Experience of Tumescent Liposuction in the Treatment of Osmidrosis

Minimally invasive 1,444-nm Nd:YAG laser treatment for axillary bromhidrosis

Background

Axillary bromhidrosis is an apocrine glands hyperactivity disease.

Methods

A total of 24 patients (15 men and 9 women) with axillary bromhidrosis underwent a laser procedure with a 1,444-nm Nd:YAG laser. Parameters evaluated in this study were as follows: the degree of malodor (T0, baseline; T30, after 1 month; and T180, after 6 months), postoperative pain, short-term decreased mobility (T1, after 1 day; T7, after 7 days; and T30, after 1 month), and overall satisfaction (T30, after 1 month and T180, after 6 months). A visual analog scale (VAS), from 0 to 10, was used to assess pain and decreased mobility, with lower values denoting less severity.

Results

A total of 24 patients were followed up for 6 months after laser treatment. At baseline, all patients (100%) complained of a strong axillary malodor (mean degree of malodor at T0 = 2.0 ± 0.00). It decreased to 0.50 ± 0.64 at T30. At T180, the degree of malodor was 0.54 ± 0.57. Both T30 and T180 degrees of malodor significantly decreased from the baseline value (p < 0.01). The mean degree of patient satisfaction at T30 was 1.75 ± 0.52, and at T180, it was 1.67 ± 0.21. Among the 24 patients, eight complained of moderated pain 1 day after treatment. The pain subsided on day 7, except for two patients, with VAS = 1. Pain and mobility restrictions were in any case resolved within T30.

Conclusion

Treatment with a 1,444-nm Nd:YAG laser for subdermal interstitial coagulation could be a less invasive and more effective option treatment for axillary bromhidrosis.

Refined tumescent liposuction-curettage with pruning in small incisions for treatment of axillary bromhidrosis

Axillary bromhidrosis is a widespread social problem in our society. Various modalities have been developed for the destruction or removal of the apocrine sweat glands to eliminate underarm odor. However, conventional surgical treatments often result in a high complication rate and frequent recurrence. In this study, we aimed to evaluate the effect of refined tumescent liposuction-curettage with pruning in small incisions as treatment for axillary bromhidrosis. Between July 2013 and April 2019, 110 patients (75 women and 35 men) with axillary bromhidrosis underwent refined tumescent liposuction-curettage with pruning. The results of eliminating underarm odor were evaluated by both the patients and doctors and rated as very satisfied (excellent), satisfied (good), slightly satisfied (fair), and not satisfied (poor). Postoperative complications, such as dehiscence, infection, wound contracture, cyst, subcutaneous hydrops, hematoma, or seroma, were also evaluated. Preoperative and postoperative histological examinations of axillary tissues were performed in two patients. In the subjective evaluation of 110 patients, 33 (30.0%) were very satisfied with the results, 70 (63.6%) were satisfied, and seven (6.4%) were slightly satisfied. The objective evaluation showed that 43 (39.1%) patients graded the results as excellent, whereas others graded the results as good. No serious complications occurred, except three patients with slight local subcutaneous hydrops and hematoma. Histologic examinations showed that the apocrine glands were significantly decreased or destroyed after the surgery. Refined tumescent liposuction-curettage with pruning in small incisions is an effective method for the treatment of axillary bromhidrosis.

Versajet-Assisted Hydraulic Epilation Through Small Incisions for Axillary Osmidrosis

Background

Osmidrosis is a malodorous disease caused by the breakdown of sweat secreted from the apocrine glands by surface bacteria. The aim of this study was to evaluate the effect of Versajet-assisted hydraulic epilation for the treatment of axillary osmidrosis.

Methods

Thirty-two patients with axillary osmidrosis (64 axillae) underwent Versajet-assisted hydraulic epilation between January 2016 and January 2017. Subjective assessments were evaluated by a patient survey at least 3 months after the procedure.

Results

There were no complications other than one mild pigmentation in the axilla at 3 months after the procedure. Thirty-two patients evaluated malodor elimination as good. No patients evaluated it as fair or poor. There were no recurrences.

Conclusion

Versajet-assisted hydraulic epilation is an ideal surgical procedure for the treatment of axillary osmidrosis that decreases complications and recurrence.

