miraDry® explained: what to expect

By Georgia Sinclair – Dermal Therapist & SkinBox miraDry® technician

The Science of Sweat

Sweating is important! It’s how we regulate body temperature (otherwise we would overheat!) There are two types of sweat glands:

• Eccrine glands: found all over the body and excrete odourless fluid. 
• Apocrine glands, found primarily in the underarms and genital area. These are responsible for producing (sometimes potent) body odour when exposed to bacteria on the skin. 

Our nerves respond to internal and external stimuli, which then send signals to these glands to produce sweat. 

It is possible to sweat too much! This is known as hyperhidrosis where the sweat glands go into overdrive and produce too much perspiration for no apparent reason.

Exploring Hyperhidrosis

Hyperhidrosis is a disorder affecting up to 8% of the population. While you might expect that excessive sweating is primarily the result of temperature or physical exertion, it can also be triggered by feelings of anxiety, stress, nervousness, certain food, or hormones. 

Hyperhidrosis occurs when the sweat glands are stuck in the “on” position, resulting in uncontrollable and often visible sweating: through clothes, dripping or running off the body. This can be extremely embarrassing and compound feelings of anxiety or low self-worth in everyday life. 

Hyperhidrosis can be Primary (no obvious cause & is possibly genetic) or Secondary (caused by a specific condition/medication), and can be Focal (one body site only) or Generalised (affects all sweat glands throughout the body).

For example, Primary Focal Hyperhidrosis is a medical condition that often begins in childhood or early adolescence and tends to involve areas such as hands/feet and armpits, whereas Secondary Generalised Hyperhidrosis occurs in adulthood, often as a side-effect of another medical condition or medication, and involves all the skin.

People with Hyperhidrosis experience profound consequences on wellbeing including low self-esteem, self-confidence, anxiety compounded by restriction to wardrobe options or social interactions. The consistent, elevated baseline of anxiety around sweating creates a vicious cycle considering anxiety is also a common sweat-trigger. 

I have experienced this firsthand! While my case was not considered severe, it was significant enough to affect me every day: it created restriction around the styles and colour of clothes I could wear and the fear of sweating in a social or work environments only worsened my episodes. 

Treating Hyperhidrosis

Current sweat treatments available in Australia include:

• Psychological interventions to help manage triggers.
• Antiperspirants applied topically to the skin.
• Iontophoresis – simple and effective for hands/feet but very temporary 
• Neurotoxin injections to the sweating area – the same product we use as a wrinkle relaxer
• Oral medications – these are rarely appropriate for long-term use due to side effects
• MiraDry® – heat treatment directly to the sweat glands of the armpit area

All the physical treatments listed (but one) will help to reduce sweat and odour; however, they require maintenance which can be costly and inconvenient.

The exception is, of course, MiraDry®.

Get to know MiraDry®

Now the fun stuff! This is a treatment that works and has long-lasting results for hyperhidrosis of the axillary (armpit) region. The treatment is quick, non-invasive, and permanently reduces sweat production, odour, and hair (of all colours) growth. 

It almost sounds too good to be true! But for me it is the real deal.

MiraDry® utilises controlled microwave energy delivered precisely through a specially designed handpiece. The energy penetrates the skin where the sweat glands and hair follicles reside, affecting only the sweat glands that sit approximately 2-5mm deep. 

The sweat glands are heated to the point of destruction, they are unable to regenerate, resulting in a remarkable reduction in sweat production. 

There are over four million sweat glands on the body, and only 2% are in the underarms, so, the treatment does not affect the body’s ability to cool itself or eliminate toxins. 

On average, patients experience an 82% reduction in sweat production from the first treatment. However, between 1-2 out of 10 patients will require a second treatment to target glands that sit too superficial or too deep. It is only a very rare occasion that a third treatment is required. 

MiraDry® is suitable for most individuals that suffer with hyperhidrosis, even at a young age, if they don’t have contraindications and their doctor and guardian authorise treatment. 

