- Underarm sweating is something
that affects millions of people around the world.
And it's a particularly debilitating problem because
it stops you from wearing the things you wanna wear,
you're sort of forced to wear dark clothes
so you don't see sweat patches.
It's a social inconvenience,
it certainly makes people very self conscious.
And it's a problem that until now
has had very few permanent solutions.
The things that can be used for underarm sweating
include things like Driclor,
which is aluminum-based antiperspirant.
It's very irritating on the skin, doesn't have a full effect
but, it does help to degree.
Things like botulinum toxin can be injected as well
into the underarms and that helps to reduce sweating
for about eight months on average.
But, in terms of long-term or permanent solutions,
the only real option that's been available has been
what you call an ETS or Endoscopic Thoracic Sympathectomy.
This is a huge operation where people go under,
they have a lung deflated,
and the surgeon literally goes into the spine
and cuts the sympathetic nerve,
which is the nerve which produces sweating
and things like flushing of the face.
So, it's the fight-or-flight drive,
so it gives you that adrenaline rush.
So, that's the nerve that they cut,
but there's so many side effects to the procedure,
including the side effects
from actually having the procedure itself
as well as, probably the worst side effect
is that the sweating moves from the underarms
to somewhere else.
So for example, the trunk or the legs or
somewhere where it's actually much harder to treat.
So, ETS is probably not the best option
for underarm sweating.
In today's video we wanna look at
one of the newer treatments for underarm sweating,
which is called miraDry.
Now, this is a very novel treatment
and is long term effect,
so it's considered to be a more permanent solution,
but it's localized so you don't need to
have a big operation to have it done.
And what it essentially does is put microwave energy
into the level of the skin which contains the sweat glands
and this helps to reduce their number
and reduce sweating by a significant amount.
You might think, first thing off the bat,
I'm gonna microwave my underarms,
but it's actually not too bad in terms of safety.
The energy only passes
into very superficially into the skin,
usually at the dermal-epidermal junction,
which is the top two layers of the skin.
And basically, it just helps to
reduce sweat glands at that level.
So, we're gonna put miraDry to the test
and try to do some scientific evaluation
of its effectiveness by doing a split study.
In other words, we have a subject Stephanie,
who is gonna volunteer to have one arm done
with botulinum toxin and the other arm down with miraDry.
So, we'll see what the effects are on both sides,
how long it takes to kick in
and what the longevity of effect is.
And I think the other thing we'd like to look at as well
is what's the value of it,
because is it better to have a longer term treatment
like miraDry or to have regular treatments
of botulinum toxin?
Now, in order to evaluate these two treatments
we need a test, a scientific test,
which will be able to tell how much sweating is going on.
We've been using this test for a while,
it's a very simple test and basically it involves
corn starch and iodine.
So, it's called a Minor's starch-iodine test.
And what it involves basically is coating
the underarm skin with iodine, letting it dry
and then trying to get the room up to a certain temperature
where the person will sweat.
And when they sweat, the iodine is lifted from the skin
and then we put cornstarch on.
So, it sounds unusual, it sounds like
some sort of cooking recipe, but actually what happens,
the cornstarch, when mixed with the sweat and the iodine,
it turns black.
So, anywhere where there's sweating
the cornstarch will turn black
and that's how we know how much sweating is going on.
So, we're able to do a direct comparison
of these two treatments,
and the room environment won't be a variable
because we're doing a split study.
So, we're on the same day, the same room,
we're testing both underarms.
And we'll see what sort of sweating reduction of each ways.
So we've turned the heat up in the room, we're gonna get...
This is Stephanie, our subject for today,
and we're gonna get her sweating.
Actually, we're all sweating I think.
But, we'll get sweating going as much as possible
and we're gonna do Minor's starch-iodine test.
We've got Laura here, our nurse
who's gonna be performing the treatment today.
Okay, first step is, let's put some iodine on her underarm.
So you can see there's a little bit of sweat there as it is,
and then the sweat starts to push
the iodine off the skin again,
and then we put the corn starch on.
So today we're using Johnson's baby powder,
which is not baby powder, it's actually pure corn starch.
And basically, that cornstarch will turn black,
so we'll know exactly probably how much is sweating
and which areas are sweating as well.
And that makeup brush will never be used ever again.
This side seems to be probably a little bit more sweaty,
is it, or not really?
Well, no, it's about the same.
And it's quite concentrated interestingly
on the areas which were hair bearing,
'cause she's had laser hair removal,
which is another benefit of the miraDry,
which is that it actually helps to remove hair
like laser hair removal does.
Cost wise, per session,
you're looking at around
30% more for the miraDry treatment, cost wise.
