Benefits and risks

Information for the public

The evidence that NICE looked at showed that the procedure benefited many people. So although there was evidence of risks, NICE decided that the procedure was safe enough and worked well enough to be used on the NHS. The 10 studies that NICE looked at included about 2500 patients who had blushing, excessive sweating or both.

Generally, they showed the following benefits:

significantly less blushing more than 2 years after the operation
'much better' quality of life in 37 out of 59 patients in one study, 'some improvement' in 9, and 'no change' in 5
satisfaction rates of 74% after 15 years and 85% after 8 months in 2 studies.

Four patients whose symptoms came back had the operation again with 'good results'.

The studies showed that the risks of the procedure included:

severe sweating described as incapacitating, intolerable, or hardly tolerable by some patients – 190 patients (with blushing, excessive sweating or both) in a study of 1700 regretted having the procedure 15 years later because of this
a type of nerve damage called Horner's syndrome – this happened in a very small number of patients
air in the chest cavity, which needed a chest tube
worse symptoms and worse quality of life.

In one study 9 patients died after having the procedure – although the study didn't report what they were being treated for or the total number of patients being treated. Five died because of internal bleeding, 3 because of problems with the anaesthetic, and 1 had a stroke.

Some other problems reported in the studies were: bleeding, blood or other bodily fluids leaking into the chest cavity, pulmonary embolism, and nerve damage.

NICE was also told about some other possible risks: harlequin face, long-term pain, wound infection, an air bubble becoming trapped in a blood vessel, and blood flow to the arm being blocked.

If you want to know more about the studies see the guidance. Ask your health professional to explain anything you don't understand.