- Consent – include pain, tenderness, infection, inadequate improvement, need for further treatments, PIH, scarring, compensatory sweating elsewhere, hair loss
- Starch-iodine sweat test and mark treatment area. Hair must be shaven.
- Apply 23%/7% lidocaine/tetracaine topical from Central Ave Pharmacy, Lipothene for at least 1 hour – 1.5 hours. Use 30% lidocaine ointment for darker skin types.
- Subsequent analgesia might be needed with either injections using mesoram device and lidocaine with epi mixture (5cc lido w epi/5cc saline/1cc bicarb) or just inject
- Pronox (Nitrous oxide mixture “Laughing Gas”) can be used as well.
- Clean off ointment with alcohol and clean skin with Hibiclens
- Use Zimmer air chiller and/or ice, ice roller, or Frozen C
- Perform 1-2 passes with each depth of Genius with breaks after each pass to chill and go to opposite side.
- 3 depths – 3.5, 3.0, 2.5mm – go deep to superficial with subsequent passes
- Energy/pin 40-60mj. Lower energies in darker skin types, poor pain tolerance
- (For Infini – Treatment level 3-5, 300-400msec if tolerated)
- Use sterile technique throughout – sterile gauze, sterile gloves, sterile saline
- Keep eye on skin reaction – avoid excessive heat build up, redness. Abort procedure if skin not tolerating energies.
- Infrared camera, if available, to monitor skin surface temperature – stay below 42C
- Clean skin with sterile gauze and saline.
- Apply Clindamycin gel.
- In darker skin types, consider 4% hydroquinone 1 week prior and for 4-6 weeks after.
- Expect decreased sweat in less than one week.
- Repeat treatment in 6 weeks or longer.
- 2-3 treatments needed to have “controllable sweating”.
