Dry is Beautiful: MiraDry w/ Dr. Carolyn Jacob

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The title of today's episode
is "Dry is Beautiful."

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Dr. Bass, I'm not sure
what we're doing here.

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Usually we're talking about working
on a body part or about a particular

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technique. What is the
focus of today's episode?

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You're right, Summer,

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here we're talking about something
that's not strictly speaking about

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appearance, but definitely
relates to how others perceive us.

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Many things about modern life tend to
amplify the differences for people with

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excess sweating medically,

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what we call hyperhidrosis
with frequent washing

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antiperspirant and our climate
controlled modern lives.

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Most of us don't think
a lot about sweating,

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but for those with hyperhidrosis,

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this can still be a devastating
social problem on a daily basis.

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And given the aseptic outlook of modern
Western life can even be a concern for

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many who sweat in a normal fashion.

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Before we get to modern options, can you
give me my history lesson for the day?

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Sure. So for people with
milder sweating issues,

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treatments with aluminum chloride
went under the brand name Drysol

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were commonly used,

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and this would create treatment
for a period of time that would be

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repeated a few times a year.

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There were also oral medicines
that block the cholinergic

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stimulation that brings on sweating.

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And for patients with severe
problems with hyperhidrosis,

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they would actually have the
sympathetic branches of the nerves cut

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surgically or even occasionally have the

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sweating area of skin
excised and then skin graft.

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And that obviously was a big
procedure that created a lot of scar.

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So these are historical things,

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not really part of our modern
discussion of hyperhidrosis.

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Okay, thanks for explaining.
So what about today in 2024?

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What are the main options?

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Well, I brought an expert to bring us
up to date on the latest in this area.

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Dr. Carolyn Jacob is a board
certified dermatologist who's an

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associate clinical professor
at Northwestern's Feinberg
School of Medicine.

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She's the founder and medical director
of Chicago Cosmetic Surgery in

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dermatology in Chicago
River North Neighborhood.

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After her dermatology training,

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she completed the cosmetic and laser
surgery fellowship at Harvard Medical

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Skincare Physicians.
And for the listeners,

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this is really the pinnacle
cosmetic and laser fellowship in the

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United States.

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She's performed research and lectured
and discussed in the media many cutting

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edge treatments in cosmetic medicine,

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including excessive sweat
reduction with MiraDry technology,

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cellular treatments,
injectable aesthetics,

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body shaping with high frequency
electromagnetic energy,

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what's called HIFEM, and
with radio frequency,

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which is in a combined device,
EmSculpt Neo as well as many others.

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So Dr. Jacob, welcome.

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Thanks for having me. Hi, Dr. Jacob.

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Thank you for joining
us today as an expert.

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Can you tell us a little more
about the biology of sweat,

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how it's made and
different kinds of sweat?

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Absolutely. So there's these
main sweat glands on your skin,

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which are known as eccrine glands.

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They also sit adjacent to these
other glands called arine glands,

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but the eccrine glands are the ones that
create the actual watery sweat that you

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notice when you're working
out or when you're nervous.

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And these glands tend to
be more concentrated in the
underarm area and the palms

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and the soles.

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Okay. Okay, that makes sense.

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Could you talk more about hyperhidrosis
in terms of how it manifests,

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where in the body it occurs,
and how it impacts patients?

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Sure.

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So more than 4% of the population is
affected by what we call primary axillary

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hyperhidrosis,

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which is excessive sweating
beyond normal physiological needs.

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This is also a condition that usually has
been present for more than six months.

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It might run in your family as well,

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and it inhibits you from some of your
daily activities because of your need to

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either wear black clothes all the time
so people can't see that you're sweating

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or to shower frequently. And then
there's other issues such as odor,

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which it can be offensive or
bothersome to yourself as well.

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Some people will sweat in a color,
which is called chrome hydrosis,

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and then also you can get different
skin conditions such as eczema and

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intertrigo in areas that
are moist and damp often.

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So it causes a lot of problems
besides just embarrassment.

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Got it. Wow, that's much more
than I ever thought about.

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So then what are the big options
today for patients with hyperhidrosis?

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Well, luckily today we have a lot of
treatments for hyperhidrosis, and again,

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some of our patients don't come
in with just the underarms.