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Surgical treatment of axillary hyperhidrosis by suction-curettage of sweat glands

Suction curettage is a dermatologic surgery technique for the treatment of axillary hyperhidrosis, which is becoming more popular.

OBJECTIVE

The purpose of this study is to describe the current technique of removal of axillary sweat glands, and evaluate its efficacy and safety.

CONCLUSION

Suction-curettage of sweat glands is a minimally invasive surgical technique that is easy to perform, safe, has high rates of success and relatively few side-effects. It is generally well tolerated by patients and requires shorter time away from daily activities, when compared with other surgical modalities.

Axillary hyperhidrosis and osmidrosis treated by ultrasonic surgical aspiration compared with transthoracic endoscopic sympathectomy

BACKGROUND

Axillary hyperhidrosis (AH) and/or osmidrosis (AO) are characterized by excessive sweating and/or malodor that originate from axillary sweat glands. The condition often causes emotional, social, and professional embarrassment. Although there have been various therapeutic modalities, none has proved entirely satisfactory. In this report, we compared the results of 2 minimally invasive therapeutic modalities (transthoracic endoscopic sympathectomy [TES] and ultrasonic surgical aspiration [USA]) in terms of efficacy and complications and demonstrated which is the better choice of treatment of AH and AO.

METHODS

In the past years, we have treated patients of AH and/or AO with TES by electrocoagulation of T2 and T3 segment of the thoracic sympathetic trunk. On the other hand, we treated patients with AH and/or AO by using USA with endoscopic confirmation for adequate removal of axillary secretion glands and subcutaneous fat.

RESULTS

During the past 7 years, 20 patients with AH and/or AO were treated with TES, in which AH obtained adequate relief but AO with only partial alleviation. Only 2 patients showed clinical significant recurrence in 2 years' follow-up. About one half of the patients were complicated with compensatory hyperhidrosis. From May 2005 to April 2006, 55 patients with AO and/or AH were treated with USA. Most patients (91%) obtained adequate relief of AH and AO with minimal wound complications. In the 1-year follow-up, no clinical recurrence was encountered except 2 patients who belonged to the early series of this study.

CONCLUSION

Based on our clinical experience with the 2 therapeutic techniques (TES and USA), USA is direct removal of local target tissue (secretion glands) and can avoid major wound complications. It has been proven that USA is more logical and effective than TES, which is less effective and often complicated with unwanted compensatory hyperhidrosis. Ultrasonic surgical aspiration aided with endoscopic confirmation is a minimally invasive technique and is considered as the treatment of choice for AO and/or AH.

Laser Doppler scanning study of axillary skin before and after liposuction curettage in patients with focal hyperhidrosis

BACKGROUND

Minimally invasive surgeries are frequently used in patients suffering from focal axillary hyperhidrosis (FAH). Sweat glands are removed surgically and the axillary skin is thinned out, with skin necrosis being a possible complication due to reduced microcirculation. Although of considerable interest, studies evaluating pre- and postoperative skin perfusion are unavailable.

OBJECTIVE

To evaluate the blood flow of axillary skin in patients with severe focal axillary hyperhidrosis before and after liposuction curettage (LC).

MATERIAL AND METHODS

The blood flow in the axillary skin of 11 patients was measured by laser Doppler perfusion imaging before surgery and on days 1, 7 and 28 after LC with a rasping cannula. Skin perfusion was measured in arbitrary units (AU) with measuring points in the axillary center (AC), the operated skin 2 cm from the center (2C) and the surrounding healthy skin (HS).

RESULTS

No significant differences of preoperative skin perfusion were found (AC: 0.39 +/- 0.08 AU/2C: 0.38 +/- 0.07 AU/HS: 0.39 +/- 0.07 AU; p > 0.05). On the first and seventh postoperative days, AC (0.2 +/- 0.04 AU/0.27 +/- 0.81 AU) and 2C (0.2 +/- 0.03 AU/0.28 +/- 0.06 AU) area were significantly less perfused, whereas the HS showed higher perfusion values (0.59 +/- 0.1 AU/0.53 +/- 0.09 AU). Twenty-eight days after LC the 2C (0.36 +/- 0.07 AU) and HS (0.4 +/- 0.06 AU) skin revealed no significant differences compared to preoperative skin perfusion (p > 0.05). The AC perfusion was still slightly reduced (0.37 +/- 0.09 AU) without significant difference compared to preoperative findings.

