December 17, 2024 • 20 mins
Excessive sweating can be a constant challenge, but you don't have to suffer in silence.
Dr. Carolyn Jacob, a dermatologist and technology researcher, joins Dr. Bass to share how MiraDry can bring relief to those who struggle with underarm sweating.
Unlike older, more invasive options, MiraDry uses microwave technology to target and eliminate sweat glands permanently, without leaving scars behind. Just two treatments can reduce underarm sweat by 89% or more.
While this treatment is about comfort, not appearance, it can give you the confidence to focus on what truly matters instead of being held back by worries about sweating.
Whether you experience sweating constantly or only in high-stress moments, MiraDry offers a lasting solution. Find out the benefits of this life-changing procedure and learn what to expect before, during, and after treatment.
About Dr. Carolyn Jacob
Dr. Carolyn Jacob is a dermatologist and associate clinical professor at Northwestern’s Feinberg School of Medicine. Founder and medical director of Chicago Cosmetic Surgery and Dermatology, she completed an elite cosmetic and laser fellowship at Harvard. Dr. Jacob has led research and media discussions on innovative treatments, including MiraDry for sweat reduction, injectables, cellular therapies, and advanced body shaping technologies like HIFEM and EmSculpt Neo.
Learn more about Chicago Dermatologist & Cosmetic Surgeon Dr. Carolyn Jacob
Follow Dr. Jacob on Instagram @drcarolynjacob
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator and technology innovator.
The title of today's episodeis "Dry is Beautiful."
(00:25):
Dr. Bass, I'm not surewhat we're doing here.
Usually we're talking about workingon a body part or about a particular
technique. What is thefocus of today's episode?
You're right, Summer,
here we're talking about somethingthat's not strictly speaking about
appearance, but definitelyrelates to how others perceive us.
Many things about modern life tend toamplify the differences for people with
(00:50):
excess sweating medically,
what we call hyperhidrosiswith frequent washing
antiperspirant and our climatecontrolled modern lives.
Most of us don't thinka lot about sweating,
but for those with hyperhidrosis,
this can still be a devastatingsocial problem on a daily basis.
(01:12):
And given the aseptic outlook of modernWestern life can even be a concern for
many who sweat in a normal fashion.
Before we get to modern options, can yougive me my history lesson for the day?
Sure. So for people withmilder sweating issues,
treatments with aluminum chloridewent under the brand name Drysol
(01:34):
were commonly used,
and this would create treatmentfor a period of time that would be
repeated a few times a year.
There were also oral medicinesthat block the cholinergic
stimulation that brings on sweating.
And for patients with severeproblems with hyperhidrosis,
(01:56):
they would actually have thesympathetic branches of the nerves cut
surgically or even occasionally have the
sweating area of skinexcised and then skin graft.
And that obviously was a bigprocedure that created a lot of scar.
So these are historical things,
(02:17):
not really part of our moderndiscussion of hyperhidrosis.
Okay, thanks for explaining.So what about today in 2024?
What are the main options?
Well, I brought an expert to bring usup to date on the latest in this area.
Dr. Carolyn Jacob is a boardcertified dermatologist who's an
(02:38):
associate clinical professorat Northwestern's Feinberg School of Medicine.
She's the founder and medical directorof Chicago Cosmetic Surgery in
dermatology in ChicagoRiver North Neighborhood.
After her dermatology training,
she completed the cosmetic and lasersurgery fellowship at Harvard Medical
(02:59):
Skincare Physicians.And for the listeners,
this is really the pinnaclecosmetic and laser fellowship in the
United States.
She's performed research and lecturedand discussed in the media many cutting
edge treatments in cosmetic medicine,
including excessive sweatreduction with MiraDry technology,
(03:21):
cellular treatments,injectable aesthetics,
body shaping with high frequencyelectromagnetic energy,
what's called HIFEM, andwith radio frequency,
which is in a combined device,EmSculpt Neo as well as many others.
So Dr. Jacob, welcome.
Thanks for having me. Hi, Dr. Jacob.
(03:43):
Thank you for joiningus today as an expert.
Can you tell us a little moreabout the biology of sweat,
how it's made anddifferent kinds of sweat?
Absolutely. So there's thesemain sweat glands on your skin,
which are known as eccrine glands.
They also sit adjacent to theseother glands called arine glands,
but the eccrine glands are the ones thatcreate the actual watery sweat that you
(04:03):
notice when you're workingout or when you're nervous.