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They'll also have hands. As
Dr. Bass had already mentioned,

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back in the old days we had mostly
topical products containing aluminum

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chloride. But the problem with those is
that they led to irritation, redness,

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and sometimes eczema in the
treated area. Fast forward,

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those have advanced to a particular
product that's called glycopyrronium

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tosylate.

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This is a prescription called QBREXZA
that you can use just on the affected

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areas of the underarm. Some people will
use it off-label for the hands and feet,

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it's a wipe,

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it just lasts for about 12 hours and
then you throw it away after you've

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applied it to the area.
Other treatments that exist,

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also brand new, something called Brella,

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which uses this sodium patch
to actually activate and

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heat up a little bit of the eccrine ducts.

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So the sweat glands called eccrine
glands have a little tube that allows the

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sweat to get to the skin and it kind of
stuns those tubes and the eccrine glands

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so that you don't sweat
for several months.

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And that's just an in-office
treatment where a patch is applied.

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But for people who really want to
stop their sweating permanently,

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there's microwave
technology known as MiraDry.

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Okay. All of those sound
really interesting.

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What are some of the benefits and cons
of some of those options just in general

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terms?

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Sure. So again, if you're talking
about just underarm sweating,

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then the go-to decreasing
sweat permanently

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treatment would be the
MiraDry microwave technology.

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It works beautifully in that it's an
in-office procedure that takes about an

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hour. The area is numbed up and
then the treatment is performed.

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Microwaves just like your microwave in
your house can heat up water and that

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helps to destroy those little sweat
glands just in the area that's being

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treated. Whereas the rest of your
sweat glands will continue to sweat

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normally and you won't have
any issues such as sweating

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excessively somewhere else.

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That has been found to occur in that
other treatment that Dr. Bass had

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mentioned, which was the one
where they actually cut the nerve.

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So we never recommend
that for patients anymore.

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I failed to also mention that
they're all oral treatments.

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There's pills that you can
take for excessive sweating.

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So if you're a sufferer who has both
your hands, your feet, your underarms,

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your face,

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you may be a better candidate for taking
some of these pills under the direction

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of your dermatologist.

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So while we're talking about pluses
and minuses, just add in there,

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Dr. Jacob, the pluses and minuses
of something like Botox injection,

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which is also cleared for hyperhidrosis
compared to something like MiraDry.

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Sure, absolutely.

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So there's other treatments that can be
done locally for focal hyperhidrosis in

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the underarm such as Botox or
botulinum toxin injections.

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These injections are performed in a
physician's office with a little bit of

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topical anesthetic and they're
very comfortable to have done,

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but they are temporary studies show
that Botox brand lasts about 260

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days on average in reducing the sweat,

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but it does have to be
done in a repeated fashion.

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In some states that treatment
can be covered by insurance,

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but in other cases it's
not covered by insurance.

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So it gets a little tricky to do a repeat
treatment that's going to be expensive

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over and over again,

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but that is another option for
treating excessive sweating.

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Thanks for sharing all of
that. You mentioned a permanent
solution with MiraDry,

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and you touched on it a bit, but can
you tell me a bit more how does it work?

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Absolutely. So this technology
has been around since 2011.

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Lots of treatments have
been done successfully and
that's what makes it such a

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great treatment in that it permanently
reduces the sweat after two simple

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treatments. The treatments
are separated by two months.

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So you'll come into the office, we'll
mark out the areas to be treated.

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A little tiny kind of fake
tattoo is put onto the area.

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The area is numbed up with
some local anesthetic,

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and that takes just a few minutes
to do. And then once it's numb,

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the applicator of the MiraDry device
is put onto the skin and little tiny

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rectangles of tissue are treated
at a time to heat up the skin.

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Their device cools the top layer of skin,

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so there isn't any issue
with the actual skin itself.

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And that energy of heat from the
microwave is put down into those sweat

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releasing glands that we call the
rine glands that then permanently

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reduces them. With one treatment you
get about a 69% reduction with two

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treatments,

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it's about an 89 or greater percent
reduction in sweat that is then permanent.

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The reason it's permanent is you
don't regenerate these eccrine sweat

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glands. So the ones that you have
are the ones that you're born with,

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and if we get rid of them
in the underarm area,

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then you don't have to
worry about them again.

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But remember that you'll sweat
normally everywhere else.

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And for these sufferers, they do sweat
normally in a lot of other places,

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but sometimes it's just the
underarms are profusely sweating.

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This sounds like an interesting
approach for combating hyperhidrosis.

