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Palmoplantar Sweating
Palmoplantar Sweating or Hyperhidrosis of the Palms and Feet in Buffalo Niagara and Southern Ontario, Canada for


Dr. Karamanoukian established the Center for Excessive Sweating in 1999 and offers EVERY treatment for hyperhidrosis including Botox for hyperhidrosis of the underarms, Botox for hyperhidrosis of the palms and feet (palmoplantar hyperhidrosis), Botox for hyperhidrosis of the face, scalp and neck (craniofacial hyperhidrosis) and Botox for hyperhidrosis of the groin (Hexsel's hyperhidrosis), underbreast, torso, chest and back.


The Center for Excessive Sweating is a National Center of Excellence for Hyperhidrosis and Excessive Sweating.


Before a trial of Botox, we treat patients with non-prescription and prescriotion topical products containing aluminum chloride. These agents are applied directly to the skin in the affected areas of the body and can cause skin irritation. They are quite messy on clothing and unfortunately, have short periods of efficacy, requiring frequent reapplications. They include Drysol, Certain Dry and Hypercare among others. Lower strength aluminum chloride containing compounds should be tried before prescription strength antiperspirants are used as they can cause significant skin irritation and burning in some patients.


Anticholinergic medications aim to suppress the cholinergic stimulation of the eccrine sweat glands by the sympathetic nerve trunks to eliminate or reduce excessive sweating. Anticholinergic agents such as such as propantheline bromide, glycopyrrolate, oxybutynin and benztropine may be effective in treating hyperhidrosis. However, they may cause significant adverse effects, which include blurry vision, dry mouth and dry eyes, abdominal cramps, sexual dysfunction in men (rare), palpitations of the heart, among others. These side effects may limit their usefulness.


Palmoplantar hyperhidrosis is commonly treated in our Center with Botox injections. This requires special expertise as success depends on correct placement of the Botox for optimal success. Therapeutic Botox for the treatment of palmar or plantar (foot) hyperhidrosis requires special expertise and we have that expertise at the Center for Excessive Sweating.


Iontopheresis is an alternative treatment which utilizes an electrical stimulation to the hands. Patients are instructed to bathe thier hands in an electrolyte or tap water solution through which an electrical current is passed. This "stuns" the eccrine sweat glands of the hand, in effect decreasing the "sweat reflex" for periods of hours to weeks. Most patients find this mode of treatment as ineffective and not of durable benefit. Iontophoresis is contraindicated for craniofacial hyperhidrosis (scalp, head) and is very impractical for hyperhidrosis of the underarms and rarely effective for hyperhidrosis of the underarms. Hyperhidrosis devics can be purchased online and those interested in trying this treatment are urged to buy these machines and to try them. WE DO NOT SELL iontophoresis products or devices.


When the less invasive medical treatments have failed to provide adequate treatment, hyperhidrosis can be effectively treated through surgical intervention. This is an important point, as most insurers want documented failure of conservative therapy before endoscopic thoracic sympathectomy is approved.


Hyperhidrosis surgery has come a long way in the last decade. Traditionally, large incisions were made in the chest to surgically interrupt the sympathetic trunk.

Micro ETS


With the advent of minimally invasive techniques to work in the chest via endoscopes and surgical instruments, Dr. Karmanoukian and other leading cardiothoracic surgeons have evolved a procedure called Micro ETS which is very effective in treating patients with sweating of the hands, underarms, face, scalp as well as patients that have facial blushing.


Dr. Karamanoukian, Director of The Center for Excessive Sweating has pioneered a variant of Micro ETS (Endoscopic Thoracic Sympathectomy) coined STITCH, Sympathetic Trunk Interruption with Titanium Clips for Hyperhidrosis.


The STITCH procedure is a revolution in Micro ETS for excessive sweating. With the STITCH technique,  the incision is smaller and less invasive than traditional Micro ETS procedures.


This is the most durable treatment for hyperhidrosis when performed by experienced hands. Clipping the thoracic sympathetic trunk at the appropriate levels will immediately eliminate hyperhidrosis.


It is not uncommon for patients to wake up from anesthesia and almost immediately take note of a dry hand or underarm. With modification of the level of sympathectomy, compensatory hyperhidrosis is also minimized or eliminated.


Micro ETS or Sympathetic Trunk Interruption with Titanium Clips for Hyperhidrosis (STITCH) can be performed with minimal side effects and excellent outcomes. The procedure is performed in an outpatient setting and takes less than 45 minutes to complete, including anesthesia time. In most cases this procedure is covered by medical insurance.


'Hyperhidrosis Expert Series - Excessive Sweating of the Palms' is a book about hyperhidrosis written by Hratch L Karamanoukian MD FACS and Raffy Karamanoukian MD FACS. 


 Excessive Sweating of the Palms


Dr. Karamanoukian has written 5 books about hyperhidrosis and will send you a free copy upon request. Go to and request your FREE pdf copy.

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