scalp and armpits. ETS is highly effective at controlling excessive sweating of the hands, scalp and face.

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LSA Facial Sweating Brochure
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LSA Hand Sweating Brochure

Excessive Sweating of Armpits (Axillary Hyperhidrosis)

We now have a new operation for axillary hyperhidrosis. Our surgeons have recently completed a study tour to Taiwan where the problem of axillary hyperhidrosis is very common in the population. Previously, the treatment for axillary hyperhidrosis by sympathectomy was to cut the sympathetic chain from the level of the second rib to the level of the fourth or fifth rib. Although effective, the operation often produced an unacceptable level of compensatory sweating elsewhere on the body and was used only as a resort for the very most serious cases.

The new technique involves selectively isolating only a small part of of the sympathetic nervous system between the fourth and fifth ribs. This is done by clamping the nerve with small titanium clips which stay in place permanently. (These clips are routinely inserted in the body in numerous different operations and have no known side-effects.) This technique has a high success rate in eliminating or greatly reducing axillary hyperhidrosis with a low incidence of severe compensatory sweating. In addition, there is some evidence that in those very few people in whom compensatory sweating is considered worse than the original condition, that removing the clips may reverse the operation. It must be emphasised that the possibility of reversal is theoretical and by no means guaranteed.

Other treatments are available for axillary hyperhidrosis and we recommend that some or all of these are discussed with your family doctor or dermatologist before considering sympathectomy. Other treatments include:

Strong anti-perspirants such as Driclor. Although effective, many people find skin irritation unacceptable.

Botox. Usually effective, but must be used repeatedly as its effect may last as little as two months. Expensive. The treatment is available through LapSurgery Australia or some dermatologists.

Lipodermosuction. This is performed by a dermatologist, usually as a day case under local anaesthetic and with little in the way of scarring. There is a significant failure rate with this treatment.

Surgical removal of the sweat gland bearing skin of the armpits. This is usually performed by a general or plastic surgeon and may be very effective. The disadvantages are very ugly scars in the armpits which usually preclude its use in women. LapSurgery Australia does not provide this service.

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LSA Armpit Sweating Brochure

Smelly Armpits (Bromihidrosis)

This distressing condition is NOT due to sympathetic nerve overactivity but is due to infection or problems with other types of glands in the armpit. ETS is usually not effective for this condition. We suggest treatment by a dermatologist.

Excessive Sweating on Other Areas of the Body

ETS cannot help sweating on other areas. People suffering from this condition should have a thorough check up from their family doctor to exclude metabolic causes such as an overactive thyroid gland. Severe obesity is also a cause of excessive sweating. If this applies, you may be interested in reading the information on the Lap. Band elsewhere on this web site.

Additional Information

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LSA Interstate and Overseas Patient Brochure


Cost of Surgery and Payment

Operations are performed only in Private Hospitals. For more information about costs please call our rooms on (03) 9760 2777 or email us at: This email address is being protected from spambots. You need JavaScript enabled to view it.

Finance is available through Health Assist. LapSurgery Australia has no direct or indirect association with Health Assist, receives no commission and makes no warranty as to the suitability of this option for individual patients.

Interstate and Overseas Patients

Travel and accommodation can be coordinated to enable assessment by the surgeon and anaesthetist so that surgery can be performed on a single visit to Melbourne.

Useful Information Links

The Internet sites listed below provide further information on Excessive Sweating and Facial Blushing.

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LSA Cost and Payment Brochure


Am I suffering from facial blushing?

The symptoms commonly associated with facial blushing are redness, heat anxiety heart palpitation in trigger situations such as stress , interviews, and meeting people and on occasion spontaneously.

Treatment is recommended when the symptoms result in a significant interference with normal daily living activities and result in avoidance behaviour.

Is Facial blushing a form of social phobia?

Avoidance behaviour is seen in some when they have facial blushing symptoms. Some specialists label the condition as social phobia and may try psychological methods of treatment. Which can be successful in controlling symptoms.

What's the cause of Facial blushing?

Facial blushing is a poorly understood condition that affects adults between the ages of 18 to 50. The exact cause is unknown but is speculated to be caused by a combination of factors the chief one being an overactivity of involuntary nerves that are also a part of the temperature controlling mechanism in all humans.

There is a strong indication that genetics could be involved. In patients with excessive sweating complaints this link is much clearer.

How is Facial blushing treated?

The treatment is individualised to fit each patient and is not one size fits all. The options include medication, cognitive therapy and behaviour modification. In some cases where all other methods are not effective ETS (endoscopic thoracic sympathectomy surgery) is the option of choice.

Am I a candidate for ETS surgery?

The eligibility to have surgery is dependent on many factors and will be discussed with you at your consultation apart from fitness for general anaesthetic, any pervious chest surgery which are relative contraindications the main reason is a lack of response to other methods of treatment and a severe disability due to the condition are the main criteria used to determine suitability.

What is ETS surgery?

ETS surgery is a relatively new keyhole technique used to target nerves within the chest cavity. Tiny incisions are made under a full anaesthetic and a fine camera and instruments passed into the chest. Under controlled conditions the lung has to be partially deflated to complete the surgery. This has no long term complications. Titanium clips are used to clamp the nerve responsible for the symptoms. The three incisions are taped but not stitched as they are small.

This usually involves an overnight stay and one week off usual work duties if work involves heavy lifting it is recommended that you take two weeks off from such activity.

Is ETS Surgery major surgery

All surgery is major as it involves anaesthetic, incisions and other interventions that carry risks. In the experience with Surgeons at LSA over a twelve year period of doing more than 1000 surgical procedures no major surgical complication has been encountered.

How effective is ETS

Surgery is not 100% effective and failures occur in around 15-20% of cases. The exact reason for failure is unknown.

LSA and research into ETS surgery

Surgeons at LSA are very interested in research and are involved closely with the Baker heart and International Diabetes institute in research into facial blushing and excessive sweating. All prospective patients will be given the opportunity to be involved with research.

Surgical Risks

As in any surgery, the risks of general anaesthetics, infection bleeding and risks of deflation of the lung are present in ETS surgery your surgeon will discuss this at length during your consultation. The minor complications have no lasting effects and with experience have been minimised.

Possible complications and side effects of ETS?

The main side effect of ETS surgery is redistribution of sweating. This can be severe in some patients such that they regret having the primary surgery. Surgeons at LSA have been performing clipping surgery because of the possibility that reversal by removal of the clips is available as a last resort. However there is no guarantee of reversibility.

Recent research done by Surgeons at LSA in conjunction with scientists at the Baker heart and international diabetes institute have shown that ETS surgery has little or no adverse effects on the circulatory system this is a breakthrough and the first to be published from around the world.

Surgical Benefits

  1. Much more confident socially meeting people
  2. New enjoyment of life's activities
  3. No embarrassment from blushing or sweating
  4. Much more confident person
  5. Very little pain related to surgery short stay in hospital

Post Operative Instructions

For instructions relating to this operation, please visit the Patient Care Instructions page.

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