These two clinical manifestations are also thought to be the product of an overactive sympathetic activity. It was also found out that patients who had sweaty hands and were treated with sympathectomy their facial sweating and or facial blushing were partially or totally cured. This brought with it the notion that patients who suffer only from facial blushing and or facial sweating could also be treated with sympathectomy. As a matter of fact this became a popular option to treat those cases. Experience has shown that patients who only have facial manifestations (blushing and or sweating) will develop more easily severe compensatory sweating which will render those patients unhappy ones. For that reason at present Dr. Reisfeld is screening those patients even more carefully before going ahead with the surgery. Patients who suffer from only those two entities should try different conservative approaches.
Attempts to reduce the amount of patients who will develop severe compensatory sweating brought us to a careful consideration of the levels the sympathetic nerve is cut or clamped. Lowering the level of the sympathectomy has not yet given us conclusive results. Also lowering the sympathectomy level from T2 to T3-T4 is not as successful in reducing facial hyperhidrosis or facial blushing. In addition to this the results that were accumulated around the world did not show a clear success rate when sympathectomy is done for those two clinical entities (facial hyperhidrosis and facial blushing). These facts led leading doctors such as Dr. Reisfeld to not recommend sympathectomy for those two clinical presentations.
Facial Blushing also called social phobia or erythrophobia. Here there is abnormal reaction to otherwise normal social or functional stimuli in which the face and the neck area are reacting with sudden reddening of the skin. The exact reason is yet to be known but thought to be caused by an overactive sympathetic response. Usually this starts in the late teens.
At The Center For Hyperhidrosis Dr. Reisfeld believes at present the only indication for ETS is severe excessive hand sweating. There are some other surgeons who do not share this belief and continue to perform ETS for facial sweating and facial blushing. All patients are encouraged to have very serious and deeply comprehensive discussions with those surgeons who advocate the procedure.