What is miraDry® ?
The miraDry procedure is a new addition to the plastic/dermatology armentarium that was recently approved by the FDA for the use in patients with excessive underarm sweating. The full medical name for this problem is axillary hyperhydrosis.

Even though this problem has been around for some time, it has never had an effective “fix.” In some cases, physicians have had success with the use of Botox toxin in this area. These patients have undergone Botox injection into the armpits. This has then translated into some relief. Unfortunately, the relief has been short lived since Botox is only effective for three months. Besides Botox, other methods have been tried. Again, most of these other methods have had anecdotal success.

In the last two years, miraDry was brought out and was used in smaller markets. In those markets, it proved that it could relieve patients of the problems of axillary hyperhydrosis. In patients that underwent therapy, miraDry showed effective permanent relief in 80-90% of patients. This was based on the use of two treatments, each separated by about 60 days. Since the procedure is office based, and now FDA approved, it gives the patients with this problem hope to be done with this once and for all.

How does miraDry work?
Great question. Not to over simply the methods and I am sure I am--the machine is a laser that delivers energy waves through the skin area of the armpit into the underlying sweat glands. The sweat glands then heat up and begin to actually degenerate. When they have actually degenerated, they no longer function. So no sweat glands—No Sweat!!! The most important thing is that the local tissues are not affected by these energy waves. At times, numbness has been reported but that is short lived. The added bonus to miraDry is that once the sweat glands are gone, they do not regenerate.

Why does axillary hyperhidrosis happen?
Another great question. Sweating is a natural body function. The body uses sweat and sweat glands to cool off and regulate the temperature. As the body heats up, sweat glands produce more sweat and then literally cool the body down. This is a normal thing. In axillary hyperhydrosis, the sweat glands don’t stop secreting, even when the body has cooled off. So they turn on and then stay on. This irregular response can happen due to stress or in a few patients, is a baseline. This can be extremely problematic for some patients. Imagine that you are in a meeting and then you take your shirt off and there is a large ring of sweat in your armpits. Ouch. Or imagine, you are at a dinner party with friends, and you take your coat off and your clothing is literally soaked. Again, a stressful type of situation that can only promote more angst.

By numbers, it is estimated that 1 in 6 adults are impacted in some way by excessive underarm sweating. In other words, if you feel that you have this problem, it is probably very normal. Unfortunately, it does not make it any more comfortable. This of course has psychological consequences in that people feel nervous when speaking about this issue. I say this because I too suffer from it. And my family members themselves have had it. But until I brought up the issue, no one seemed to mention it. Because most people are unaware that this is a medical problem, most American adults do not seek the advice of a physician. Most just learn to live/deal with it. Most people do not realize that we now have a medical intervention, mira Dry, that can appropriately address this problem.

So how does this miraDry Procedure work?
Good question. Well after you have been thoroughly educated about the procedure, and have been consented, we let you lie on a padded bed. We then measure the area of your armpits and the extend of your gland and hair follicle distribution. We go through a series of markings. Once we have marked everything, we then inject the areas in your armpit with a series of local injections to make the area numb. When the area has become numb and you are comfortable, we then have your information entered into the computer protocol. It then generates a treatment plan for you. Based on your armpit size and the pattern of hair distribution (the hair and gland distribution are very similar), we then start the treatments.

The treatment starts with applying the hand piece from miraDry to the armpit. By now, we have you marked with a grid pattern, and the miraDry treatment plan literally walks us through on how much energy to place on each area of the armpit. We continue to do this is a series of steps. At each point, we make sure that the armpit is numb and the patient is comfortable. If for some reason, the patient feels pain, we stop the procedure and give you additional numbing medications.

Once the hand piece has delivered the amount of energy at each point that the computer had calculated, the treatment on that armpit will be done. We then go ahead and apply the numbing medicine into the other armpit and again enter the information for that side. The computer then calculates the amount of energy to be applied. After that, we get started on the new side.

When we have concluded the procedure on both sides, we pack the area with ice packs and give the patient a bit of time to recover. More often that not, they are very comfortable. No one has relayed any complaints of difficulty. No one has relayed any complaints of pain. Again, please note that if a patient has any pain during the procedure, we stop and address it immediately.

After the procedure, most patients notice some bruising and definitely some swelling. Also patients commonly note numbness. This is understandable because of the numbing medicine that has been injected into the area.

When will I see the results?
Most often, patients begin to notice results almost immediately. Most patients have called or been seen in a few days and have noted that there is no sweating. This actually throws some patients with hyperhydrosis off since they are used to treating to their problem so many times a day. They actually are somewhat caught off guard. They then notice in the next several days that there is minimal or no sweating whatsoever.

