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Hyperhidrosis ETS surgery
Condition Guide

Hyperhidrosis
Endoscopic Thoracic Sympathectomy (ETS) — a day-surgery treatment

Hyperhidrosis means sweating far more than the body needs to — most often the hands, underarms, or face. It can be stressful and affect work and confidence. When antiperspirants and other treatments haven’t worked, a short day-surgery procedure called ETS can stop the sweating at its source.

ETS (sympathectomy)
Procedure
Day surgery
Home same day
Keyhole
Minimally invasive
~1 week
Back to work

What is hyperhidrosis?

It’s overactive sweat signalling from a chain of nerves in the chest. In focal hyperhidrosis, specific areas — palms, underarms or face — sweat heavily even when you’re cool and calm. It isn’t dangerous, but it can really affect daily life.

Signs & symptoms

  • Dripping or clammy hands
  • Sweat that soaks through clothing
  • Paper getting wet or smudged when you write
  • Trouble gripping tools, sports equipment, or a phone
  • Sweating regardless of temperature or stress
  • Embarrassment in social or work settings

Hyperhidrosis often starts in childhood or the teenage years and can run in families. It isn’t caused by anxiety, though stress and heat can make it worse.

How it’s assessed

  • A review of where and how much you sweat
  • The HDSS severity scale (below)
  • Ruling out generalized, whole-body sweating from other causes
  • Checking that you’ve tried antiperspirants or Botox first

Treatment options

  • Strong antiperspirants and medications first
  • Botox injections for some areas
  • ETS keyhole surgery for the palms (hands) and underarms that haven’t responded
  • miraDry — a non-surgical option for underarm sweating
Patient tool
How severe is your sweating?

Take the one-question HDSS severity scale doctors use, and see how severe your sweating is and what to do next — in under a minute.

Open tool →
Patient tool · New
Virtual consultation: which treatment is next for you?

Answer a few questions and walk through the same treatment algorithm used in clinic — from prescription antiperspirants to Botox, miraDry, and ETS surgery.

Start →
Do you struggle with facial flushing or blushing? See the step-by-step treatment options — from medication and CBT to T2 sympathectomy surgery. →
Dr. Irshad’s approach

Endoscopic Thoracic Sympathectomy (ETS)

Through tiny keyhole cuts, Dr. Irshad interrupts the overactive nerves that drive sweating in the hands (palms) and underarms. It’s done as day surgery, so you go home the same day, and sweating in the treated areas usually stops right away.

He will explain compensatory sweating (sweating that can shift to other areas) so you can decide with full information.

Travelling from outside Ontario? See how out-of-province patients have ETS surgery in Toronto — virtual referral, what to expect, and travel tips. →

Your recovery, step by step

Hospital

Day surgery — home the same day.

Days 1–3

Mild chest soreness; most patients are back at work within about a week.

Week 2

Fully back to normal; sweating in the treated areas stops immediately.

Long term

Some patients notice compensatory sweating on the trunk or back — discussed before surgery.

Download recovery guide (PDF)A printable guide to take home.