Contraindications include:

• Pregnancy
• Breastfeeding
• Heart pacemaker
• Other implanted electrical devices 
• Supplemental oxygen
• Allergy or previous concerns with the local anaesthetic (lidocaine and adrenaline)
• Certain underlying skin conditions (discuss with doctor prior to treatment).

What to expect from the MiraDry® treatment

The treatment takes between 1.5 to 2 hours. We like to “Netflix ‘n’ MiraDry” at SkinBox, so we’ll set up the TV with your favourite show and ply you with refreshments to get you through. 

MiraDry® is performed under a local anaesthetic. If you needles give you the heebie jeebies, don’t read the next part: 

Approximately 120ml of local anaesthetic is delivered into the treatment area, through a multi-needle tip (seven needles), this allows for even dispersion of the product. (FYI your brain can only feel a single prick, so it’s not nearly as bad as it sounds.) 

When the anaesthetic has been administered, we apply a temporary stencil to the armpit skin to guide the operator on the area for treatment. A small amount of KY jelly is used to create slip on the skin and avoid any pinching from the handpiece tip. 

The tip is aligned on the stencil and suctions to the skin, drawing the skin inside the tip slightly where it heats the skin, then cools the skin as it releases. This process is repeated until both armpits are done, and it usually takes between 20-30 minutes on each side. 

Some patients experience a feeling of pressure, slight pulling and potentially some low-level heat. Comfort is key at SkinBox, so we can administer more local anaesthetic if required.

Immediately after treatment the underarms will have some ‘love bite’ like marks on them from the handpiece suction. Some moderate swelling will be present and will increase over a few hours, but most of the swelling immediately after can be attributed to the local anaesthetic. 

Bepanthen® Cream is applied to keep the skin clean and lubricated and avoid infection or irritation from skin-on-skin friction. This is also your go-to for post treatment care and needs to be applied a few times a day, or as needed. 

We will give you some little MiraDry® icepacks to apply on the drive home and ask you to continue to use an icepack or frozen drink bottle on the area intermittently over the next day or so.

After your treatment

Expect some swelling. There are three phases of swelling likely to occur in the area: Firstly, swelling from the local anaesthetic, which will be naturally eliminated by the body in the days following. Secondly, inflammation swelling caused by the heat and handpiece suction. This will subside over a couple of weeks. 

Lastly, your sweat glands will be inflamed and swollen. You may be able to feel small, lentil-sized lumps under the skin. This will reduce over a three-month period as the components that made up the sweat glands are removed by the body’s scavenger cells.

Tip: we are usually able to determine if subsequent treatments are required by the three-month post treatment mark.

There are common side effects that are expected post MiraDry® treatment, and some that are less common but can be alarming if the patient is not expecting it.

I wanted to share my experience with patients thinking of having this procedure, so that you know I understand what you are going through and that this is a treatment we trust enough to use on ourselves. I have detailed below a breakdown of my own experience of the MiraDry® recovery and what I went through during this time. I did experience a less common side effect, which was interesting to say the least, but I’m glad I knew what to expect and how to fix it.

Day One: Leaving the Clinic.

My underarm felt like I was smuggling a golf ball. The area was cold and very dry (interestingly, sweating will stop immediately on Day One, it takes a minute to get used to). The Bepanthen® Cream is great to add lubrication and keep the skin clean to avoid infection. Apply this as often as necessary throughout the day. 

My skin was also numb halfway down to the bend in my arm, which was a strange feeling and lasted about a week or two.

Day Two: Swelling

Overnight I took some paracetamol before bed, just in case. Aside from very mild stinging in my underarm, which was soothed with Bepanthen®, my sleep was mostly uninterrupted. On the morning of Day Two I was puffy in my armpit and shoulder, and the golf ball much bigger. The area was tender but not intolerable. The paracetamol was sufficient and helped a lot, but I only needed to use it for the first couple of days. I was able to do some light exercise and everything else I would normally do, just with a bit extra care.

