Palmar hyperhidrosis surgery: one side vs both sides

Surgery for very sweaty palms usually means a thoracic sympathectomy. A randomized trial at 11 Brazilian centers, published Nov 4, 2026 in Clinics (São Paulo), compared operating on both sides at once with operating only on the dominant side. Here is what it found, including the trade-off with compensatory sweating, and why dermatologists treat surgery as a later option.

What the trial found Read the sources

Key findings

Both-side surgery gave more complete control of both hands and larger quality-of-life gains.
Severe compensatory sweating was more frequent after both-side surgery: 40.4% vs 21.0% (nominal, unadjusted p = 0.0344).

The trial

163 adults, 11 centers

Adults with primary palmar hyperhidrosis were randomized 1:1 to one-stage bilateral sympathectomy or sympathectomy on the dominant side only. From six months, the one-side group could choose surgery on the other side (PubMed abstract).

Surgery is later-line

When other treatments fail

AAD says surgery may be considered if other treatments fail to bring relief, and that most patients have some degree of compensatory sweating, ranging from mild to heavy (AAD).

FAQ

Palmar hyperhidrosis surgery: quick answers

What surgery is used for sweaty palms?

AAD lists sympathectomy for the palms and underarms. The surgeon cuts or removes nerves going to the area, interrupting nervous-system signals that trigger sweating. It is done under general anesthesia.

Is one-side surgery an option?

In the Clinics trial, surgery on the dominant side gave excellent control of that hand and less severe compensatory sweating than both-side surgery. About 1 in 7 untreated hands improved on its own.

How many people had the second side done?

Thirty-two patients in the one-side group, 40.0% of that randomized group, later had surgery on the other side. Follow-up data after that second surgery were available for a smaller subset.

What is compensatory sweating?

The trial defined it as new excessive sweating in previously unaffected body areas after surgery. AAD says most patients have some degree of it.

Should I try other treatments first?

AAD describes surgery as an option when other treatments fail. Talk with a dermatologist about the options that fit your situation.

What the trial found

Improvement in the operated dominant hand was similar after both approaches, while control of the non-operated hand favored both-side surgery. In the one-side group, about 1 in 7 untreated hands improved spontaneously (Clinics abstract).

About 25% of patients in each group had no compensatory sweating. Severe compensatory sweating was more frequent after both-side surgery (40.4% vs 21.0%; nominal, unadjusted p = 0.0344), an absolute difference of 19.4 percentage points. Quality-of-life scores improved in both groups, with larger and more sustained improvement after both-side surgery (p < 0.001).

Among the 16 patients reassessed after completing the second side, compensatory sweating occurred in 9 (56.2%), and eight of the nine cases were classified as mild.

The authors' conclusion

The authors conclude that one-stage both-side surgery provides more complete bilateral symptom control and greater quality-of-life improvement, but at the cost of more severe compensatory sweating. One-side surgery offers excellent control on the treated side, reduces the risk of severe compensatory sweating, and supports a staged approach in which many patients avoid a second procedure.

Limits of this study

We read the PubMed abstract; the full text was not accessible to us. The compensatory-sweating p-value is nominal and unadjusted, and post-completion results come from a small selected group. The trial studied palms in a Brazilian population and says nothing about topical antiperspirants.

Less invasive options first

AAD notes that non-prescription antiperspirants are only effective for mild hyperhidrosis and many patients need a prescription antiperspirant, and describes other options such as iontophoresis, botulinum toxin and medication before surgery (AAD). The International Hyperhidrosis Society calls ETS an option of last resort because of compensatory sweating and other effects (IHHS).

Maxim® Ulti-Dri™ 15%

Clinical-strength roll-on for heavy underarm sweating.

Shop Maxim 15%

Maxim Sensitive

Sensitive formula option if standard strength feels too strong on skin.

Shop Maxim Sensitive

Maxim is a topical underarm antiperspirant. The research on this page did not test Maxim, and is not evidence that Maxim prevents, treats or replaces any medical treatment. Follow the label; individual results vary.

Sources

Educational information, not a diagnosis or medical advice. Sources were opened and read on Nov 9, 2026. Research summaries are based on the published abstract or full text as noted; they are not evidence for any Maxim product.

Considering surgery for sweaty hands?

Ask a dermatologist about all your options and the risk of compensatory sweating before deciding.

What the trial found Read the sources

Educational information only, not medical advice. This study did not test Maxim or any antiperspirant, and Maxim does not claim to replace or prevent surgery.