And these glands tend tobe more concentrated in the underarm area and the palms
and the soles.
Okay. Okay, that makes sense.
Could you talk more about hyperhidrosisin terms of how it manifests,
where in the body it occurs,and how it impacts patients?
Sure.
So more than 4% of the population isaffected by what we call primary axillary
(04:27):
hyperhidrosis,
which is excessive sweatingbeyond normal physiological needs.
This is also a condition that usually hasbeen present for more than six months.
It might run in your family as well,
and it inhibits you from some of yourdaily activities because of your need to
either wear black clothes all the timeso people can't see that you're sweating
or to shower frequently. And thenthere's other issues such as odor,
(04:50):
which it can be offensive orbothersome to yourself as well.
Some people will sweat in a color,which is called chrome hydrosis,
and then also you can get differentskin conditions such as eczema and
intertrigo in areas thatare moist and damp often.
So it causes a lot of problemsbesides just embarrassment.
Got it. Wow, that's much morethan I ever thought about.
(05:13):
So then what are the big optionstoday for patients with hyperhidrosis?
Well, luckily today we have a lot oftreatments for hyperhidrosis, and again,
some of our patients don't comein with just the underarms.
They'll also have hands. AsDr. Bass had already mentioned,
back in the old days we had mostlytopical products containing aluminum
chloride. But the problem with those isthat they led to irritation, redness,
(05:34):
and sometimes eczema in thetreated area. Fast forward,
those have advanced to a particularproduct that's called glycopyrronium
tosylate.
This is a prescription called QBREXZAthat you can use just on the affected
areas of the underarm. Some people willuse it off-label for the hands and feet,
it's a wipe,
it just lasts for about 12 hours andthen you throw it away after you've
(05:55):
applied it to the area.Other treatments that exist,
also brand new, something called Brella,
which uses this sodium patchto actually activate and
heat up a little bit of the eccrine ducts.
So the sweat glands called eccrineglands have a little tube that allows the
sweat to get to the skin and it kind ofstuns those tubes and the eccrine glands
(06:17):
so that you don't sweatfor several months.
And that's just an in-officetreatment where a patch is applied.
But for people who really want tostop their sweating permanently,
there's microwavetechnology known as MiraDry.
Okay. All of those soundreally interesting.
What are some of the benefits and consof some of those options just in general
terms?
(06:37):
Sure. So again, if you're talkingabout just underarm sweating,
then the go-to decreasingsweat permanently
treatment would be theMiraDry microwave technology.
It works beautifully in that it's anin-office procedure that takes about an
hour. The area is numbed up andthen the treatment is performed.
(06:58):
Microwaves just like your microwave inyour house can heat up water and that
helps to destroy those little sweatglands just in the area that's being
treated. Whereas the rest of yoursweat glands will continue to sweat
normally and you won't haveany issues such as sweating
excessively somewhere else.
That has been found to occur in thatother treatment that Dr. Bass had
(07:20):
mentioned, which was the onewhere they actually cut the nerve.
So we never recommendthat for patients anymore.
I failed to also mention thatthey're all oral treatments.
There's pills that you cantake for excessive sweating.
So if you're a sufferer who has bothyour hands, your feet, your underarms,
your face,
you may be a better candidate for takingsome of these pills under the direction
of your dermatologist.
(07:42):
So while we're talking about plusesand minuses, just add in there,
Dr. Jacob, the pluses and minusesof something like Botox injection,
which is also cleared for hyperhidrosiscompared to something like MiraDry.
Sure, absolutely.
So there's other treatments that can bedone locally for focal hyperhidrosis in
(08:02):
the underarm such as Botox orbotulinum toxin injections.
These injections are performed in aphysician's office with a little bit of
topical anesthetic and they'revery comfortable to have done,
but they are temporary studies showthat Botox brand lasts about 260
days on average in reducing the sweat,
but it does have to bedone in a repeated fashion.
(08:24):
In some states that treatmentcan be covered by insurance,
but in other cases it'snot covered by insurance.
So it gets a little tricky to do a repeattreatment that's going to be expensive
over and over again,
but that is another option fortreating excessive sweating.
Thanks for sharing all ofthat. You mentioned a permanent solution with MiraDry,
(08:45):
and you touched on it a bit, but canyou tell me a bit more how does it work?
Absolutely. So this technologyhas been around since 2011.
Lots of treatments havebeen done successfully and that's what makes it such a
great treatment in that it permanentlyreduces the sweat after two simple
treatments. The treatmentsare separated by two months.
