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Hyperhidrosis | Sweating
Treatments for Hyperhidrosis and Facial | Hand | Body | Feet | Scalp Sweating

Sweating is a normal physiologic response to excessive heat, but some people sweat profusely from their hands, feet, and armpits. This sweat can sometimes be so debilitating and life-changing that it is known as Hyperhidrosis.  If sweating is excessive and is localized to a specific area regardless of environmental temperature, a condition known as primary focal hyperhidrosis may be made. This condition typically affects approximately one to two percent of the normal adult population and can affect the face, back, chest, axilla, palms, feet, and private areas of the body.

Primary hyperhidrosis has many causes and can be effectively treated by Dr. Karamanoukian, a board certified plastic surgeon in Los Angeles.

Patients with specific areas of hyperhidrosis, in which sweat is produced in excessive quantities, can benefit from antisweat injections,  suction curettage, Miradry treatment, Robinul, iontophoresis, and laser sweat therapy. 

Hyperhidrosis is a difficult condition that is associated with abnormal sweating from a particular part of the body. Most commonly, hyperhidrosis occurs on the palms, feet, underarms, face, and scalp.  How do you know if you have hyperhidrosis?  Well, Dr. Karamanoukian has specialized tests to determine the quantity of sweat, but usually this is not necessary.  Hyperhidrosis is related to excessive sweat that is not related to core body temperature or the environment.

There are countless individuals living with hyperhidrosis and excessive sweating. Although there are common patterns among patients with hyperhidrosis, symptoms vary from person to person and the severity of sweating.  For many patients, excessive sweating is a debilitating condition that affects one’s quality of life. Hyperhidrosis can be exacerbated by daily stress, the environment, social interactions, or strenuous exercise.  Unlike physiologic sweating, hyperhidrosis does not necessarily reflect the ambient temperature in a room.  Patients can sweat regardless of core body temperature as the mechanism of pathologic sweating does not correlate with heat transfer. Emotionally, the impact of excessive sweating can be severe, with patients often avoiding social and work situations because of the amount of sweat exuding from their face, armpits, hands, and feet.


The most common areas for hyperhidrosis are the face, trunk, axilla, palms, and feet.  Facial hyperhidrosis can be associated with facial flushing, whereas other areas do not correlate as well with skin blushing.  Due to the hyperstimulated sweat glands, patients with hyperhidrosis constantly sweat to a degree that is both emotionally and physically debilitating. 


The treatment of hyperhidrosis or excessive sweating begins with careful examination and history taken by Dr. Raffy Karamanoukian, a national specialist on hyperhidrosis and the management of excessive sweating.  The causes of excessive sweating are multifactorial and include increased nerve innervation or increased sweat gland response to normal innervation. 


Treatments are effective and Dr. Raffy Karamanoukian, a board certified plastic surgeon and hyperhidrosis specialist, can provide you with details for surgical or non-surgical management of hyperhidrosis.  Hyperhidrosis and excessive sweating can be difficult to treat because of intrinsic factors that may exacerbate the sweating. Dr. Karamanoukian will likely begin your treatment with conservative measures and will then evaluate your improvement during follow-up visits for hyperhidrosis.  Excessive sweating can lead to many emotional and social challenges and it is imperative for Dr. Karamanoukian to maintain close observation of your progress, even if the hyperhidrosis resolves with initial treatment. 


Excessive sweating can be treated primarily with observation and/or localized treatment with antiperspirants in the hair-bearing areas of the armpits or pubic area. Antiperspirants are less likely to work on the palms or feet as the sweat usually dilutes the antiperspirants and leads to diminishing benefit over the course of a day.  Prescription antiperspirants are also available during your consultation and these are stronger but more irritating to the skin.  For those with lifestyle-altering hyperhidrosis, Dr. Karamanoukian can prescribe an anticholinergic prescription medication for those patients who have uncontrolled hyperhidrosis but who do not wish to undergo surgical management. 


Botox therapy is a primary mode for treatment of hyperhidrosis on the palms, armpits and feet and results can last from four to six months, but  patients often report pain during injection.  Dr. Karamanoukian uses a Zimmer Chiller and topical creams such as LidoMax to numb the area prior to administration of Botox for palmar or plantar hyperhidrosis. 


Dr. Karamanoukian is a national expert on suction curettage of hyperhidrosis which provides permanent relief in many patients who suffer from axillary hyperhidrosis.  Dr. Karamanoukian also treats hyperhidrosis with a laser that can destroy overactive sweat glands and reduce hyperhidrosis. This innovative treatment can provide relief for small areas of hyperhidrosis including the axilla, palms and feet.

Although facial blushing seems unrelated to hyperhidrosis, it represents a parallel problem for those that have a hypersympathetic response to normal stimuli. Facial blushing or redness can occur as a result of rosacea, normal vascular skin tone, or from a hypersympathetic response that causing excessive redness and blushing in response to stimuli.  Our current treatment of choice for facial blushing includes the VBeam pulsed dye laser.  This innovative treatment uses light energy to destroy unwanted and defective blood vessels near the surface of the skin. 

Schedule an appointment for VBeam pulsed dye laser in our Los Angeles plastic surgery office by calling (310) 998-5533. 


Everyone who has hyperhidrosis has a different variant of the problem. The severity of hyperhidrosis, coupled with the distribution of the problem make it unique from individual to individual.  Sweaty feet can be a major source of problem for many individuals because the sweat can interfere with normal daily activities and can impact one's social and emotional well being.  Although it is often easier for patients to conceal their sweaty feet compared to sweaty palms, they both represent big problems for patients.  

