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Laser Sweat Ablation

Laser Sweat Ablation (LSA) is a new local anaesthetic procedure to stop sweating from the arm-pits (axillary hyperhidrosis).

What is LSA?

The Laser Sweat Ablation technique was named and introduced to the UK by consultant surgeon – Prof Mark Whiteley.

Sweat is produced from the eccrine glands in the skin. Laser sweat ablation is aimed at destroying the eccrine glands and then removing them, whilst causing as little damage to the skin as possible.

How does it work?

The principles of laser sweat ablation are as follows:

  • The area of maximum sweating is marked on the skin by performing an iodine and starch test
  • Local anaesthetic is used to completely numb the area
  • 2 small incisions – typically about 5mm long, are made and the dermis is separated from the subcutaneous fat
  • The laser fibre is put into this area and the laser is fired at the underside of the dermis, destroying the eccrine glands. As these glands lie deep in the dermis, they are easily reached by approaching them from below.
  • The dead glands are removed by suction curretage – literally scraping the underside of the dermis and sucking out the tissue that is scraped off the underside of the dermis.
  • Long acting local anaesthetic is placed along with compression dressings to push the skin back into place on the sub-cutaneous fat. A compression waistcoat holds this in place for 2 – 3 days after the operation.

Why LSA is required for Underarm Sweating?

Excessive sweating, also known as hyperhidrosis, is an embarrassing condition that can have dramatic negative effects on peoples’ lives.

Hyperhidrosis can affect most areas of the body – but it is usually a major problem in one or two main areas. Common areas to be affected by excessive sweating are:

  • Head – scalp and face (often associated with facial flushing)
  • Hands – called (Palmar Hyperhidrosis)
  • Under-arms or armpits – called axillary hyperhidrosis
  • Feet – called Plantar Hyperhidrosis
  • Occasionally groins, backs, chests

Hyperhidrosis is the excessive production of the watery sweat. This sweat causes the damp patches on clothes, and in severe cases, beads of sweat form and can drip down the body from the affected area. This sweat is produced by the Eccrine glands. It’s main purpose is to cool the body.

This condition is not to be confused with smelly sweat – properly called Bromhidrosis – which is a more greasy sweat of low volume that has a distinctive – and often nasty – smell. Bromhidrosis is formed by the Apocrine glands. These produce a greasy substance called sebum that is discharged into hair follicles.

Hyperhidrosis is controlled by the sympathetic nervous system, although many other factors also influence it – such as heat or local heat, psychological effects (embarrassment or fear), some hormones, some drugs, some sorts of food.

What you should expect

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.

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 Prof Whiteley or one of his colleagues. Prior to the sweat test you will also be given a list of do’s and don’ts.

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 cotton wool pads under your arms. You will then be asked to return to the waiting room.

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
  • Any 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.

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).

The Patented Whiteley Laser Sweat Ablation Cannula - if this is not used, then the procedure is not Laser Sweat Ablation

The Patented Whiteley Laser Sweat Ablation Cannula – if this is not used, then the procedure is not Laser Sweat Ablation

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.