(09:05):
So you'll come into the office, we'llmark out the areas to be treated.
A little tiny kind of faketattoo is put onto the area.
The area is numbed up withsome local anesthetic,
and that takes just a few minutesto do. And then once it's numb,
the applicator of the MiraDry deviceis put onto the skin and little tiny
rectangles of tissue are treatedat a time to heat up the skin.
(09:29):
Their device cools the top layer of skin,
so there isn't any issuewith the actual skin itself.
And that energy of heat from themicrowave is put down into those sweat
releasing glands that we call therine glands that then permanently
reduces them. With one treatment youget about a 69% reduction with two
treatments,
it's about an 89 or greater percentreduction in sweat that is then permanent.
(09:53):
The reason it's permanent is youdon't regenerate these eccrine sweat
glands. So the ones that you haveare the ones that you're born with,
and if we get rid of themin the underarm area,
then you don't have toworry about them again.
But remember that you'll sweatnormally everywhere else.
And for these sufferers, they do sweatnormally in a lot of other places,
but sometimes it's just theunderarms are profusely sweating.
(10:15):
This sounds like an interestingapproach for combating hyperhidrosis.
What does the data show about the results?
The results are great.
As I mentioned in the firsttrial that was done back in 2010,
published in 2011,
they showed that the resultsdecreased sweating by about 69%.
They then added a secondtreatment, did another study,
(10:35):
and found out that therewas an 89% reduction overall of the amount of sweat for
these patients who sufferfrom underarm sweating.
That's a really good permanent amount.
They did biopsies to show you thatthere's no more of the sweat glands in the
area. And so a few little areas mightget skipped because as I mentioned,
you're doing little tiny rectangles oftreatment in the entire underarm area.
(10:57):
So if someone does havesweating, we have them come back.
We'll do what's called a star iodine test.
We'll find out where those areas are thatthey might be sweating from and have a
conversation as to whether ornot they need a third treatment.
But the majority of patients get twotreatments done two months apart.
There's about two days of having alittle bit of swelling under your arms,
and so we ask people to ice the area,
(11:18):
take some ibuprofen and takeit easy for a couple of days.
Okay, great. Thanks forwalking through that.
So how is microwave energy differentand what makes it well suited for
MiraDry?
Sure. So patients with hyperhidrosis cansweat excessively while they're sitting
still. It usually doesn'toccur until puberty.
(11:39):
And then after that itbecomes a bigger problem.
The patients are suffering so badly,
they may have to wear padsunder their arms, et cetera.
What happens with microwave technologyis microwave energy is very specific for
water as to fat or skin or muscle tissue.
So specifically microwave technologyhas only been used in the medical field
(12:01):
for treating things thatdeal with water such as tate
enlargement.
They've used microwave technologyto decrease the size of the prostate
nonsurgically from that technology.
They then developed using thisfor the underarm sweating.
So microwave technology is stillthe number one permanent treatment
(12:22):
for treating underarm sweating,
and we're really excited that we havethe ability to offer this for our
patients.
Okay, great. And I know youalso touched on this before,
but you mentioned for recovery you mighthave to ice the area and there might be
swelling. Is there anything else I shouldknow if I want to go for a treatment?
You would need to shave the area two daysprior, and this includes men as well.
(12:45):
When you have the treatment done,
the collateral damage from the heatsometimes reduces a little bit of the hair
in the area.
One recent study showed thatit decreased the hair by 72%,
and it doesn't matter what color the hairis because the microwave technology is
just using heat. It's not being absorbedby a particular color repair. So far,
(13:06):
I've never had a single man be upsetthat he has less underarm hair after
the series of the MiraDry treatments,
but then we need to have you iceit and take a little ibuprofen.
There can be some swelling because wehave used this device to create heat.
We tell people to kind of refrain frombig physical activities like beach
volleyball and those sort of thingsfor a couple of days. I haven't had a
(13:28):
patient call me in years with any issuesof side effects after the treatment.
But during the healing phase, there'sno changes on the surface of the skin.
Everything's happening underneath theskin. But sometimes because of that heat,
you can get a little bit of bumps thatyou can feel under the skin and those
bumps go away with time or with sometreatments that we'll do in the office,
(13:51):
such as a little shockwave treatmentor a little injection with a mild
steroid like we would do for an acnepimple. So those occasionally happen,
but they're very easily resolvedwith some treatments and with time.