CONCLUSION

LC reduces the axillary skin blood flow with the axillary center being the least perfused area. However, in our collective, no correlation to possible side effects was observed.

Repeat liposuction-curettage treatment of axillary hyperhidrosis is safe and effective

BACKGROUND

Liposuction-curettage (LC) is an effective surgical therapy option for axillary hyperhidrosis, with less scarring compared with radical excision of axillary skin. Although this method has proven to be effective, the treatment of nonresponders to minimally invasive surgery has not been previously defined. Whether these patients benefit from a second surgical procedure has not been evaluated so far.

OBJECTIVES

To investigate efficacy and side-effects of a second LC with an aggressive rasping cannula in patients with insufficient prior surgery.

METHODS

Nineteen nonresponders to prior LC (13 female and six male) underwent a second LC with a rasping cannula. Gravimetry was performed before and 8 months after surgery. Side-effects, patient satisfaction, the surgeons' intraoperative evaluation and the Vancouver Scar Scale (VSS) before and after surgery were documented.

RESULTS

Sweat rates showed a reduction of 69% in 17 (89%) patients. Two patients (11%) did not respond to surgery. Eighty-four per cent of all patients were completely satisfied or satisfied with postoperative results. No severe side-effects were observed. The surgeon reported slightly increased difficulties during dissection of dermis from subcutaneous fat in three patients. Assessment of scars showed an excellent aesthetic outcome (mean VSS 0.79 before vs. 1.1 after surgery).

CONCLUSIONS

LC using an aggressive cannula is an effective therapy option for patients with insufficient response to prior LC surgery, with a low risk of side-effects.

Diagnosis, Impact, and Management of Focal Hyperhidrosis: Treatment Review Including Botulinum Toxin Therapy

Idiopathic localized hyperhidrosis, called for hyperhidrosis, affects almost 3% of the US population. The most frequent anatomic sites of involvement include the axillae, palms, soles, and face. For those affected, this condition can be extremely socially debilitating and interfere with work activities. Until recently, frequently ineffective topical regimens or problematic surgical procedures have been the treatments of choice. Since 1996, intracutaneous injections of botulinum toxin have been used as a minimally invasive treatment for this condition with numerous studies documenting safety, efficacy, and extremely high levels of patient satisfaction. Botulinum toxin type A (Botox) was approved by the US Food and Drug Administration in 2004 for the treatment of axillary hyperhidrosis.

Treatment of osmidrosis with the Cavitron ultrasonic surgical aspirator

BACKGROUND

Axillary osmidrosis is an uncomfortable condition that can be a personal or social handicap.

OBJECTIVE

The objective was to present the treatment of osmidrosis with the Cavitron ultrasonic surgical aspirator (CUSA).

MATERIALS AND METHODS

Fifteen patients (3 males and 12 females) underwent surgery for bilateral axillary osmidrosis with the CUSA.

RESULTS

The outcome of this operation with the CUSA was evaluated by the patients themselves according to the following criteria. Postoperative improvement was evaluated as good when the odor was decreased by >75%, fair when it was decreased by > or =50 and < or =75%, and poor when it was decreased by <50%. A total of 15 patients (3 males and 12 females) were evaluated. Eight patients (53.3%) had a good result, 6 patients (40%) had a fairly good result, and 1 patient (6.7%) had a poor result. None of the patients experienced any complications, such as skin necrosis, infection, or serous cyst. One dissatisfied patient underwent reoperation and achieved a good result after the second procedure.

CONCLUSIONS

This treatment of osmidrosis with the CUSA achieves satisfactory therapeutic efficacy.