However, with miraDry, usually you only need
maybe one or two treatments and that's it.
Whereas, botulinum toxin,
you need treatments every eight months
and the sweating goes back to baseline.
So, it's a much simpler procedure,
botulinum toxin injections,
it's just come in and get some injections done
as opposed to miraDry which involves local anesthetic,
and we'll demonstrate a treatment to you in a minute.
But miraDry requires a lot more preparation,
but once it's done, it's done.
And cost-wise in the long term,
I think what you'll find,
it's a better solution in the long run
at a lower cost for the patient.
Convenience also is a factor as well.
I mean having to have come in every eight months,
may be inconvenient for some people.
What Laura's doing here is
she's sizing up the underarm for the miraDry.
And what you need to do is make sure that
the areas that we saw earlier are covered,
and we're gonna use a template as appropriate for that.
We've got a stick-on template, which is like the
temporary tattoos that the kids use on themselves.
And you stick it on to the area to be treated,
and that acts as a template
so we know exactly where to fire the miraDry.
It's gonna stick on this template.
And then we're gonna remove
paper, and you can see the template remains.
So this is all the markings that we need
to perform the miraDry.
And there's 13 lines which we need to fire it across
and positions on each line to fire it on.
So, Laura's injecting some local anesthetic
into a few points to start with,
and using the device to make it more comfortable.
So a lot of local anesthetic is used to infiltrate,
it's quite stingy this bit.
So we're gonna use a bit of cold spray
to make it less painful.
So we put little entry points in
and then we ban the local
from those entry points
using a cannula.
One question people often ask for this is,
if you get compensatory sweating elsewhere,
the area that we're treating was so small
that the body won't compensate.
Whereas, when you have an Endoscopic Thoracic Sympathectomy,
which cuts off sweating over a large area
you can compensate elsewhere.
So, that's the difference between treating a small area
and a larger area with an operation.
We're just putting a couple of entry points with a needle
into the bits of local anesthetic that we injected,
and through these entry points with the needle
we use a cannula to infiltrate local anesthetic.
Local anesthetic will go in quite easily with a long cannula
and that saves you on multiple needle injections as well.
So, this is actually a rounded tip needle,
or cannula I should say.
It actually is only a very small concentration
of local anesthetic, but it does the job
in what it needs to do, which is to numb the area
and spread around before we perform the miraDry.
And the other important factor is that
local anesthetic also gives you a bit more of a buffer
for the microwave energy, so basically
your thickening up the skin layer and fat layer
so that the microwave energy doesn't go through
and affect any of the nerves or underlying structures.
Now you can see the area is turning white
and there's some adrenaline in the local anesthetic
and this helps to constrict the blood vessels
and keep the local anesthetic in the one spot.
So, local anesthetic with adrenaline
always lasts a lot longer and is more localized
and more effective than local anesthetic without adrenaline.
As the procedure continues, it becomes less and less painful
as the local anesthetic from one area numbs the next area.
So, it gets better as time goes by it,
it is a bit stingy at the beginning.
The whole procedure does take over an hour,
but, once you've got the local in
you don't feel anything at all.
While we're waiting for the local anesthetic
to work on the left armpit, we're gonna do some
botulinum toxin injections on the right side.
We're gonna just grid up the underarm with squares
and then basically inject a set amount of botulinum toxin
into each square there so it is nicely evenly distributed.
- (laughs)
- We're having a problem with ticklishness,
Stephanie's a bit ticklish.
So, Laura's injecting the epidermis or dermis of the skin
with botulinum toxin to help shut down
those sweat glands temporarily.
And you can see it raises a little mozzie bite
appearance on the armpit.
- That reacts more than the...
- Yeah, the cold spray is used to again,
distract from the pain, it's quite effective.
It can be a little bit stinky too,
but I think people tend to prefer
some sort of analgesia than just straight needle.
You can also put numbing gel on as another option,
but then you have to wait.
So, a lot of people just come in
and do it with the cold spray.
miraDry's a good system, which uses a template
and a very easy to use interface.
Basically it shows you the corresponding markings
on the template on the screen.
You align the handpiece to the same point on the template
that's indicated on the screen, and fire.
So, each one of these will deliver a set dose of energy
and that will help to give you a nice even smooth results.
We're doing the miraDry treatment now,
and it makes a lovely sound
when the skin is sucked in to the handpiece.
And it goes through certain phases
of transmitting the microwave energy across to the skin.
It takes quite a few seconds for each pulse
and then it will shut off by itself.
So, we're at 17 seconds left for this pulse
and then we go on to the next spot in the template.
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