Excessive sweating: when surgery for hyperhidrosis may be recommended
Drying one’s hands before shaking hands, avoiding certain colours of clothing or constantly worrying about sweat patches can become habitual behaviours for those suffering from hyperhidrosis. Sweating is a natural bodily function. However, when it occurs intensely, even at rest or in cool conditions, and interferes with everyday activities, it may be a medical condition requiring assessment.
Hyperhidrosis frequently affects the hands, armpits, feet or face. Its impact depends not only on the amount of sweat, but also on how it affects a person’s life: working with documents or electronic devices, using tools, choosing clothes, taking part in certain activities or interacting with others naturally.
There are various treatments available to manage it. In some patients, particularly when hand sweating is severe and other options have proved insufficient, a minimally invasive procedure may be considered: clip-based thoracic sympathectomy.
Dr Javier Gallego Poveda, a specialist in Thoracic Surgery, co-director of the Sweat Clinic at the Publio Cordón Memorial Hospital and an international authority on minimally invasive thoracic surgery, explains in which cases it may be indicated and what patients need to know before making a decision.
When can excessive sweating be hyperhidrosis?
Normal sweating increases with exercise, heat or certain emotional situations. In hyperhidrosis, however, the body produces more sweat than is necessary to regulate temperature. It usually begins at an early age, appears symmetrically and is localised to specific areas. Many people experience frequent episodes without any obvious cause, even in cool environments or during activities that do not require physical exertion.
Before making a diagnosis, it is important to rule out the possibility that the sweating is related to another medical condition, a hormonal change or certain medicines. This distinction is important because treatment will depend on the underlying cause.
“Not everyone who sweats a lot is in the same situation,” explains Dr Gallego Poveda. “The assessment must identify where the sweating occurs, when it started, and to what extent it is interfering with daily life.”
What treatments are available before surgery?
Surgery is not usually the first line of treatment. Depending on the affected area and the severity of the symptoms, specific antiperspirants, iontophoresis, botulinum toxin injections or certain medications may be used.
The choice depends on factors such as age, the type of hyperhidrosis, the response to previous treatments and the patient’s preferences. Some alternatives offer good control, although they may require regular applications or sessions.
Surgery is considered when excessive sweating continues to be highly debilitating and the patient wishes a permanent solution
In which cases might surgery be indicated?
Thoracic sympathectomy offers the most consistent results for primary palmar hyperhidrosis, particularly when the hands remain habitually damp or wet and the problem significantly affects professional, social or personal life.
Some cases of underarm sweating or facial flushing may also be considered, although the indication and expected outcome must be assessed on a case-by-case basis.
Before recommending the procedure, the medical team assesses:
The area and intensity of the sweating.
Its impact on daily life.
Any previous treatments.
The existence of any other possible causes.
The expected benefits and possible side effects.
The recommendations of the Society of Thoracic Surgeons emphasise that the extent of intervention on the sympathetic nervous system should be chosen according to the affected area and that the decision must be tailored to the individual. As Dr Gallego points out, ‘the operation must be adapted to each patient’s sweating pattern. Precision begins long before entering the operating theatre.”
How is clip-assisted thoracic sympathectomy performed?
Clip-assisted thoracic sympathectomy is a minimally invasive procedure carried out in the operating theatre, under deep sedation or general anaesthesia, and usually lasts between 15 and 20 minutes.
The surgeon makes two small incisions of approximately 5 millimetres beneath the armpits. Through one of these, they insert a high-definition camera, and through the other, very fine surgical instruments.
The camera allows the surgeon to locate the sympathetic chain, a group of nerves situated inside the chest that helps control sweating. A small titanium clip is placed at the chosen site to interrupt the nerve signals responsible for excessive sweating.
The exact location of the clip varies from patient to patient. It is selected depending on whether the hyperhidrosis mainly affects the hands or armpits, or manifests as facial flushing. This planning allows the procedure to be tailored to the specific characteristics of each case.
The effect on sweating of the hands and armpits is usually noticeable immediately. There may also be a reduction in sweating on the feet, although the response in these areas is more variable. “It is a brief procedure, but it requires great precision,” explains the specialist. “The point we treat must be chosen according to each patient’s sweating pattern.”
A generally rapid recovery
The small size of the incisions minimises the impact on the chest wall and promotes an early recovery. Discomfort following the procedure is usually mild and can be managed with pain relief medication prescribed by the medical team. It is not usually necessary to leave chest drains in place.
After spending a few hours under observation and confirming that recovery is progressing well, most patients can return home the same day.
During the first few days, you may experience slight discomfort around the incision sites or a feeling of tightness in the chest. A return to normal activities is usually quick, although this will depend on each individual’s recovery and the type of activity they undertake.
