About The British Institute for Blushing and Sweating 

The British Institute for Blushing and Sweating is based in London and is run by Mr David Greenstein MD BSc FRCS.  Mr Greenstein is a Leading Consultant Vascular Surgeon who has a special interest in the treatment of hyperhidrosis (excess sweating) and erythrophobia (blushing).

An operation to cure blushingBlushing

The constant fear of facial blushing (erythrophobia) or excessive sweating of the hands, face or armpits (hyperhidrosis) can result in a feeling of frustration and unhappiness. Many patients feel this condition often 'holds back' their life, both socially and at work. Some patients develop avoidance behaviour. Erythrophobia and hyperhidrosis can both be successfully treated by a new 'keyhole' surgical technique called endoscopic thoracic sympathectomy (ETS).

Hyperhidrosis treatment (excess sweating)

Excessive hand, facial or armpit sweating is usually caused by an overactive sympathetic nervous system. This nervous system is also known as the autonomic nervous system as we have no control over it. In addition these nerves can cause rapid facial blushing and as a result can lead to social embarrassment, social phobia and impaired quality of life.

These conditions can be significantly improved by dividing the sympathetic nerves using a technique known as endoscopic thoracic sympathectomy (ETS). Generalised body sweating as well as a more prolonged facial flushing do not respond well to ETS.

Non-operative treatment for hyperhidrosis

Non-operative treatment for hyperhidrosis should always be considered initially as ETS is irreversible. The mainstay of treatment for axillary (armpit) sweating is botulinum toxin injections, which are only effective for up to 12 months. These are less effective for palm sweating. These toxins are also used for the treatment of skin creases.  Psychological treatment as well as drugs such as beta blockers may help with facial blushing and social phobias.

Operative treatment for facial blushing and excess sweatingeblushing

The decision to operate for these distressing conditions must be weighed up against the risk of the potential complications and side effects associated with surgery. This can only be decided on an individual basis. Traditionally, ETS surgery is irreversible as the cut nerve does not regrow. However, a new technique which involve the clipping of the sympathetic nerve has the benefit that it can be reversed in 20-30% of cases if the side effects of surgery prove too severe.

Contraindications to surgery

ETS surgery is contra-indicated in patients who are obese or who have suffered from significant chest disease.  The procedure is also not indicated in elderly patients, patients with cardio-respiratory disease or patients who have previously had chest surgery.

After the surgery 

Often there can be some sharp pain around the wounds and sometimes the upper back, although this soon wears off. Return to work can be as little as 2 days post surgery, but the time can vary depending on the individual. Return to sporting activities can take up to two weeks. 

Conventional ETS surgery

This is 'keyhole' surgery that is performed under a general anaesthetic. Two small cuts are made in each armpit 0.5cm in diameter and the sympathetic nerve is divided. The wound is closed with dissolvable sutures and the scar is minimal. The procedure lasts approximately 40 minutes. A post-operative chest X-ray is performed to confirm full lung expansion. 

A new technique for ETS surgery

Clipping of the sympathetic nerve has been shown to be as effective as conventional ETS surgery in stopping blushing and sweating. It has the advantage in that it can be successfully reversed in 20-30% of cases should it be clinically indicated. The only reason to reverse the surgery is if the side effects are too severe.

Results of treatment

ETS surgery has an immediate effect. The hands become warm and dry, however the effect on facial blushing will only be noticed in the situations that elicited that particular response. Despite a successful result, patients may occasionally feel a tingling sensation which used to precede sweating or blushing. This can last up to a few months. In the first two weeks after the operation up to 30% of patients can experience 'rebound sweating'. This usually lasts for one day and can be thought of as the last outpouring of the sweat glands.

Current data reveal results of 93-99% immediate cure for palm sweating, 93-95% for axillary sweating and 97% for facial sweating. At 2-year follow-up these results are 87%, 68% and 76% respectively. For facial blushing the immediate technical success is 96%, reducing to 85% at 2 years.

Quality of life after ETS surgery

Evidence reveals that ETS in fully informed individuals improves quality of life.  For facial blushing 85% of patients reported that they were fully satisfied, 15% were to some degree dissatisfied and 2-4% of patients regretted having the operation.


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