Hyperhydrosis, The facts:

What Is Hyperhidrosis?

Throughout every day, our bodies perspire to regulate temperature — a normal, essential process. In some people, however, perspiration is far beyond what the body needs. This condition is known as hyperhidrosis: the production of sweat beyond what is physiologically necessary to cool the body.

Hyperhidrosis most commonly affects the hands, feet, armpits, and face — but unlike normal sweating, it occurs regardless of heat, activity, or emotional state. It is unpredictable, uncontrollable, and significantly impacts daily life.

The Sympathetic Nervous System: The Root Mechanism

The sweating process is controlled by the Sympathetic Nervous System — an involuntary nerve network that regulates the approximately five million sweat glands distributed throughout the body. Remarkably, about two-thirds of the body’s sweat glands are located in the hands alone.

In hyperhidrosis, specific segments of this nerve network become overactive — “supercharged” in their signalling — causing the sweat glands to produce far more than the body requires. The primary structure responsible is the Thoracic Sympathetic Ganglion Chain, which runs along the vertebrae inside the chest cavity. This is the nerve chain directly targeted by Endoscopic Thoracic Sympathectomy (ETS).

The Genetic Factor

A definitive single cause for primary hyperhidrosis has not been established, but the evidence for a genetic origin is strong. In Dr. Basseri’s patient studies, approximately 40% of patients show a clear genetic pattern. Other studies have reported an even higher percentage of genetic origin. The condition often runs in families and typically begins in childhood or adolescence — consistent with an inherited predisposition.

Researchers around the world continue to study the exact genetic mechanisms involved. The goal is not only to understand the cause more precisely, but to enable increasingly targeted and effective treatments.

A Brief History of Surgical Treatment

For decades, patients tried herbal remedies, topical lotions, and oral medications to manage hyperhidrosis. None provided lasting relief. The surgical approach to hyperhidrosis began roughly 60 years ago — but early procedures required highly invasive operations through the neck, chest cavity, or back. The risk and recovery burden made these operations uncommon and unpopular.

The introduction of minimally invasive surgery transformed the field. Over the past 20 years, access to the sympathetic nerve chain evolved from open surgery to small endoscopic incisions. Over the last decade, the endoscopic approach was refined to a point where the procedure can be performed on an outpatient basis — the patient returns home the same day. The operation is highly precise with a very low complication rate.

Continuous Improvements in Technique

The field continues to advance. Two of the most significant improvements in recent years are:

• Clamping versus cutting: The clipping method uses titanium clips to interrupt the nerve rather than permanently cutting it. This preserves the theoretical possibility of reversal and has shown comparable efficacy to the cutting approach.
• Sympathectomy level refinement: Earlier procedures targeted the T2 level (second rib). Shifting to the T3 and T4 levels has meaningfully reduced the incidence of compensatory sweating — particularly in more severe cases — without compromising the primary success rate.

These refinements reflect a commitment to optimising not just the resolution of hyperhidrosis, but the overall quality of outcome for each patient. Our 99.2% success rate across more than 9,400 procedures is the result of decades of continuous improvement.

Research and Recognition

The Center for Hyperhidrosis has contributed significantly to the published medical literature on sympathectomy. Dr. Basseri and Dr. Reisfeld have authored multiple peer-reviewed studies, presented at international surgical symposiums, and have been featured across major media including CBS, FOX, 48 Hours, Newsweek, and Heart & Soul. Their work has helped establish the standards of care followed by hyperhidrosis specialists worldwide.

To learn more about our published research, visit the hyperhidrosis research section.