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What does the data show about the results?

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The results are great.

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As I mentioned in the first
trial that was done back in 2010,

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published in 2011,

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they showed that the results
decreased sweating by about 69%.

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They then added a second
treatment, did another study,

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and found out that there
was an 89% reduction overall
of the amount of sweat for

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these patients who suffer
from underarm sweating.

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That's a really good permanent amount.

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They did biopsies to show you that
there's no more of the sweat glands in the

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area. And so a few little areas might
get skipped because as I mentioned,

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you're doing little tiny rectangles of
treatment in the entire underarm area.

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So if someone does have
sweating, we have them come back.

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We'll do what's called a star iodine test.

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We'll find out where those areas are that
they might be sweating from and have a

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conversation as to whether or
not they need a third treatment.

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But the majority of patients get two
treatments done two months apart.

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There's about two days of having a
little bit of swelling under your arms,

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and so we ask people to ice the area,

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take some ibuprofen and take
it easy for a couple of days.

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Okay, great. Thanks for
walking through that.

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So how is microwave energy different
and what makes it well suited for

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MiraDry?

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Sure. So patients with hyperhidrosis can
sweat excessively while they're sitting

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still. It usually doesn't
occur until puberty.

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And then after that it
becomes a bigger problem.

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The patients are suffering so badly,

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they may have to wear pads
under their arms, et cetera.

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What happens with microwave technology
is microwave energy is very specific for

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water as to fat or skin or muscle tissue.

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So specifically microwave technology
has only been used in the medical field

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for treating things that
deal with water such as tate

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enlargement.

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They've used microwave technology
to decrease the size of the prostate

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nonsurgically from that technology.

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They then developed using this
for the underarm sweating.

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So microwave technology is still
the number one permanent treatment

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for treating underarm sweating,

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and we're really excited that we have
the ability to offer this for our

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patients.

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Okay, great. And I know you
also touched on this before,

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but you mentioned for recovery you might
have to ice the area and there might be

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swelling. Is there anything else I should
know if I want to go for a treatment?

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You would need to shave the area two days
prior, and this includes men as well.

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When you have the treatment done,

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the collateral damage from the heat
sometimes reduces a little bit of the hair

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in the area.

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One recent study showed that
it decreased the hair by 72%,

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and it doesn't matter what color the hair
is because the microwave technology is

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just using heat. It's not being absorbed
by a particular color repair. So far,

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I've never had a single man be upset
that he has less underarm hair after

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the series of the MiraDry treatments,

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but then we need to have you ice
it and take a little ibuprofen.

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There can be some swelling because we
have used this device to create heat.

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We tell people to kind of refrain from
big physical activities like beach

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volleyball and those sort of things
for a couple of days. I haven't had a

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patient call me in years with any issues
of side effects after the treatment.

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But during the healing phase, there's
no changes on the surface of the skin.

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Everything's happening underneath the
skin. But sometimes because of that heat,

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you can get a little bit of bumps that
you can feel under the skin and those

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bumps go away with time or with some
treatments that we'll do in the office,

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such as a little shockwave treatment
or a little injection with a mild

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steroid like we would do for an acne
pimple. So those occasionally happen,

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but they're very easily resolved
with some treatments and with time.

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We started this discussion
with a focus on hyperhidrosis,

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but that's only part of the target
audience that can benefit from this

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technology. What other groups of people
do you see coming in for treatment?

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Well,

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there are a lot of patients like me
who are perfectly normal throughout the

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day until they have to get up on podium
and give a lecture and then they start

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sweating. So people that
have to give performances,

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people that have to be in big
audiences to give lectures and talks,

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sometimes that creates this
situational sweating for them.

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And that's really problematic,

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especially if you haven't remembered to
wear a dark outfit because your sweat

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will show when you're
in front of everyone.

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So the situational sweaters also
can benefit very greatly from

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having miry treatments.

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And we have some people who just don't
want the sweat in their underarms at all.

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Again, remember you're going to
sweat normally everywhere else,

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but this will reduce the amount of
sweat by about 89% in the underarm.

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So there's a lot of people that can
enjoy improvement from the MiraDry

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treatment.

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Yeah, I mean that's a huge reduction
in sweating just in daily life.

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I know you've been an active
researcher in this area.

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We like to have people like you on the
podcast who can speak authoritatively

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about a subject and know all
the ins and outs because of that

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extensive experience with it.

