Minimally Invasive Surgery for Axillary Osmidrosis Using a Combination of Subcutaneous Tissue Removal and a 1,444-nm Nd:YAG Laser

Many treatment modalities have been developed for axillary osmidrosis. It is well known that the surgical treatment has the best results. However, there is a high possibility of side effects. The 1,444-nm lipolysis laser has been recently introduced to remove the apocrine glands. So far, subdermal coagulation treatment with a 1,444-nm Nd:YAG laser may be the least invasive and most effective therapy for axillary osmidrosis. However, according to our previous experience, the recurrence rate was 20%~30%. This emphasizes the need for combination of surgical method and non-surgical method and we combined subcutaneous tissue removal and photothermocoagulation with a 1,444-nm Nd:YAG laser. Three patients for bilateral axillary osmidrosis were enrolled. After an incision of about one-third the length of the widest transverse diameter, the apocrine glands were separated from the skin. And then apocrine glands within the marked area were destroyed by irradiation with a 1,444-nm Nd:YAG laser thereafter. All patients exhibited no relapse of axillary osmidrosis and were satisfied with the treatment results. A combination of subcutaneous tissue removal and Interstitial laser photothermocoagulation with a 1,444-nm Nd:YAG laser could be an effective treatment for mild to moderate axillary osmidrosis.

A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis

BACKGROUND: Surgery for bromhidrosis has a high risk of complications such as hematoma and necrosis. New nonsurgical methods may reduce the burden on surgery and the risks for the patient. OBJECTIVE: This study was performed to evaluate the efficacy and side-effects of the 1,444 nm Nd:YAG interstitial laser for treating axillary bromhidrosis. METHODS: Eighteen bromhidrosis patients were treated with a 1,444 nm Nd:YAG laser at Korea University Ansan Hospital. The post-treatment follow-up was 6 months. After the procedure, we confirmed apocrine gland destruction through histopathological examination. At each follow-up, we measured the severity of the remaining odor, postoperative pain, degree of mobility restriction, and overall satisfaction. RESULTS: After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands. CONCLUSION: Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis.

Subdermal Coagulation Treatment of Axillary Bromhidrosis by 1,444 nm Nd:YAG Laser: A Comparison with Surgical Treatment

Bromhidrosis is a disease presenting as malodor caused by interaction between the discharge of apocrine glands and bacteria. The main therapeutic modalities are applying topical agents, liposuction surgery, and elective surgery. Among these, elective surgery is reported to be most effective. However, the efficiency largely depends on surgical technique. Additionally, other side effects, such as hematoma and scarring, are occasionally reported. Currently, CO2 laser and 1,064 nm Nd:YAG laser therapy are used, but as the wavelength is not specific to apocrine glands, these laser therapies have certain limitations. Recently, a 1,444 nm wavelength Accusculpt(TM) laser (LutronicCorp., Seoul, Korea) has been developed which is now commonly used for facial fat plasty and laser liposuction therapy. The use of this laser for bromhidrosis therapy targeting apocrine sweat glands is currently being discussed. Still, no studies on practical clinical use and side effects of this 1,444 nm wavelength laser have been published. In this report, we treated one bromhidrosis patient with 1,444 nm wavelength Accusculpt(TM) laser therapy on one side while conventional surgery was performed on the other side using a modified Inaba's method. We compared the efficacy of this laser therapy to the surgical modality by measuring malodor severity and overall satisfaction by questionnaire. We also checked for other complications and recurrence for 12 months after the treatment. This patient was largely satisfied as it has a much shorter down time with the same therapeutic outcome. As subdermal coagulation treatment by 1,444 nm Nd:YAG laser may be less invasive but effective therapy, we would like to recommend this modality as a possible treatment option.