Key Points

• Primary hyperhidrosis involves excessive sweating from the hands, axillae or feet
• Craniofacial sweating or blushing is a rare subset of primary hyperhidrosis
• A variety of medical and surgical therapies exist depending on the location of the excessive sweating
• Endoscopic thoracic sympathectomy (ETS) is an excellent surgical technique to permanently abolish palmar and axillary hyperhidrosis
• Intraoperative identification of visual and tactile landmarks helps to identify the sympathetic chain
• The level at which the sympathetic nerve is clipped/divided is determined by the preoperative patient symptomatology