We started this discussionwith a focus on hyperhidrosis,
but that's only part of the targetaudience that can benefit from this
(14:12):
technology. What other groups of peopledo you see coming in for treatment?
Well,
there are a lot of patients like mewho are perfectly normal throughout the
day until they have to get up on podiumand give a lecture and then they start
sweating. So people thathave to give performances,
people that have to be in bigaudiences to give lectures and talks,
(14:34):
sometimes that creates thissituational sweating for them.
And that's really problematic,
especially if you haven't remembered towear a dark outfit because your sweat
will show when you'rein front of everyone.
So the situational sweaters alsocan benefit very greatly from
having miry treatments.
And we have some people who just don'twant the sweat in their underarms at all.
(14:56):
Again, remember you're going tosweat normally everywhere else,
but this will reduce the amount ofsweat by about 89% in the underarm.
So there's a lot of people that canenjoy improvement from the MiraDry
treatment.
Yeah, I mean that's a huge reductionin sweating just in daily life.
I know you've been an activeresearcher in this area.
(15:17):
We like to have people like you on thepodcast who can speak authoritatively
about a subject and know allthe ins and outs because of that
extensive experience with it.
Tell us a little bit about whatyou found in your research.
Some of the research that we conductedyears ago was basically patient
satisfaction because again,
this was a condition that didn'thave a really great treatment for it.
(15:40):
People don't want to take pills every day.
They don't want to have touse solutions every day.
And when we looked at thepatients that were treated,
the satisfaction level wasabove 95% for these patients.
The comments we got from patientswere things such as life changing,
saved my life, saving me time and energy,
saving me time and money becausethey're not ruining clothes,
(16:02):
they don't have to changeclothes frequently.
They don't have to take extra showers.So very overwhelmingly pleased patients,
which makes it a great treatment forus to get to do for patients as well.
Now moving into the future,
we're actually looking at someother applications with the device.
It is a little tricky in that thedevice has a disposable tip that's
(16:23):
used for each individual person thathas to vacuum up the skin a little bit
away from the underlying structure.And because of that,
we cannot use this treatmenttip on the hand. However,
we've known that there's been lots ofpatients who've suffered with sweating on
the chest and on the back.
And this also causes great concernand stress for the patients.
(16:44):
So we will be doing astudy in the near future,
testing it for the usage on thechest and on the back in different
patches to reduce excessivesweating in those areas,
which will bring great reliefto those patients. And as aside,
we actually have done this to patientsoff-label already. We know that it works,
but it's now time for us to actually putit to the test and do a rigorous study
(17:06):
on it.
So this is really a huge thing.
And so much of what we do in aestheticmedicine is about appearance.
As I said at the beginning,this is not appearance,
but it has to do withconvenience, lifestyle,
your ability to do work, your abilityto interact with people socially,
and to have the confidence to knowyou're going to be able to do that.
(17:30):
And that confidence lets you projectyour personality instead of your
anxieties about the problemof sweating or some feature of
appearance.
And that's really everything that wedo every day in aesthetic medicine.
Yeah, absolutely. And I think that's thefeedback we get from patients is that,
oh my, there's a way to potentiallycure this problem permanently,
(17:53):
and that's what they really want,
because if you're sweat botheredor if you have excessive sweating,
it's a home run treatmentfor these patients.
Before we end this podcast, Dr. Jacob,
can you share some takeawayswith our listeners?
Sure. So don't suffer in silence.
Dermatologists are the doctors ofsweat. Not everybody knew that.
Raise your hand if you have troublesweating because we've lots of different
(18:17):
ways that we can help you treatyou and make you not embarrassed,
make you not feel stressed aboutthe condition that you have.
And with MiraDry microwave treatment,
we can permanently reduce your underarmsweating and give you a life that's so
much easier to lead.
Great. Thank you. And whatare your takeaways, Dr. Bass?
(18:37):
So as I said,
everything that affects how we feelabout ourselves is part of how we project
to friends, family, andoutsiders part of our image,
and therefore it's part of beauty.
The durable response ofsweat glands to energy-based
destruction makes it a particularlyappealing approach that has that
(18:58):
benefit of permanence that most ofthe other treatments cannot offer.
Reducing sweat productionminimizes dampness and also
odor.
And so it's an important part ofhygiene and daily maintenance for
hyperhidrosis patients. Otherareas are still unsolved problems.
(19:19):
Some of them may be addressable this way,
as Dr. Jacob pointed out on the torso.