What results can be expected?
Thoracic sympathectomy yields its most consistent results in patients with severe primary palmar hyperhidrosis.
The team at the Sweat Clinic, comprising Dr Gallego and Dr Diego González Rivas, currently performs over 400 procedures a year, a figure that has remained consistent on average over the last five years. This makes it one of the teams with the highest annual volume of surgical cases for the treatment of this condition.
A study published in 2025 in the *Journal of Clinical Medicine* analysed 180 patients treated by means of clip placement on the sympathetic chain. The researchers assessed the reduction in sweating, satisfaction with the procedure and perceived changes in daily life.
The treatment successfully controlled sweating in approximately 96 per cent of the cases assessed. A similar proportion of patients reported an improvement in their quality of life, particularly when carrying out manual tasks and socialising. Over 94 per cent stated that they would undergo the procedure again.
Although these are very favourable results, the study was conducted at a single centre and is partly based on the patients’ own reports. Therefore, its conclusions must be interpreted within that context.
Another study, also published in 2025, investigated the duration of the results of thoracic sympathectomy. The authors contacted individuals who had undergone the operation approximately twenty years earlier and compared their current situation with that recorded before the surgery and during the first year of follow-up.
Among the patients who could be traced, the reduction in hand sweating was maintained and the level of satisfaction remained high. The study provides valuable information on the potential duration of the benefit, although only 24 of the 106 initially evaluable patients completed the twenty-year follow-up. For this reason, the results cannot be generalised without caution.
Taken together, these studies support the view that surgery can provide rapid and sustained improvement in appropriately selected patients, particularly when the problem is confined to the hands.
‘The outcome is not measured solely by a reduction in sweating,’ notes Dr Gallego Poveda. ‘It is also important that the person is able to work, socialise and carry out their daily activities without constantly being self-conscious about their hands.’
Can clip surgery be reversed?
One of the features of this technique is that the titanium clips can be removed via a further operation. However, this does not mean that the procedure is completely reversible. The sustained pressure on the nerve can cause changes to its fibres, so removing the clip does not guarantee that nerve function will be fully restored or that side effects will disappear.
Some people may experience an improvement after the clips are removed, particularly when this is done at an early stage, but the outcome varies.
The possibility of removal should therefore be understood as a technical option rather than a guarantee. The initial decision must be made in the knowledge that some of the effects of the procedure may persist.
The pre-operative assessment determines the true value of the surgery
Clip-based thoracic sympathectomy can offer significant and lasting improvement, particularly when hyperhidrosis severely affects the hands and other treatments have failed to control the problem.
Before recommending it, it is necessary to confirm the diagnosis, rule out other causes of sweating and analyse the affected area, the severity of the symptoms, the treatments undertaken and their impact on daily life. The consultation also provides an opportunity to explain what results can reasonably be expected and to address any concerns regarding the procedure, recovery and possible side effects.
At the Sweat Clinic at the Publio Cordón Memorial Hospital, this assessment is carried out on an individual basis, combining the clinical evaluation of hyperhidrosis with expertise in minimally invasive thoracic surgery. As Dr Gallego Poveda summarises, ‘the best surgery is not the one that can be performed, but the one that the patient actually needs’.
Frequently asked questions about surgery for hyperhidrosis
When will the results be noticeable?
In patients with palmar hyperhidrosis, a reduction in sweating is usually noticeable immediately after the procedure.
Is an overnight stay required?
Usually not. If the recovery goes well, the patient can go home the same day.
Does the procedure leave visible scars?
The incisions are approximately 5 millimetres long and are made under the armpits, so they are usually barely visible once they have healed.
Does the operation stop sweating all over the body?
No. The surgery acts on the nerve signals related to specific areas. The body retains its ability to sweat in other areas.
Are the results permanent?
The improvement in palmar hyperhidrosis is usually long-lasting, although no procedure can guarantee exactly the same response in all patients.
A brief procedure for a problem that can affect your life for years
Clip thoracic sympathectomy is a minimally invasive procedure that is short in duration and generally involves a rapid recovery. In most cases, it does not require drains and allows patients to return home a few hours after the procedure.
In patients with severe palmar hyperhidrosis, it can provide an immediate and sustained reduction in sweating, with a positive impact on professional, social and everyday activities.
Its true value, however, does not depend solely on the technique. It begins with an accurate diagnosis, clear information and a treatment plan tailored to each individual’s circumstances.
About this content
This article is intended for general information purposes and has been prepared to facilitate a better understanding of the medical information covered. Its content is for guidance only and is not a substitute for an individual assessment or the recommendations of a healthcare professional.
The information in this article is provided for general awareness and does not replace an individualised medical assessment.