The treatment options for sweaty feet include sympathectomy, Robinul oral therapy, laser therapy, and antisweat injections such as Botox Medical, Xeomin, and Dysport.  All of these options have pros and cons and your consultation with Los Angeles surgeon Dr. Raffy Karamanoukian can help identify the procedure of choice for your condition. Excessive sweating in the feet is most commonly treated with Botox Medical until the therapy because resistant to routine treatment.  


A new laser system is now available to reduce sweating of the armpits and hands.  The laser is calibrated to focus energy on the active sweat glands that are causing excessive sweating and perspiration and effectively modifies their ability to produce sweat.  Patients who are not surgical candidates for surgical sympathectomy may be candidates for the hyperhidrosis laser.  




Clinicians who treat hyperhidrosis often use a severity scale to characterize just how bad the excessive sweating is in a person's life. The Hyperhidrosis Disease Severity Scale (HDSS) is a 4-point scale can provide some objective insight into the degree of hyperhidrosis in an individual.  The scale ranges from Severity 1 to Severity 4 as follows:


    1. Underarm sweating never noticeable and never interferes with daily activities
    2. Sweating tolerable and sometimes interferes with  daily activities
    3. Sweating barely tolerable and frequently interferes with daily activities
    4. Sweating is intolerable and always interferes with my daily activities



Recovery is minimal after Botox injections for hyperhydrosis on the palms and armpits.  Usually, the procedure takes about 15 to 30 minutes to perform, followed by administration of pressure with a sterile gauze or icepacks. Patients are able to return to work or normal activities immediately thereafter.  Some patients will develop some bruising, so avoidance of aspirin and other blood thinners is essential. Most patients will report a decrease in symptomatic axillary and palmar sweating approximately one week to two weeks after administration of Botox or other Botulinum based neurotoxins.  Regular intervals of treatment provide effective symptomatic relief of hyperhidrosis and Dr. Karamanoukian has incorporated several anesthetic techniques to minimize pain during treatment with Botox for hyperhidrosis.  

Our surgeon, Dr. Raffy Karamanoukian is now evaluating preliminary data from MiraDry treatments for axillary hyperhidrosis.  Miradry is a new treatment that uses heat to effectively destroy terminal sweat glands on the axilla that are causing hyperhidrosis.  These sweat glands are overactive and the MiraDry system can eliminate the glands, thereby reducing the production of sweat on the axillary or underarm skin.  Dr. Karamanoukian currently recommends the Retrograde Suction Curettage system for hyperhidrosis as the long term outcome from patients treated for axillary hyperhidrosis has been extremely positive.  Consultation for axillary hyperhidrosis with Dr. Karamanoukian will include a discussion of the available options for you, including Retrograde Suction Curettage and Miradry.  


  1. How do you pronounce hyperhidrosis? Hyperhidrosis (“hy-per-hy-droh-siss”).  Hyperhidrosis is a benign skin condition characterized by overactive sweat glands that do not respond to normal room temperature. 
  2. What is the starch iodine test for hyperhidrosis? The starch iodine test is an old and established test to determine the extent of hyperhidrosis and allows doctors to gauge the level of improvement after hyperhidrosis treatment has been started.  The test begins with identifying the area of excessive sweat.  An iodine solution is then applied onto the skin and allowed to dry.  Starch is then placed onto the area and if there is sweat, the wet iodine begins to turn the starch a darker purple color.  Our Los Angeles hyperhidrosis clinic utilizes the test when appropriate. 
  3. What are some common areas of hyperhidrosis? In our office, we see many patients with hyperhidrosis and have found that the most common areas of treatment include the face, scalp, armpits, hands, and feet.  Other areas of hyperhidrosis may be the genital area and pubic areas, followed by the abdomen and back. 
  4. Does it matter if my hyperhidrosis happens at night or in the day? What we try to determine is whether your excessive sweat production occurs in response to your body temperature, room temperature, or independent of the surrounding temperature.  Night sweats may have other causes, so it is best to obtain a hyperhidrosis consultation or even a second opinion. 
  5. What are some common treatments for hyperhidrosis? The most common treatments for hyperhidrosis include Botox injections, laser, ETS, endoscopic thoracic sympathectomy, iontophoresis, Robinul, antiperspirants, Miradry, and Suction currettage. Dr. Karamanoukian can help you understand the different options for hyperhidrosis during your consultation in our Los Angeles plastic surgery office. 
  6. Is the Retrograde Suction Curettage procedure right for me if I have chapped skin on my armpits as a result of Aluminum Chloride antiperspirants?  If your hyperhidrosis procedure is causing chapped skin on your armpits as a result of antiperspirant use, you may benefit from a more definitive approach to hyperhidrosis.  The first step would be to consider a procedure known as MiraDry or Retrograde Suction Curettage to improve the underarm sweating. 
  7. What are the names of some of the antisweat injections that are used for hyperhidrosis? Antisweat injections are used to treat hyperhidrosis, and these include Botox Medical, Xeomin, and Dysport.  All three of these medicines can be used to treat sweating from the inside out, namely, to deactivate the release of acetylcholine that regulates the production of sweat.  In treating the sweat glands with Botox or other neurotoxins, these antisweat injections can reduce the overall output of sweat from these problematic areas.  The most common areas for antisweat injections include the hands, feet, and face.  
  8. Is there a genetic predisposition to develop hyperhidrosis? It is still not clear whether genetics plays a role in hyperhidrosis.  Certainly, in our Los Angeles hyperhidrosis clinic, we see patients who have family members with hyperhidrosis and others who do not have a single family member with the problem.  Genetics may play a role, but at the current time, this information does not help us in deciding on treatment choices for hyperhidrosis.  

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