Radical treatment of axillary osmidrosis by subdermal excision of apocrine glands: a prospective study in 31 cases

Axillary osmidrosis is a troublesome and distressing problem. Medical treatment is only temporally effective. From March 2003 to November 2004, 36 patients with axillary osmidrosis (nine cases combined with axillary hyperhidrosis) have been treated by excision of the subcutaneous glands via a small transverse incision, of which 31 cases could be followed up for a minimum of 3 months (average 7.3 months). In terms of malodour elimination, 30 cases had good results, one had fair result, and none had a poor result. All patients reported significant reducing of sweating, especially those with hyperhidrosis. Postoperative complications were minor, including small haematoma (one axillae), small seroma (two axillae), and superficial epidermal necrosis (21 axillae) which were all spontaneously healed within a week. Twenty-nine (93.5%) patients were very satisfied with the procedure and two (6.5%) patients satisfied, with none regretful. The operation has the advantage of a high success rate in radical elimination of the malodour with minor complications.

Tumescent liposuction with dermal curettage for treatment of axillary osmidrosis and hyperhidrosis

BACKGROUND

Axillary osmidrosis and hyperhidrosis are distressing social problems, particularly in Asian societies. Various treatment methods have been developed for removal of the apocrine and eccrine glands. But conventional surgical methods often lead to significant scarring and frequent recurrence.

OBJECTIVE

To evaluate the effect of liposuction with curettage using a new device, the Fatemi cannula, in the treatment of axillary osmidrosis and hyperhidrosis.

METHODS

From August 2003 through December 2004, 25 patients (15 women and 10 men) with axillary osmidrosis or hyperhidrosis were treated by tumescent liposuction and curettage. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. Changes in axillary sweating and hair growth, postoperative scarring, patient satisfaction degree, and complications were also evaluated. Biopsies of the axillary skin were performed in 14 patients.

RESULTS

Of the 50 axillae, 38 (76.0%) were graded as excellent results, 11 (22.0%) were good, and one (2.0%) was fair. No serious complications were noted except temporary ecchymosis and local infection in minor cases. The preoperative histologic examinations showed large and numerous apocrine glands and postoperative significant decrease and degeneration of them.

CONCLUSION

Tumescent liposuction with dermal curettage using the Fatemi cannula is an effective and safe method in the treatment of axillary osmidrosis and hyperhidrosis.

Endoscopy-assisted ultrasonic surgical aspiration of axillary osmidrosis: a retrospective review of 896 consecutive patients from 1998 to 2004

Axillary osmidrosis is a distressing and troublesome problem that causes a serious handicap in personal and social life. Many different methods have been introduced to treat axillary osmidrosis, however, they are often accompanied by marked complications. We analysed our experiences using endoscopy-assisted ultrasonic surgical aspiration in treating the axillary osmidrosis. From June 1998 to February 2004, a total of 896 patients (562 females, 334 males) were treated for axillary osmidrosis using endoscopy-assisted ultrasonic surgical aspiration. Our method was satisfactory in 815 patients (91%) and recurrence of odour occurred only in 29 (3.2%) patients. It also showed complications in 28 (3.1%) patients. Our method leaves a small inconspicuous scar and no contracture of the axillary skin after a short and comfortable recovery period and maintains normal axillary hair growth patterns. Axillary osmidrosis can be best treated by endoscopy-assisted ultrasonic surgical aspiration and this operation has many advantages with a high success rate, a low complication rate, and a rapid recovery period.

A Case of Foul Genital Odor Treated with Botulinum Toxin A

BACKGROUND

Genital odor is an uncommon condition characterized by an offensive and malodorous smell in the genital area. Although the etiology of foul genital odor is multifactorial, an important cause is sweat secretion and decomposition of sweat components by bacteria. Different methods are effective in reducing body odor secondary to bromhidrosis. Conservative methods only act for a short period of time, and more invasive surgical methods carry risk of complications or are inapplicable for the genital region.

METHODS

A patient with localized foul odor in the genital hair bearing area was treated with botulinum toxin A.

RESULTS

Botulinum toxin A was effective in creating an odorless and anhydrous response in the genital region, and no major adverse effects were noted during a follow-up of 9 months after injection.

CONCLUSION

Local injection of botulinum toxin A appears to be a useful treatment for foul genital odor related to sweat glands activity.