But areas like the palms areperennial problem areas that
we're still a little bit frustratedwith. And as you also heard,
occasionally there's rebound in otherareas with increased sweating with
certain constant treatments. But overall,
(19:42):
anything that reduces your concernsabout how others perceive you
is a plus towards improving your life.And this is a perfect example of that.
I'd like to thank Dr. Jacob for joiningus today and sharing her research and
perspective in thissometimes overlooked area.
Thanks so much for havingme. I appreciate it.
(20:03):
Thank you,
Dr. Jacob for opening up our understandingof this horizon in self-care.
You're very welcome.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
Follow us on Apple Podcasts,
write a review and sharethe show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
(20:25):
we'd love to hear from you,
send us an email atpodcast@drbass.net or DM us on
Instagram @drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator and technology innovator.
The title of today's episodeis "Dry is Beautiful."
(00:25):
Dr. Bass, I'm not surewhat we're doing here.
Usually we're talking about workingon a body part or about a particular
technique. What is thefocus of today's episode?
You're right, Summer,
here we're talking about somethingthat's not strictly speaking about
appearance, but definitelyrelates to how others perceive us.
Many things about modern life tend toamplify the differences for people with
(00:50):
excess sweating medically,
what we call hyperhidrosiswith frequent washing
antiperspirant and our climatecontrolled modern lives.
Most of us don't thinka lot about sweating,
but for those with hyperhidrosis,
this can still be a devastatingsocial problem on a daily basis.
(01:12):
And given the aseptic outlook of modernWestern life can even be a concern for
many who sweat in a normal fashion.
Before we get to modern options, can yougive me my history lesson for the day?
Sure. So for people withmilder sweating issues,
treatments with aluminum chloridewent under the brand name Drysol
(01:34):
were commonly used,
and this would create treatmentfor a period of time that would be
repeated a few times a year.
There were also oral medicinesthat block the cholinergic
stimulation that brings on sweating.
And for patients with severeproblems with hyperhidrosis,
(01:56):
they would actually have thesympathetic branches of the nerves cut
surgically or even occasionally have the
sweating area of skinexcised and then skin graft.
And that obviously was a bigprocedure that created a lot of scar.
So these are historical things,
(02:17):
not really part of our moderndiscussion of hyperhidrosis.
Okay, thanks for explaining.So what about today in 2024?
What are the main options?
Well, I brought an expert to bring usup to date on the latest in this area.
Dr. Carolyn Jacob is a boardcertified dermatologist who's an
(02:38):
associate clinical professorat Northwestern's Feinberg School of Medicine.
She's the founder and medical directorof Chicago Cosmetic Surgery in
dermatology in ChicagoRiver North Neighborhood.
After her dermatology training,
she completed the cosmetic and lasersurgery fellowship at Harvard Medical
(02:59):
Skincare Physicians.And for the listeners,
this is really the pinnaclecosmetic and laser fellowship in the
United States.
She's performed research and lecturedand discussed in the media many cutting
edge treatments in cosmetic medicine,
including excessive sweatreduction with MiraDry technology,
(03:21):
cellular treatments,injectable aesthetics,
body shaping with high frequencyelectromagnetic energy,
what's called HIFEM, andwith radio frequency,
which is in a combined device,EmSculpt Neo as well as many others.
So Dr. Jacob, welcome.
Thanks for having me. Hi, Dr. Jacob.
(03:43):
Thank you for joiningus today as an expert.
Can you tell us a little moreabout the biology of sweat,
how it's made anddifferent kinds of sweat?
Absolutely. So there's thesemain sweat glands on your skin,
which are known as eccrine glands.
They also sit adjacent to theseother glands called arine glands,
but the eccrine glands are the ones thatcreate the actual watery sweat that you
(04:03):
notice when you're workingout or when you're nervous.
And these glands tend tobe more concentrated in the underarm area and the palms
and the soles.
Okay. Okay, that makes sense.
Could you talk more about hyperhidrosisin terms of how it manifests,
where in the body it occurs,and how it impacts patients?
Sure.
So more than 4% of the population isaffected by what we call primary axillary
(04:27):
hyperhidrosis,
which is excessive sweatingbeyond normal physiological needs.
This is also a condition that usually hasbeen present for more than six months.
It might run in your family as well,
and it inhibits you from some of yourdaily activities because of your need to
either wear black clothes all the timeso people can't see that you're sweating
or to shower frequently. And thenthere's other issues such as odor,
(04:50):
which it can be offensive orbothersome to yourself as well.