Days Three to Seven: Recovery

The majority of the swelling and ‘puffiness’ subsided from Day Three onward. (This was the local anaesthetic being absorbed by the body and expelled via urine). During this time some of the tenderness and the love bite marks also reduced significantly. Applying roll-on deodorant was a bit uncomfortable but in saying that, I was attending my boxing classes without any issues (taking it easy, of course). My sweating during the week was zero – my underarms were dry! I was enjoying having a taste of a life without sweat and wearing whatever clothes I wanted. 

Tip: be very careful shaving the underarm as it is numb and swollen, shaving cuts happen easily!

Days Eight to Thirteen: I can see my future

In the second week post treatment, inflammation was unnoticeable unless I put pressure in the area. With gentle pressure I could feel small lumps just under the skin, these are the inflamed sweat glands that were dying off. My sweating was about 90% reduced still, I would occasionally get clammy and have some faint odour, but only when it was warranted (e.g. exercise) so I was a happy lady! 

Day Fourteen: An interesting side effect develops

My sweat production was still very low! (Hooray!) Not quite as low as the first week, but about an 80% decrease compared to pre-treatment. In the third week I started to experience some strange discomfort in my underarm and was unable to lift my arms higher than my shoulder without pain and a tight/pulling sensation. 

This is known as “tight banding” and is when the ligament becomes tight due to the treatment, heat, and inflammation. It quite literally feels like a piece of thick string, from underarm to wrist, that’s going to snap. It was even visible when I lifted my arm. I consulted Dr Sarah Boxley and she assured me it was a normal, but a less common side effect to occur and will disappear in good time with some stretching and massage. Phew!

Day 21: Almost back to normal

After a week of gentle stretching and massage, the tight banding was almost gone and I could lift my arms as normal, only over extending is when I could notice the pulling sensation. My armpits still had some residual inflammation and lumpiness but had almost completely resolved by this point. Any remaining small lumps will likely resolve around the three-month post treatment mark and then we can determine if a second or third treatment is required. In my case it was not. I still had a good 80% reduction in sweat and odour.

Day 30: Recovered

By Day 30 pretty much all side effects had subsided, except tiny little lumps felt only when pressure was applied, but there I experienced no discomfort at all. Since having the treatment I hadn’t experienced any noticeable sweat patches under my arms and I was able to wear clothes of all different colours, fabrics and styles. I no longer worry about my sweating, which was generally the underlying cause of the outbreaks, and I can socialise at total ease!

Three months later

By this time the side effects were completely gone, no “lentil lumps” or inflammation present under the skin and no tight banding at all. I reckon my sweat production has remained at an 80% reduction (so only 20% of what it was before treatment), and I rarely have any odour. I have never been happier! 

Comparing my own recovery at two weeks and then again at three months post treatment, to a random selection of 10 SkinBox patients’ follow-ups it is clear recovery and efficacy depends very much on the individual, the size of the armpit/thickness of the skin and the severity of hyperhidrosis. 

Every one of these patients had the same general recovery process in the first two weeks, give or take a couple of days of inflammation and tenderness. Pain is perceived very differently so some patients did not require pain medication at all, whereas others did. Some of them iced their underarms for days and others did for the first two only. Seven out of 10 of these patients reported a >80% reduction in their sweat and odour, the other three experienced around 50% reduction and would consider getting a second treatment in the future. 

Regardless, they all reported that they are now enjoying a vastly improved quality of life and can go about daily life anxiety and sweat-free!

You can book a consultation for a miraDry® Sweat Treatment via our website; you will find it listed under 1. New Patient + Consultations.

by Georgia Sinclair, Dermal Therapist – SkinBox Clinics

REFERENCES
– What is hyperhidrosis? https://www.sweathelp.org/home/understanding-hyperhidrosis.html
– Different types of hyperhidrosis: https://www.sweathelp.org/home/types-of-hyperhidrosis.html
– Understanding triggers: https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis#:~:text=In%20hyperhidrosis%2C%20certain%20sweat%20glands,Emotional%20stress%2C%20especially%20anxiety.
– Treatment options: https://www.sweathelp.org/hyperhidrosis-treatments/treatment-overview.html