Upper thoracic sympathectomy for axillary osmidrosis or bromidrosis

The difference between axillary osmidrosis (AO) and axillary bromidrosis (AB) is the degree of odor and quantity of sweat, which is associated with selection of therapeutic modality theoretically. Upper thoracic sympathectomy has been used for both diseases but its effect needs to be further evaluated with more clinical data. We collected 108 patients with AO or AB treated by upper thoracic sympathectomy from July 1995 to July 2002. Of these patients, 42 suffered AO alone, 17 had AB (AO with axillary hyperhidrosis [AH]), and 49 had AO with palmar hyperhidrosis (PH). Ninety-two patients (183 sides) received anterior subaxillary transthoracic endoscopic sympathectomy (TES) and 17 patients (33 sides) received posterior percutaneous thoracic phenol sympathicolysis (PTPS). The levels of sympathectomy or sympathicolysis were T3-4 for AO and AB, and T2-4 for AO with PH. Mean follow-up period was 45.2 months (13-97 months). The satisfaction rates of patients were 52.4%, 70.6% and 61.2% for AO, AB and AO with PH, respectively. The rates of patients with improvement and satisfaction were 78.6%, 88.2% and 85.7% for AO, AB, and AO with PH, respectively. These results suggest that upper thoracic sympathectomy may be an acceptable treatment for AB or AO with PH rather than AO only.

Treatment of hyperhidrosis and drooling with botulinum exotoxin

The treatment of focal hyperhidrosis and drooling with neurolysis of the neuroglandular junction is a relatively new and useful technique for managing such obvious conditions and improving the patient's quality of life. The treatment is safe, minimally invasive, and an effective alternative to other treatment modalities.

Treatment of hyperhidrosis with botulinum toxin

Focal hyperhidrosis is a common problem that affects up to 2.8% of the population with significant psychosocial implications. Traditional therapies have not proven effective for most of these patients, which further adds to patient anxiety. Botulinum toxin is emerging as a novel treatment for focal hyperhidrosis and is proving to be safe and effective. A therapeutic protocol for focal hyperhidrosis includes an individualized treatment plan for each site of involvement. For those who are affected in the palms and soles, the most common treatments include topical treatment with aluminum chloride, iontophoresis, botulinum toxin,systemic medications, and sympathectomy. For those who have axillary focal hyperhidrosis, iontophoresis is often difficult and botulinum toxin becomes the second line therapy. As of June 2003, BTX A has been approved for the treatment of hyperhidrosis in 13 countries: England, Canada, New Zealand, Australia, Taiwan, Netherlands, Switzerland, Brazil, Argentina, Columbia, El Salvador, Guatemala, and Mexico. With the currently available literature and ongoing studies, it should only be a short time before the U.S. Food and Drug Administration approves botulinum toxin therapy for focal hyperhidrosis in the United States.

Gravimetrically controlled efficacy of subcorial curettage: a prospective study for treatment of axillary hyperhidrosis

BACKGROUND

Botulinum toxin A (BTX-A) proved to be effective for the treatment of axillary hyperhidrosis by means of gravimetry. Quantitatively controlled studies for surgical treatment are lacking so far.

OBJECTIVE

To prospectively test the efficacy of subcorial axillary curettage by gravimetric evaluation of pre- and postsurgical sweat rates.

METHODS

Conservatively pretreated patients received subcorial curettage under tumescent local anesthesia using a sharp spoon. Sweat rates of each axilla were determined gravimetrically before and 4-8 weeks after surgery. Evaluation was performed with respect to baseline sweat rates greater than 50 mg/min (group A), greater than 25 and less than 50 mg/min (group B), and less than 25 mg/min (group C). Side effects and patients' ratings were also recorded.

RESULTS

Of 42 treated patients, 38 could be evaluated completely. In 29 axillae of group A (high sweat rates), an average reduction from the baseline of 85.6 mg/min to 21.6 mg/min could be achieved (P <.0001). Corresponding values for 22 axillae of group B (medium sweat rates) were 36.8 mg/min and 16.5 mg/min (P <.0001). In 25 axillae with low sweat rates (group C), a significant reduction in sweat rates could not be achieved. The results remained almost stable during a median follow-up of 11 months (range 4-24 months). Only minor side effects were observed and patient satisfaction was high in groups A and B.

CONCLUSION

Subcorial curettage is an effective treatment of axillary hyperhidrosis for patients with baseline sweat rates greater than 25 mg/min.