Dear patient, you are presenting with a cosmetic problem. While your excessive sweating (blushing) is embarrassing to you, and may cause you to dislike or avoid social situations, and this can indeed have a negative impact on your quality of life, it is important that you understand that your condition is not physically harmful to you in any way.

In order to treat this, since you find oral and topical medications ineffective, we are proposing to do a sympathectomy. This means we are going to kill some of your sympathetic nerves. If we do that, you will notice several permanent changes.

First and foremost, draw an imaginary line all the way around your body, right at the level of your nipples. Above that line, including the arms, hands, upper back, chest, face and scalp, you may never sweat again. Not from heat, not from exercise, never. This is called anhidrosis, and while some people tolerate it, other people find the extreme dryness to be very uncomfortable, especially in the hands and scalp.

Below the imaginary line, in areas such as the belly, lower back, and crotch, you will most likely sweat much more than before. This is called compensatory hyperhidrosis, and again, some people tolerate it while others find it disturbing, even disabling. Compensatory hyperhidrosis can be severe enough to soak through clothing. It may require oral or topical medication (the same medications you currently find ineffective) or it may require that you wear dark clothing to hide the sweat. Please look at this:

Furthermore, dear patient, the same nerves which go to your sweat glands also lead to many other body parts. If you have this surgery, you may have a lowered heart rate, reduced cardiac strength, and lowered blood pressure. You may notice that your heart does not respond as strongly to emotion and exercise. The blood vessels in your upper body may be unable to constrict and dilate. Your bronchial tubes may not open as wide, and you may notice a loss of goose bumps and the pleasurable “chills” sensation that goes with them. You may develop a tingling or sweating reaction to eating certain foods. You may begin to lose your hair prematurely, and the skin on your upper body may be 10-12 degrees hotter than the skin below.

The combination of all these changes may cause you to be intolerant of hot and cold weather, to have a diminished exercise capacity, to be more easily fatigued, and to have reduced alertness. As a result, you may need to alter your lifestyle and/or career, especially if they involve warm-weather activities.

If we accidentally damage too much nerve tissue, you may develop “Horner’s Syndrome”, which is a drooping eyelid, a constricted pupil, and a dry sore red sunken eyeball. Or, you may suffer chronic pain in the ribs or between the shoulder blades.

As with any surgery, there is a danger of bleeding, infection, or complications from anesthesia.

While there is much that we know about sympathectomy, there is still much that we don't know. For instance, the sympathetic nerves lead to the thyroid gland, and help regulate fat burning and immune function, but what any of these mean to you in terms of long term health consequences, we simply don't know. There are scientific studies being done right now, including at the National Institutes of Health, and if you have the surgery you may be eligible to participate.

The bottom line is this: Many ETS patients are satisfied with the cosmetic results, and tolerate the physical changes well. Other ETS patients do not tolerate them well at all, and consider themselves to be permanently disabled. If you elect to have the surgery, this is the risk you will take.