Living with hyperhidrosis, or excessive sweating well beyond what the body needs for cooling, can quietly shape everyday decisions. Someone with palmar hyperhidrosis may hesitate before shaking a hand or holding a phone. Someone with axillary hyperhidrosis may plan an outfit around hidden sweat marks rather than the weather.
Torrance Hyperhidrosis Institute focuses exclusively on hyperhidrosis care and ETS surgery to help patients with these day to day decisions impacting their life. For many patients, prescription antiperspirants, oral medications, and injectable treatments provide meaningful relief along the way. When those options fall short, some patients look toward a more definitive approach: endoscopic thoracic sympathectomy, commonly known as ETS.
How ETS Targets the Source of Excessive Sweating
Unlike topical or injectable treatments that act directly on the sweat glands, ETS works further upstream, on the sympathetic nervous system itself. This network of nerves governs automatic bodily functions, including how much the hands and underarms sweat. During Endoscopic Thoracic Sympathectomy, a surgeon uses a small endoscope inserted through tiny chest incisions to reach the sympathetic chain, the bundle of nerves running alongside the spine that carries these signals to the sweat glands. Selected portions of the sympathetic chain are then divided, interrupting the signal before it ever reaches its target. This is why minimally invasive ETS is positioned as a one-time procedure with a permanent effect, rather than a treatment that needs to be repeated. A 2024 study published in the Journal of Thoracic Disease followed patients for more than a decade after ETS and reported an overall surgical efficacy rate of 94.5 percent, with the large majority showing measurable improvement on a standard hyperhidrosis severity scale.
The Procedure, Recovery, and Informed Consent
ETS is performed under general anesthesia and is classified as minimally invasive surgery. The procedure typically takes about 30 minutes, with appropriate patients able to go home the same day, making same-day discharge the norm rather than the exception. Recovery instructions are individualized, though most patients resume light activity within a short window, guided by their surgical team’s advice on wound care and follow-up. Because ETS permanently interrupts nerve signals, informed consent is central to the process. Before surgery, the care team offers a transparent discussion of ETS risks so patients understand the potential benefits alongside the surgical risks involved, including the risks associated with general anesthesia and, in particular, compensatory sweating.
Understanding Compensatory Sweating
Compensatory sweating is an increase in sweating in parts of the body other than the one originally treated, such as the back, chest, or abdomen. It is a well documented and common effect of ETS, and its severity varies considerably from patient to patient.
A long-term study published in the British Journal of Surgery followed more than a thousand patients for an average of nearly fifteen years and found that ETS produced strong, durable results for palmar hyperhidrosis in particular, while compensatory sweating remained the most frequently reported trade-off among respondents. Findings like these are why a transparent discussion of ETS risks belongs at the very start of the decision, not as an afterthought once surgery has already been scheduled.
Take the Next Step
Prescription antiperspirants, iontophoresis, oral medications, and injectable treatments each have a role in treating excessive sweating, particularly for patients with milder symptoms or those not yet ready for surgery. These options generally require ongoing use to maintain results. ETS stands apart because it is a minimally invasive procedure intended as a one-time procedure with a permanent effect on the treated nerve pathway. For patients with severe, persistent palmar or axillary hyperhidrosis, that permanence is often exactly what makes ETS worth considering, provided the decision fully accounts for the possibility of compensatory sweating elsewhere.
Torrance Hyperhidrosis Institute’s approach to hyperhidrosis care and ETS surgery is built around an experienced surgical team, including Dr. Jiri A. Konecny, who has performed thousands of ETS procedures for patients dealing with palmar and axillary hyperhidrosis.
The practice offers both a complimentary same-day virtual consultation and in-person consultation options, along with out-of-state patient accommodation for those traveling from farther away.
If excessive sweating has been limiting your daily life, you can schedule a free consultation to discuss your history and treatment options, or visit the financial information page to learn more about coverage and costs before your visit.