Some people will sweat in a color,which is called chrome hydrosis,
and then also you can get differentskin conditions such as eczema and
intertrigo in areas thatare moist and damp often.
So it causes a lot of problemsbesides just embarrassment.
Got it. Wow, that's much morethan I ever thought about.
(05:13):
So then what are the big optionstoday for patients with hyperhidrosis?
Well, luckily today we have a lot oftreatments for hyperhidrosis, and again,
some of our patients don't comein with just the underarms.
They'll also have hands. AsDr. Bass had already mentioned,
back in the old days we had mostlytopical products containing aluminum
chloride. But the problem with those isthat they led to irritation, redness,
(05:34):
and sometimes eczema in thetreated area. Fast forward,
those have advanced to a particularproduct that's called glycopyrronium
tosylate.
This is a prescription called QBREXZAthat you can use just on the affected
areas of the underarm. Some people willuse it off-label for the hands and feet,
it's a wipe,
it just lasts for about 12 hours andthen you throw it away after you've
(05:55):
applied it to the area.Other treatments that exist,
also brand new, something called Brella,
which uses this sodium patchto actually activate and
heat up a little bit of the eccrine ducts.
So the sweat glands called eccrineglands have a little tube that allows the
sweat to get to the skin and it kind ofstuns those tubes and the eccrine glands
(06:17):
so that you don't sweatfor several months.
And that's just an in-officetreatment where a patch is applied.
But for people who really want tostop their sweating permanently,
there's microwavetechnology known as MiraDry.
Okay. All of those soundreally interesting.
What are some of the benefits and consof some of those options just in general
terms?
(06:37):
Sure. So again, if you're talkingabout just underarm sweating,
then the go-to decreasingsweat permanently
treatment would be theMiraDry microwave technology.
It works beautifully in that it's anin-office procedure that takes about an
hour. The area is numbed up andthen the treatment is performed.
(06:58):
Microwaves just like your microwave inyour house can heat up water and that
helps to destroy those little sweatglands just in the area that's being
treated. Whereas the rest of yoursweat glands will continue to sweat
normally and you won't haveany issues such as sweating
excessively somewhere else.
That has been found to occur in thatother treatment that Dr. Bass had
(07:20):
mentioned, which was the onewhere they actually cut the nerve.
So we never recommendthat for patients anymore.
I failed to also mention thatthey're all oral treatments.
There's pills that you cantake for excessive sweating.
So if you're a sufferer who has bothyour hands, your feet, your underarms,
your face,
you may be a better candidate for takingsome of these pills under the direction
of your dermatologist.
(07:42):
So while we're talking about plusesand minuses, just add in there,
Dr. Jacob, the pluses and minusesof something like Botox injection,
which is also cleared for hyperhidrosiscompared to something like MiraDry.
Sure, absolutely.
So there's other treatments that can bedone locally for focal hyperhidrosis in
(08:02):
the underarm such as Botox orbotulinum toxin injections.
These injections are performed in aphysician's office with a little bit of
topical anesthetic and they'revery comfortable to have done,
but they are temporary studies showthat Botox brand lasts about 260
days on average in reducing the sweat,
but it does have to bedone in a repeated fashion.
(08:24):
In some states that treatmentcan be covered by insurance,
but in other cases it'snot covered by insurance.
So it gets a little tricky to do a repeattreatment that's going to be expensive
over and over again,
but that is another option fortreating excessive sweating.
Thanks for sharing all ofthat. You mentioned a permanent solution with MiraDry,
(08:45):
and you touched on it a bit, but canyou tell me a bit more how does it work?
Absolutely. So this technologyhas been around since 2011.
Lots of treatments havebeen done successfully and that's what makes it such a
great treatment in that it permanentlyreduces the sweat after two simple
treatments. The treatmentsare separated by two months.
(09:05):
So you'll come into the office, we'llmark out the areas to be treated.
A little tiny kind of faketattoo is put onto the area.
The area is numbed up withsome local anesthetic,
and that takes just a few minutesto do. And then once it's numb,
the applicator of the MiraDry deviceis put onto the skin and little tiny
rectangles of tissue are treatedat a time to heat up the skin.
(09:29):
Their device cools the top layer of skin,
so there isn't any issuewith the actual skin itself.
And that energy of heat from themicrowave is put down into those sweat
releasing glands that we call therine glands that then permanently
reduces them. With one treatment youget about a 69% reduction with two
treatments,
it's about an 89 or greater percentreduction in sweat that is then permanent.
