If iontophoresis and botox are not treating the hyperhidrosis, the effected area of skin can be excised (usually only used for axillae), denervated with a sympathectomy, or liposuction can be performed to remove the sweat glands at the dermal/subcutaneous border (usually only used in axillae). The surgeries should only have to be done once, but are significantly more involved than the prior treatments discussed. The article in the Canadian literature referenced yesterday has a nice discussion about when to use which treatment. And Emedicine has a good summary of the surgical procedures.
Boni R. Tumescent suction curettage in the treatment of axillary hyperhidrosis: experience in 63 patients. Dermatology 2006; 213:215– 217.
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