http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10819557

1: Br J Dermatol. 2000 Jan;142(1):194-5.  Related Articles, Links  

  
A caution about surgical treatment for facial blushing.

Drummond PD.

Publication Types: 
Letter

PMID: 10819557 [PubMed - indexed for MEDLINE] 

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Drummond PD.

School of Psychology, Murdoch University, Western Australia. drummond@central.murdoch.edu.au

ESFB Channel
Re: Post ETS Flushing Explanation

Endoscopic Thoracic Sympathectomy for Blushing
Peter D. Drummond
School of Psychology, Murdoch University
Perth, Western Australia

Over the past ten years, endoscopic thoracic sympathectomy (ETS) has been put forward as an effective treatment for facial blushing. In several series of patients, including one published recently in this journal,1 self-reported ratings of blushing decreased substantially after surgery and only a low incidence of adverse outcomes was encountered.2-4 

Although the operation is usually successful in the short-term, side-effects from the procedure may ultimately cause patient dissatisfaction (Reisfeld, http://www.sweaty-palms.com/blushing.html). Unfortunately, the distress experienced by a minority of patients after surgical sympathectomy is given little weight in most of the published literature. Nevertheless, the establishment of support groups and internet forums testify that this distress is real and is not limited to a few isolated cases (e.g., http://home.swipnet.se/sympatiska/index3.htm; http://www.ets-sideeffects.netfirms.com; http://pub157.ezboard.com/betsandreversals). In fact, dissatisfaction with the long-term outcome after ETS has resulted in the development of a nerve graft procedure to reverse the sympathectomy in the hope that this would also eliminate disabling side-effects.5,6 In anticipation of unwanted side-effects, some surgeons prefer to clamp rather than sever the sympathetic chain to facilitate later reversal of the procedure.4 

The most common reason for dissatisfaction with ETS is the development of excessive (compensatory) sweating below the level of the sympathectomy.3,7-10 Compensatory sweating develops in up to 90% of patients who undergo surgical sympathectomy of the upper limbs and face, and can be severe and disabling.10 Although not as widely recognized as compensatory sweating, some patients also develop gustatory sweating and a range of other less specific symptoms after ETS.3,4 Bilateral thoracic sympathectomy alters cardiovascular control and inhibits increases in cardiac output during exercise.11,12 Whether this contributes to the circulatory problems and chronic fatigue reported by some sympathectomized patients is unclear. 

From a psychological point of view, it is hard to endorse a destructive surgical procedure to prevent the physiological disturbances associated with anxiety,13 particularly when the procedure carries risks of operative complications and disabling side-effects. In the case of emotional blushing, perceptions about blushing frequently do not match physiological signs. In particular, people who are concerned about blushing consistently report high levels of social distress and overestimate the intensity of blushing when they feel self-conscious or embarrassed.14 That is, the patients problem often is fear of blushing rather than blushing itself. This fear develops easily; simply telling people who usually are unconcerned about blushing that they blushed during a social encounter can engender embarrassment and concern about blushing in future social encounters.15 

Drott et al.1 noted that patients should be encouraged to try non-surgical options as the first line of treatment for facial blushing (page 11. In my view ETS should not be offered to people concerned about recurrent emotional blushing, because the risks of irreversible operative complications and side-effects outweigh the potential for indirect and possibly transient psychological gains.
