miraDry vs Botulinum Toxin Split Study for Sweating

miraDry vs Botulinum Toxin Split Study for Sweating


– Underarm sweating is something that affects millions of
people around the world. And it’s a particularly
debilitating problem because it stops you from wearing
the things you wanna wear, you’re sort of forced to wear dark clothes so you don’t see sweat patches. It’s a social inconvenience, it certainly makes people
very self conscious. And it’s a problem that until now has had very few permanent solutions. The things that can be
used for underarm sweating include things like Driclor, which is aluminum-based antiperspirant. It’s very irritating on the
skin, doesn’t have a full effect but, it does help to degree. Things like botulinum toxin
can be injected as well into the underarms and that
helps to reduce sweating for about eight months on average. But, in terms of long-term
or permanent solutions, the only real option that’s
been available has been what you call an ETS or
Endoscopic Thoracic Sympathectomy. This is a huge operation
where people go under, they have a lung deflated, and the surgeon literally
goes into the spine and cuts the sympathetic nerve, which is the nerve which produces sweating and things like flushing of the face. So, it’s the fight-or-flight drive, so it gives you that adrenaline rush. So, that’s the nerve that they cut, but there’s so many side
effects to the procedure, including the side effects from actually having the procedure itself as well as, probably the worst side effect is that the sweating
moves from the underarms to somewhere else. So for example, the trunk or the legs or somewhere where it’s actually
much harder to treat. So, ETS is probably not the best option for underarm sweating. In today’s video we wanna look at one of the newer treatments
for underarm sweating, which is called miraDry. Now, this is a very novel treatment and is long term effect, so it’s considered to be
a more permanent solution, but it’s localized so you don’t need to have a big operation to have it done. And what it essentially
does is put microwave energy into the level of the skin
which contains the sweat glands and this helps to reduce their number and reduce sweating by
a significant amount. You might think, first thing off the bat, I’m gonna microwave my underarms, but it’s actually not too
bad in terms of safety. The energy only passes into very superficially into the skin, usually at the dermal-epidermal junction, which is the top two layers of the skin. And basically, it just helps to reduce sweat glands at that level. So, we’re gonna put miraDry to the test and try to do some scientific evaluation of its effectiveness
by doing a split study. In other words, we have
a subject Stephanie, who is gonna volunteer
to have one arm done with botulinum toxin and the
other arm down with miraDry. So, we’ll see what the
effects are on both sides, how long it takes to kick in and what the longevity of effect is. And I think the other thing
we’d like to look at as well is what’s the value of it, because is it better to
have a longer term treatment like miraDry or to have regular treatments of botulinum toxin? Now, in order to evaluate
these two treatments we need a test, a scientific test, which will be able to tell
how much sweating is going on. We’ve been using this test for a while, it’s a very simple test
and basically it involves corn starch and iodine. So, it’s called a Minor’s
starch-iodine test. And what it involves basically is coating the underarm skin with
iodine, letting it dry and then trying to get the room
up to a certain temperature where the person will sweat. And when they sweat, the
iodine is lifted from the skin and then we put cornstarch on. So, it sounds unusual, it sounds like some sort of cooking recipe,
but actually what happens, the cornstarch, when mixed
with the sweat and the iodine, it turns black. So, anywhere where there’s sweating the cornstarch will turn black and that’s how we know how
much sweating is going on. So, we’re able to do a direct comparison of these two treatments, and the room environment
won’t be a variable because we’re doing a split study. So, we’re on the same day, the same room, we’re testing both underarms. And we’ll see what sort of
sweating reduction of each ways. So we’ve turned the heat up in
the room, we’re gonna get… This is Stephanie, our subject for today, and we’re gonna get her sweating. Actually, we’re all sweating I think. But, we’ll get sweating
going as much as possible and we’re gonna do Minor’s
starch-iodine test. We’ve got Laura here, our nurse who’s gonna be performing
the treatment today. Okay, first step is, let’s put
some iodine on her underarm. So you can see there’s a little
bit of sweat there as it is, and then the sweat starts to push the iodine off the skin again, and then we put the corn starch on. So today we’re using
Johnson’s baby powder, which is not baby powder, it’s
actually pure corn starch. And basically, that
cornstarch will turn black, so we’ll know exactly
probably how much is sweating and which areas are sweating as well. And that makeup brush will
never be used ever again. This side seems to be probably
a little bit more sweaty, is it, or not really? Well, no, it’s about the same. And it’s quite concentrated interestingly on the areas which were hair bearing, ’cause she’s had laser hair removal, which is another benefit of the miraDry, which is that it actually
helps to remove hair like laser hair removal does. Cost wise, per session, you’re looking at around 30% more for the miraDry
treatment, cost wise. However, with miraDry,