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Tell us a little bit about what
you found in your research.

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Some of the research that we conducted
years ago was basically patient

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satisfaction because again,

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this was a condition that didn't
have a really great treatment for it.

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People don't want to take pills every day.

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They don't want to have to
use solutions every day.

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And when we looked at the
patients that were treated,

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the satisfaction level was
above 95% for these patients.

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The comments we got from patients
were things such as life changing,

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saved my life, saving me time and energy,

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saving me time and money because
they're not ruining clothes,

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they don't have to change
clothes frequently.

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They don't have to take extra showers.
So very overwhelmingly pleased patients,

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which makes it a great treatment for
us to get to do for patients as well.

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Now moving into the future,

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we're actually looking at some
other applications with the device.

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It is a little tricky in that the
device has a disposable tip that's

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used for each individual person that
has to vacuum up the skin a little bit

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away from the underlying structure.
And because of that,

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we cannot use this treatment
tip on the hand. However,

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we've known that there's been lots of
patients who've suffered with sweating on

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the chest and on the back.

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And this also causes great concern
and stress for the patients.

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So we will be doing a
study in the near future,

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testing it for the usage on the
chest and on the back in different

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patches to reduce excessive
sweating in those areas,

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which will bring great relief
to those patients. And as aside,

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we actually have done this to patients
off-label already. We know that it works,

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but it's now time for us to actually put
it to the test and do a rigorous study

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on it.

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So this is really a huge thing.

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And so much of what we do in aesthetic
medicine is about appearance.

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As I said at the beginning,
this is not appearance,

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but it has to do with
convenience, lifestyle,

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your ability to do work, your ability
to interact with people socially,

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and to have the confidence to know
you're going to be able to do that.

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And that confidence lets you project
your personality instead of your

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anxieties about the problem
of sweating or some feature of

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appearance.

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And that's really everything that we
do every day in aesthetic medicine.

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Yeah, absolutely. And I think that's the
feedback we get from patients is that,

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oh my, there's a way to potentially
cure this problem permanently,

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and that's what they really want,

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because if you're sweat bothered
or if you have excessive sweating,

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it's a home run treatment
for these patients.

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Before we end this podcast, Dr. Jacob,

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can you share some takeaways
with our listeners?

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Sure. So don't suffer in silence.

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Dermatologists are the doctors of
sweat. Not everybody knew that.

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Raise your hand if you have trouble
sweating because we've lots of different

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ways that we can help you treat
you and make you not embarrassed,

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make you not feel stressed about
the condition that you have.

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And with MiraDry microwave treatment,

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we can permanently reduce your underarm
sweating and give you a life that's so

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much easier to lead.

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00:18:34,020 --> 00:18:37,290
Great. Thank you. And what
are your takeaways, Dr. Bass?

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So as I said,

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everything that affects how we feel
about ourselves is part of how we project

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to friends, family, and
outsiders part of our image,

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and therefore it's part of beauty.

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The durable response of
sweat glands to energy-based

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destruction makes it a particularly
appealing approach that has that

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benefit of permanence that most of
the other treatments cannot offer.

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Reducing sweat production
minimizes dampness and also

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odor.

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And so it's an important part of
hygiene and daily maintenance for

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hyperhidrosis patients. Other
areas are still unsolved problems.

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Some of them may be addressable this way,

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as Dr. Jacob pointed out on the torso.

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But areas like the palms are
perennial problem areas that

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we're still a little bit frustrated
with. And as you also heard,

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occasionally there's rebound in other
areas with increased sweating with

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certain constant treatments. But overall,

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anything that reduces your concerns
about how others perceive you

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is a plus towards improving your life.
And this is a perfect example of that.

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I'd like to thank Dr. Jacob for joining
us today and sharing her research and

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perspective in this
sometimes overlooked area.

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Thanks so much for having
me. I appreciate it.

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Thank you,

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Dr. Jacob for opening up our understanding
of this horizon in self-care.

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You're very welcome.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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00:20:14,220 --> 00:20:16,140
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00:20:16,200 --> 00:20:18,450
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00:20:18,600 --> 00:20:22,110
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00:20:22,110 --> 00:20:25,680
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00:20:25,680 --> 00:20:26,880
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00:20:26,970 --> 00:20:31,620
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00:20:31,620 --> 00:20:34,140
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