Common questions

What’s the difference between primary and secondary hyperhidrosis?
Primary (focal) hyperhidrosis is heavy sweating in specific areas — palms, underarms, face or feet — with no underlying illness. It often starts young and can run in families, and it’s the type ETS is designed for. Secondary hyperhidrosis is sweating caused by another condition (such as a thyroid problem) or by a medication, and it tends to affect the whole body. Telling them apart matters, because secondary sweating is treated by addressing its cause — not by ETS.
What is compensatory sweating, and will it be a problem?
After ETS, the body sometimes redirects sweating to other areas such as the trunk, back or thighs. This happens to some degree in most patients, but is bothersome in only a minority. Dr. Irshad discusses this in detail so you can make an informed decision.
Is ETS covered by OHIP?
ETS for hyperhidrosis is covered by OHIP with a referral from your family doctor. The microwave sweat-gland treatment is considered elective and is not OHIP-covered; some private insurers may cover it if deemed medically necessary — check with your insurer.
I’ve tried antiperspirants and Botox. Is surgery really my next step?
For palm sweating that hasn’t responded to non-surgical treatments, ETS has strong evidence for long-term success, with high satisfaction and low recurrence reported in published studies.
Which areas can ETS treat?
ETS works best for sweaty palms, where success rates are very high, and can also help underarm sweating in selected cases. It is generally not recommended for sweating of the head and face only (cranial hyperhidrosis) or for sweaty feet, as these carry a higher chance of side effects or a poorer result. Dr. Irshad will advise which areas are likely to respond in your case.
Is there a non-surgical option for underarm sweating?
Yes. Yes — miraDry. It’s a non-invasive, in-office treatment that uses precisely targeted microwave energy to destroy the underarm sweat glands, with no surgery or incisions. Because those glands don’t grow back, the reduction in sweating is long-lasting, and most people see results after one or two short sessions with little downtime. It treats the underarms only (not the palms or face). As an elective treatment it isn’t OHIP-covered, though some private insurers may help if it’s deemed medically necessary.
Who is a candidate for ETS?
Good candidates have focal hyperhidrosis — heavy sweating confined to the palms, underarms, face or feet, with normal sweating elsewhere — who haven’t responded to antiperspirants or Botox. A thorough assessment is done before any recommendation.
Who is not a good candidate for ETS?
ETS gives the best results for focal sweating of the hands. Dr. Irshad has identified the following as risk factors for an unfavourable outcome, and they usually make someone unsuitable for ETS:
  • Night-time (nocturnal) sweating
  • Total-body (generalized) hyperhidrosis
  • An overactive thyroid (hyperthyroidism)
  • Sweating of the head and face only (cranial hyperhidrosis)
  • Morbid obesity (BMI over 35)
  • Medication-induced hyperhidrosis (sweating caused by a medication)
If one or more of these applies to you, Dr. Irshad will discuss other options that may suit you better.

Dedicated sweating clinic

Toronto Sweat Clinic logo

Toronto Sweat Clinic

Founded by Dr. Kashif Irshad in 2008 to serve patients living with excessive sweating, the Toronto Sweat Clinic brings together medically supervised treatment options for hyperhidrosis — from antiperspirants and Botox to the microwave sweat-gland treatment and ETS surgery — in one place.

Disclosure: Dr. Irshad founded and has a financial interest in the Toronto Sweat Clinic. The microwave sweat-gland treatment (miraDry) is a private service and is not OHIP-covered.

Visit torontosweatclinic.com @torontosweatclinic

Preparing for your surgery at William Osler

Your operation takes place at William Osler Health System (Brampton Civic Hospital). These are the hospital’s general instructions for getting ready, the day itself, and afterwards — always follow any specific advice Dr. Irshad gives you. Full details are on the Osler Surgical Services page.

Before your surgery
  • Do not eat anything (including gum) after midnight the night before. Unless told otherwise, you may have clear fluids — water, pulp-free juice, black coffee or tea — up to 2 hours before.
  • No alcohol, smoking, or marijuana for 24 hours before surgery.
  • Shower the evening before and the morning of surgery (with chlorhexidine soap if you have it). Skip lotion, perfume, makeup and nail polish.
  • Bring your OHIP card and photo ID, all your medications in their original containers (inhalers, insulin, supplements), and your CPAP machine if you use one.
  • Arrange a responsible adult to drive you home — a taxi, Uber or Lyft does not count, and surgery may be cancelled without one.
  • Leave jewellery, money and valuables at home.
The day of your surgery
Arrive about 2 hours before your scheduled time. Register at the central registration desk in the main lobby at Brampton Civic Hospital (2100 Bovaird Drive East), then go to the Day Surgery area. Staff will help you change, check your vitals, confirm the details from your pre-anaesthesia visit, and start an IV before you go to the operating room. Your family member can wait in the surgery waiting area.
After your surgery
You’ll wake up in the Post-Anaesthesia Care Unit, then move to Day Surgery or an inpatient room (or the Intensive Care Unit if you need closer monitoring). For the first 24 hours after the anaesthetic, have an adult with you, do not drive or operate machinery, avoid alcohol, and hold off on big decisions. A follow-up appointment is booked before you leave. Learn more about discharge and pain management.
The pre-anaesthesia clinic
Before your operation you’ll get a call from the pre-anaesthesia clinic for an education call or an in-person visit, where the team reviews your health, your medications and your anaesthetic plan.

Medically reviewed by Dr. Kashif Irshad, MD, MSc, FRCSC · Last updated July 2026

Ontario patients need a referral from a family doctor. Find the referral forms and clinic details below — out-of-province patients, see the section above.

Referral information →