(09:53):
The reason it's permanent is youdon't regenerate these eccrine sweat
glands. So the ones that you haveare the ones that you're born with,
and if we get rid of themin the underarm area,
then you don't have toworry about them again.
But remember that you'll sweatnormally everywhere else.
And for these sufferers, they do sweatnormally in a lot of other places,
but sometimes it's just theunderarms are profusely sweating.
(10:15):
This sounds like an interestingapproach for combating hyperhidrosis.
What does the data show about the results?
The results are great.
As I mentioned in the firsttrial that was done back in 2010,
published in 2011,
they showed that the resultsdecreased sweating by about 69%.
They then added a secondtreatment, did another study,
(10:35):
and found out that therewas an 89% reduction overall of the amount of sweat for
these patients who sufferfrom underarm sweating.
That's a really good permanent amount.
They did biopsies to show you thatthere's no more of the sweat glands in the
area. And so a few little areas mightget skipped because as I mentioned,
you're doing little tiny rectangles oftreatment in the entire underarm area.
(10:57):
So if someone does havesweating, we have them come back.
We'll do what's called a star iodine test.
We'll find out where those areas are thatthey might be sweating from and have a
conversation as to whether ornot they need a third treatment.
But the majority of patients get twotreatments done two months apart.
There's about two days of having alittle bit of swelling under your arms,
and so we ask people to ice the area,
(11:18):
take some ibuprofen and takeit easy for a couple of days.
Okay, great. Thanks forwalking through that.
So how is microwave energy differentand what makes it well suited for
MiraDry?
Sure. So patients with hyperhidrosis cansweat excessively while they're sitting
still. It usually doesn'toccur until puberty.
(11:39):
And then after that itbecomes a bigger problem.
The patients are suffering so badly,
they may have to wear padsunder their arms, et cetera.
What happens with microwave technologyis microwave energy is very specific for
water as to fat or skin or muscle tissue.
So specifically microwave technologyhas only been used in the medical field
(12:01):
for treating things thatdeal with water such as tate
enlargement.
They've used microwave technologyto decrease the size of the prostate
nonsurgically from that technology.
They then developed using thisfor the underarm sweating.
So microwave technology is stillthe number one permanent treatment
(12:22):
for treating underarm sweating,
and we're really excited that we havethe ability to offer this for our
patients.
Okay, great. And I know youalso touched on this before,
but you mentioned for recovery you mighthave to ice the area and there might be
swelling. Is there anything else I shouldknow if I want to go for a treatment?
You would need to shave the area two daysprior, and this includes men as well.
(12:45):
When you have the treatment done,
the collateral damage from the heatsometimes reduces a little bit of the hair
in the area.
One recent study showed thatit decreased the hair by 72%,
and it doesn't matter what color the hairis because the microwave technology is
just using heat. It's not being absorbedby a particular color repair. So far,
(13:06):
I've never had a single man be upsetthat he has less underarm hair after
the series of the MiraDry treatments,
but then we need to have you iceit and take a little ibuprofen.
There can be some swelling because wehave used this device to create heat.
We tell people to kind of refrain frombig physical activities like beach
volleyball and those sort of thingsfor a couple of days. I haven't had a
(13:28):
patient call me in years with any issuesof side effects after the treatment.
But during the healing phase, there'sno changes on the surface of the skin.
Everything's happening underneath theskin. But sometimes because of that heat,
you can get a little bit of bumps thatyou can feel under the skin and those
bumps go away with time or with sometreatments that we'll do in the office,
(13:51):
such as a little shockwave treatmentor a little injection with a mild
steroid like we would do for an acnepimple. So those occasionally happen,
but they're very easily resolvedwith some treatments and with time.
We started this discussionwith a focus on hyperhidrosis,
but that's only part of the targetaudience that can benefit from this
(14:12):
technology. What other groups of peopledo you see coming in for treatment?
Well,
there are a lot of patients like mewho are perfectly normal throughout the
day until they have to get up on podiumand give a lecture and then they start
sweating. So people thathave to give performances,
people that have to be in bigaudiences to give lectures and talks,
(14:34):
sometimes that creates thissituational sweating for them.
And that's really problematic,
especially if you haven't remembered towear a dark outfit because your sweat
will show when you'rein front of everyone.
So the situational sweaters alsocan benefit very greatly from
having miry treatments.
And we have some people who just don'twant the sweat in their underarms at all.
(14:56):
Again, remember you're going tosweat normally everywhere else,
but this will reduce the amount ofsweat by about 89% in the underarm.
