Effectiveness of Liposuction for Axillary Hyperhidrosis
Liposuction-curettage of axillary sweat glands is highly effective for treating hyperhidrosis, with studies showing 76-89% excellent or good results and sweat reduction rates of up to 69% in patients. 1, 2
Mechanism and Technique
Liposuction-curettage works by:
- Physically removing or destroying both apocrine and eccrine sweat glands in the axillary region
- Using tumescent local anesthesia (typically lidocaine with epinephrine) for the procedure
- Often employing specialized cannulas like the Fatemi cannula for effective gland removal 1
Efficacy Data
The evidence strongly supports the effectiveness of this approach:
- In a study of 25 patients (50 axillae), 76% achieved excellent results and 22% good results 1
- Even for patients who didn't respond adequately to initial liposuction-curettage, a second procedure with an aggressive rasping cannula provided 69% sweat reduction in 89% of patients 2
- Quality of life improvements are significant, with 91% of patients reporting satisfaction after the procedure 3
Procedural Considerations
For optimal results, the procedure should include:
- Tumescent local anesthesia using lidocaine with epinephrine (maximum safe dose 55 mg/kg for patients weighing 43.6-81.8 kg) 4
- Warm anesthetic solution and slow infiltration rate to decrease patient discomfort during administration 4
- Starch-iodine testing to delineate the hyperhidrotic areas before and after the procedure 5
- Curettage in addition to liposuction for more complete removal of sweat glands 1
Advantages Over Other Treatments
Compared to other treatment options:
- More permanent solution than botulinum toxin injections, which require repeated treatments
- Less scarring compared to radical surgical excision methods
- Fewer complications than more invasive surgical approaches like sympathectomy
- One-time procedure versus ongoing medical therapy
Potential Complications and Limitations
The procedure is generally safe with minimal complications:
- Temporary ecchymosis (bruising)
- Minor local infections in some cases
- No severe side effects reported in the studies reviewed 1, 2
- Excellent aesthetic outcomes with minimal scarring (mean Vancouver Scar Scale 1.1 after surgery) 2
Alternative Options
For patients who may not be candidates for liposuction-curettage:
- Botulinum toxin injections (effective but temporary)
- Newer microwave energy thermolysis (minimally invasive) 6
- For palmar hyperhidrosis, wrist nerve blocks have shown efficacy 4
Follow-up Care
Post-procedure care should include:
- Regular application of bland emollients to prevent dryness
- Monitoring for any signs of infection
- Assessment of treatment efficacy through patient satisfaction and potentially repeat gravimetry
Liposuction-curettage represents a safe, effective, and relatively permanent solution for axillary hyperhidrosis with high patient satisfaction rates and minimal complications.