usually you only need maybe one or two treatments and that’s it. Whereas, botulinum toxin, you need treatments every eight months and the sweating goes back to baseline. So, it’s a much simpler procedure, botulinum toxin injections, it’s just come in and
get some injections done as opposed to miraDry which
involves local anesthetic, and we’ll demonstrate a
treatment to you in a minute. But miraDry requires a
lot more preparation, but once it’s done, it’s done. And cost-wise in the long term, I think what you’ll find, it’s a better solution in the long run at a lower cost for the patient. Convenience also is a factor as well. I mean having to have come
in every eight months, may be inconvenient for some people. What Laura’s doing here is she’s sizing up the
underarm for the miraDry. And what you need to do is make sure that the areas that we saw earlier are covered, and we’re gonna use a template
as appropriate for that. We’ve got a stick-on
template, which is like the temporary tattoos that the
kids use on themselves. And you stick it on to
the area to be treated, and that acts as a template so we know exactly where
to fire the miraDry. It’s gonna stick on this template. And then we’re gonna remove paper, and you can see
the template remains. So this is all the markings that we need to perform the miraDry. And there’s 13 lines which
we need to fire it across and positions on each line to fire it on. So, Laura’s injecting
some local anesthetic into a few points to start with, and using the device to
make it more comfortable. So a lot of local anesthetic
is used to infiltrate, it’s quite stingy this bit. So we’re gonna use a bit of cold spray to make it less painful. So we put little entry points in and then we ban the local from those entry points using a cannula. One question people often ask for this is, if you get compensatory
sweating elsewhere, the area that we’re treating was so small that the body won’t compensate. Whereas, when you have an
Endoscopic Thoracic Sympathectomy, which cuts off sweating over a large area you can compensate elsewhere. So, that’s the difference
between treating a small area and a larger area with an operation. We’re just putting a couple
of entry points with a needle into the bits of local
anesthetic that we injected, and through these entry
points with the needle we use a cannula to
infiltrate local anesthetic. Local anesthetic will go in
quite easily with a long cannula and that saves you on multiple
needle injections as well. So, this is actually a rounded tip needle, or cannula I should say. It actually is only a
very small concentration of local anesthetic, but it does the job in what it needs to do,
which is to numb the area and spread around before
we perform the miraDry. And the other important factor is that local anesthetic also gives
you a bit more of a buffer for the microwave energy, so basically your thickening up the
skin layer and fat layer so that the microwave
energy doesn’t go through and affect any of the nerves
or underlying structures. Now you can see the area is turning white and there’s some adrenaline
in the local anesthetic and this helps to
constrict the blood vessels and keep the local
anesthetic in the one spot. So, local anesthetic with adrenaline always lasts a lot longer
and is more localized and more effective than local
anesthetic without adrenaline. As the procedure continues, it
becomes less and less painful as the local anesthetic from
one area numbs the next area. So, it gets better as time goes by it, it is a bit stingy at the beginning. The whole procedure
does take over an hour, but, once you’ve got the local in you don’t feel anything at all. While we’re waiting for
the local anesthetic to work on the left
armpit, we’re gonna do some botulinum toxin injections
on the right side. We’re gonna just grid up
the underarm with squares and then basically inject a
set amount of botulinum toxin into each square there so it
is nicely evenly distributed. – (laughs) – We’re having a problem
with ticklishness, Stephanie’s a bit ticklish. So, Laura’s injecting the
epidermis or dermis of the skin with botulinum toxin to help shut down those sweat glands temporarily. And you can see it raises
a little mozzie bite appearance on the armpit. – That reacts more than the… – Yeah, the cold spray is used to again, distract from the pain,
it’s quite effective. It can be a little bit stinky too, but I think people tend to prefer some sort of analgesia
than just straight needle. You can also put numbing
gel on as another option, but then you have to wait. So, a lot of people just come in and do it with the cold spray. miraDry’s a good system,
which uses a template and a very easy to use interface. Basically it shows you
the corresponding markings on the template on the screen. You align the handpiece to
the same point on the template that’s indicated on the screen, and fire. So, each one of these will
deliver a set dose of energy and that will help to give you
a nice even smooth results. We’re doing the miraDry treatment now, and it makes a lovely sound when the skin is sucked
in to the handpiece. And it goes through certain phases of transmitting the microwave
energy across to the skin. It takes quite a few
seconds for each pulse and then it will shut off by itself. So, we’re at 17 seconds
left for this pulse and then we go on to the
next spot in the template. (rousing music) (upbeat music)

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About the Author: John Markowski

5 Comments

  1. Treat sweating yes and then stop peeing stop all fluids coming out body is stupid to produce it! Omg people are stupid!

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