After I had myself treated, I noted an interesting issue. I had one side treated with a deeper energy level than the other. It took about 5 weeks before I actually had noticed any type of actual sweat. Finally, during a workout, I noticed that my right side was sweating. This was the area that was treated with less energy. So I now know that I have to continue with some deodorant on my right side. My left side is completely dry. This was an experiment in gauging the different energy levels. I plan to go through my second treatment in the next several weeks to finish off the therapy. But I can tell that compared to my baseline, there is very little sweat, even after only one treatment on each side.

Am I a candidate?
Most people are candidates for the mira Dry procedure. There are however some firm absolute contraindications. First amongst these is an allergy to local anesthetics. This is an obvious contraindications because if we cannot get you numb, we cannot treat you effectively. The second contraindication is the presence of an electrical pacing device, like an ICD pacer or a heart-pacing machine. This again makes sense since the energy given by the machine may have an effect on the internal workings of the heart pacer. This cannot be and should not be attempted. Lastly, patients with supplemented oxygen should not undergo this procedure. This is for the obvious risk of igniting the oxygen due to the energy distribution.

There is a relative contraindication in that patients need to be over 18 years of age for this to be used. This however must be explained. Like most procedures, there is a concern about applying it to younger individuals. Physiologically, there are NO contraindications on using it on young individuals. However, the effort here is to educate the patient and their families about the use of mira Dry. I have many patients who at 15, 16, or 17 are physically taller and bigger than me. These patients are for the most part adults in their physiology. For them, mira Dry can easily be used. But first and foremost, the young individual needs to be seen, examined with the parent(s) present. Then the family has to be thoroughly educated about the procedure, its risks and its benefits. Only then, when everyone is ready, can the procedure be implemented. On these patients, the use of mira Dry would be considered an off-label use. Age by itself is not a contraindication to the use of mira Dry.

What are the complications of mira Dry?
Important question. With mira Dry, a few complications have been documented. Thankfully, none are severe. First and most common is numbness. As I explained, numbing medicine is applied into the armpits to make sure that the procedure is comfortable. With the numbing medications and the actual energy distributed by the hand piece, very routinely the armpit is numb for several weeks. This tends to return with no long-term residual effects. Some patients have noted that the numbness has extended and has affected their ring and small fingers. This too is a short-term issue. However, this has prompted the company and the practitioners of miraDry to start injecting the area with additional fluid like a liposuction procedure. In this way, the added tumescent fluid acts as a barrier to further cushion the armpit tissues from taking too much of an energy hit. With this new added tumescent fluid injection, the rates of numbness have dropped. This is now the standard.

Like numbness, bruising is almost expected. Most patients, myself included, had a great deal of bruising in the armpit. This goes away. It takes about 2 weeks. The bruising is minimal but it can in some cases be more. Again, all the bruising tends to dissipate by two weeks.

Along with the bruising, some notice swelling in the area. This is understandable considering the amount of energy given and the fact that the area is initially filled with numbing medications. The swelling tends to dissipate within a week. This then is in some cases replaced by knots. I too had knots. I did not notice the knots until week 3. Then the knots became slightly harder. They were not uncomfortable but definitely noticeable. By week 5, they were less noticeable. And by week, 6, the knots and the swelling was gone.

Does insurance pay for it?
Sadly, no. The procedure was designated as an out of pocket procedure. Even though insurance pays for many of the other interventions that do not work as well, the insurance companies have not in any way been forthcoming to pay for mira Dry. This may change in the future but as of now, insurance does not cover this procedure.

Reported benefits of miraDry
The miraDry procedure has been shown to result in an immediate and dramatic reduction of sweating in the underarm area. In fact, clinical studies have reported that the procedure resulted in an average sweat reduction of 82%, based on measuring the weight of sweat produced before and after the procedure. These results have been proven to last, since sweat glands do not regenerate once they are eliminated, and benefits are achieved without the need for invasive incisions or cuts, as is done in surgical procedures to treat the condition. The miraDry procedure is quick, relatively painless and non-invasive, and requires virtually no recuperation time. Patients can typically return to regular activities immediately, although patients may experience some minor and short-term discomfort and swelling.

How do I get started?
For us to be able to best serve you, we would first need to see you and complete a thorough history and physical. This would give us a chance to examine the problem, look through your history and see if there are any issues of concern. When we have done this initial part, we can then be able to appropriately assess the usefulness of mira Dry. Once the assessment is done, we can then look at your schedule and ours and make up a treatment plan that fits you and your schedule best.

To get started, call us at (806) 322-5438. Ask for any of our team members (Stephanie, Patricia, or Kayla).