Liposuction for axillary hyperhidrosis: Reconciling trial results and expert opinion

Primary focal axillary hyperhidrosis is a bothersome and potentially debilitating condition that affects up to 3 % of the US population. In recent years, treatment modalities have flourished. They include topical formulations, systemic medications, injectable neurotoxins, laser- and energybased procedures, and surgical interventions. Liposuction, or suction-curettage, of the axillae has emerged in the forefront of the surgical techniques to control axillary hyperhidrosis. The procedure entails infiltration of the axillary vault with tumescent anesthesia, followed by the passage of rasping cannulas at the dermal-subcutaneous fat junction, in an attempt to remove deep dermal eccrine glands. Satisfaction rates can reach up to 95-98 %, and treatment-related adverse effects are rare, ranging from hyperpigmentation to full-thickness necrosis. Despite the reported success rates, there is a lack of a standardized operative method. Surgical technique varies from surgeon to surgeon and over time, and rates of adverse effects are proportional to the aggressiveness of the surgical procedure. In the age of increasingly safe alternatives to surgery such as botulinum toxin injections and microwave thermolysis, the surgeon should and can achieve meticulous mastery of suction-curettage in order to safely perform the procedure with few complications, low recurrence rates, and high patient satisfaction.