Sympathicotomy for Isolated Facial Blushing: Long-term Follow-up of a Randomized Trial

Abstract

Abstract Objectives Thoracoscopic sympathicotomy may be an effective treatment for disabling facial blushing in selected patients. Short- and midterm results are good but very long-term results are scarce in the medical literature and there is no knowledge which extent of sympathicotomy is better long-term for isolated facial blushing. Methods We previously randomized 100 patients between a rib-oriented R2 or R2–R3 sympathicotomy for isolated facial blushing, and reported local effects, side effects and Quality of life (QoL) after 12 months. In the present study, we sent identical questionnaires to all patients after a median of 16 years (IQR 15-17 years). Results The response rate was 66%. Overall, 82% reported excellent or satisfactory results on facial blushing, with significant better local effect after R2-sympathicotomy compared with R2-R3-sympathicotomy. Patients who underwent R2-sympathicotomy were also significantly more satisfied with the operation. We found no significant difference between R2 and R2–R3-sympathicotomy in QoL or rates of compensatory sweating (77%) and recurrence of blushing (41%) which was milder than preoperatively in most patients. Conclusion R2-sympathicotomy should be the preferred approach for isolated facial blushing because of better local effect and higher satisfaction rates. Although this was a very long-term follow-up of the only randomized trial of its kind the response rate was limited leaving a risk of undetected bias.