So there's a lot of people that canenjoy improvement from the MiraDry
treatment.
Yeah, I mean that's a huge reductionin sweating just in daily life.
I know you've been an activeresearcher in this area.
(15:17):
We like to have people like you on thepodcast who can speak authoritatively
about a subject and know allthe ins and outs because of that
extensive experience with it.
Tell us a little bit about whatyou found in your research.
Some of the research that we conductedyears ago was basically patient
satisfaction because again,
this was a condition that didn'thave a really great treatment for it.
(15:40):
People don't want to take pills every day.
They don't want to have touse solutions every day.
And when we looked at thepatients that were treated,
the satisfaction level wasabove 95% for these patients.
The comments we got from patientswere things such as life changing,
saved my life, saving me time and energy,
saving me time and money becausethey're not ruining clothes,
(16:02):
they don't have to changeclothes frequently.
They don't have to take extra showers.So very overwhelmingly pleased patients,
which makes it a great treatment forus to get to do for patients as well.
Now moving into the future,
we're actually looking at someother applications with the device.
It is a little tricky in that thedevice has a disposable tip that's
(16:23):
used for each individual person thathas to vacuum up the skin a little bit
away from the underlying structure.And because of that,
we cannot use this treatmenttip on the hand. However,
we've known that there's been lots ofpatients who've suffered with sweating on
the chest and on the back.
And this also causes great concernand stress for the patients.
(16:44):
So we will be doing astudy in the near future,
testing it for the usage on thechest and on the back in different
patches to reduce excessivesweating in those areas,
which will bring great reliefto those patients. And as aside,
we actually have done this to patientsoff-label already. We know that it works,
but it's now time for us to actually putit to the test and do a rigorous study
(17:06):
on it.
So this is really a huge thing.
And so much of what we do in aestheticmedicine is about appearance.
As I said at the beginning,this is not appearance,
but it has to do withconvenience, lifestyle,
your ability to do work, your abilityto interact with people socially,
and to have the confidence to knowyou're going to be able to do that.
(17:30):
And that confidence lets you projectyour personality instead of your
anxieties about the problemof sweating or some feature of
appearance.
And that's really everything that wedo every day in aesthetic medicine.
Yeah, absolutely. And I think that's thefeedback we get from patients is that,
oh my, there's a way to potentiallycure this problem permanently,
(17:53):
and that's what they really want,
because if you're sweat botheredor if you have excessive sweating,
it's a home run treatmentfor these patients.
Before we end this podcast, Dr. Jacob,
can you share some takeawayswith our listeners?
Sure. So don't suffer in silence.
Dermatologists are the doctors ofsweat. Not everybody knew that.
Raise your hand if you have troublesweating because we've lots of different
(18:17):
ways that we can help you treatyou and make you not embarrassed,
make you not feel stressed aboutthe condition that you have.
And with MiraDry microwave treatment,
we can permanently reduce your underarmsweating and give you a life that's so
much easier to lead.
Great. Thank you. And whatare your takeaways, Dr. Bass?
(18:37):
So as I said,
everything that affects how we feelabout ourselves is part of how we project
to friends, family, andoutsiders part of our image,
and therefore it's part of beauty.
The durable response ofsweat glands to energy-based
destruction makes it a particularlyappealing approach that has that
(18:58):
benefit of permanence that most ofthe other treatments cannot offer.
Reducing sweat productionminimizes dampness and also
odor.
And so it's an important part ofhygiene and daily maintenance for
hyperhidrosis patients. Otherareas are still unsolved problems.
(19:19):
Some of them may be addressable this way,
as Dr. Jacob pointed out on the torso.
But areas like the palms areperennial problem areas that
we're still a little bit frustratedwith. And as you also heard,
occasionally there's rebound in otherareas with increased sweating with
certain constant treatments. But overall,
(19:42):
anything that reduces your concernsabout how others perceive you
is a plus towards improving your life.And this is a perfect example of that.
I'd like to thank Dr. Jacob for joiningus today and sharing her research and
perspective in thissometimes overlooked area.
Thanks so much for havingme. I appreciate it.
(20:03):
Thank you,
Dr. Jacob for opening up our understandingof this horizon in self-care.
You're very welcome.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
Follow us on Apple Podcasts,
write a review and sharethe show with your friends.
Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
(20:25):
we'd love to hear from you,
send us an email atpodcast@drbass.net or DM us on
Instagram @drbassnyc.
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