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Presentation

Microwave Thermolysis for Permanent Treatment of Axillary Hyperhidrosis

Description

The transcript explains microwave thermolysis as a more permanent treatment for axillary hyperhidrosis using the MiraDry system, which was FDA approved for underarm sweating and later for bromhidrosis and hair reduction. Microwave energy targets water molecules in sweat glands, converting vibration into heat that destroys eccrine and apocrine glands and can also reduce hair follicles, with cooling used to protect the skin surface. The procedure focuses energy at the dermal-subcutaneous junction, often guided by a starch iodine test, and typically requires local anesthesia before a treatment lasting about an hour; many patients need two sessions spaced four weeks apart. The speaker then describes an institutional attempt to optimize the procedure by switching from many small lidocaine injections to high-volume tumescent anesthesia delivered through a blunt cannula. Their trial found no difference in sweat reduction between standard and tumescent anesthesia, but tumescent anesthesia produced lower pain scores, better spread, and more separation of underlying structures, potentially protecting nerves and allowing use of a higher energy setting. With this protocol, most patients reportedly achieved desired sweat reduction in one treatment, with sustained efficacy.

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Conclusions

Microwave thermolysis with the MiraDry system can permanently reduce axillary sweating by destroying eccrine sweat glands rather than providing only temporary relief.
The treatment can also reduce axillary odor and underarm hair because the energy affects nearby apocrine glands and hair follicles.
Cooling during the procedure helps protect the epidermis while allowing heat to be concentrated at the dermal-subcutis junction where the sweat glands reside.
Sweat glands appear to be durably eliminated after treatment, with histology showing later absence of eccrine coils and no apparent regenerative return.
Using starch-iodine mapping improves targeting of the treatment area compared with relying on hair distribution alone.
Tumescent anesthesia did not reduce sweat-control efficacy compared with standard multi-injection lidocaine anesthesia.
High-volume tumescent anesthesia appears to improve comfort and may protect underlying nerves by creating a larger fluid buffer in the axilla.
Because of the buffering effect of tumescent anesthesia, higher treatment energy can be used safely, which may help most patients achieve the desired response in a single session.
In this institution’s experience, more than 90% of patients reached satisfactory sweat reduction after one treatment with the optimized protocol.
Overall, the optimized protocol maintained sustained clinical efficacy while improving patient comfort and potentially reducing the need for repeat treatments.

Glaser, D. A., MD, FAAD. AAD Annual Meeting presentation on MiraDry and microwave thermolysis for axillary hyperhidrosis, Denver, March 27–31, 2026.
Use of Microwave Thermolysis for Axillary Hyperhidrosis. Daniel Tinker, MD, FAAD. AAD Annual Meeting, St. Louis, Missouri, March 28, 2026.