Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 267–277 | Cite as

Shortening of Incision by “Pinch and Turn-Over Technique” in the Treatment of Axillary Osmidrosis

  • Eui-Tae LeeEmail author
Original Article Special Topics



The pinch and turn-over technique was developed to minimize the incision in the manual subdermal excision of apocrine glands in axillary osmidrosis for the best cure and fewest complications.


Through a 2-cm-long incision, peripheral subdermal tissue was excised by the technique under direct vision using intravenous anesthesia and tumescent technique. Ninety-nine axillae in 50 patients including seven secondary cases were operated on from 2009 to 2018. Long-term follow-up (average 30.3 months) could be done on 40 patients with questionnaires consisting of four-point ordinal-scale questions regarding osmidrosis grade, hyperhidrosis grade and satisfaction. For systematic review regarding incision length, 220 articles from 1962 to 2018 were reviewed with the search terms “osmidrosis” or “bromhidrosis.”


Thirty-five and 30 of 40 respondents (87.5% and 75.0%) had excellent or good postoperative results in osmidrosis and hyperhidrosis grade. Postoperative improvement of osmidrosis grade (from 2.53 to 0.80) and hyperhidrosis grade (from 1.88 to 0.95) was statistically significant (p < 0.01). Thirty-four patients (85.0%) reported very satisfactory or satisfactory. Hematoma (2.0%), hyperpigmentation (5.0%), infection (5.0%) and noticeable scar (2.5%) were rare. Necrosis of flap margins was frequent (27.3%) but necessitated revision in two cases (2.0%). Among eleven articles found to describe incision length in pure manual subdermal excision, this technique provided the shortest incision compared with eight direct subdermal excision methods with an average incision length of 5.0 cm.


This technique offers an open, direct and selective approach with a short incision. It could maintain the best efficiency while neutralizing negative side effects of conventional manual subdermal excision for axillary osmidrosis.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors


Osmidrosis Bromhidrosis Hyperhidrosis Subdermal excision Pinch and turn-over technique 


Compliance with Ethical Standards

Conflicts of interest

No conflicts of interest were declared.


  1. 1.
    Park YJ, Shin MS (2001) What is the best method for treating osmidrosis? Ann Plast Surg 47:303–309CrossRefGoogle Scholar
  2. 2.
    Kim JR, Cha JH, Na MH, Kim YW, Park HJ, Lee DJ, Kim HJ (2003) Comparison of treatment effect between superficial suction and subdermal excision in osmidrosis. J Korean Soc Plast Reconstr Surg 30:15–19Google Scholar
  3. 3.
    Ha SU, Lee KC, Park JH, Park JM, Kim SK, Sohn HS, Baek CY, Jung GY, Song KH (2004) A comparative evaluation of various axillary osmidrosis treatment. J Korean Soc Aesthet Plast Surg 10:84–90Google Scholar
  4. 4.
    Shin JY, Roh SG, Lee NH, Yang KM (2017) Osmidrosis treatment approaches: a systematic review and meta-analysis. Ann Plast Surg 78:354–359CrossRefGoogle Scholar
  5. 5.
    Kim KY, Cho SD (2008) Long term follow up of surgical treatment of axillary osmidrosis and hyperhidrosis by instrumental shaving and manual shaving. J Korean Soc Plast Reconstr Surg 35:709–715Google Scholar
  6. 6.
    Shim HS, Min SK, Lim JS, Han KT, Kim MC (2013) Minimal subdermal shaving by means of sclerotherapy using absolute ethanol: a new method for the treatment of axillary osmidrosis. Arch Plast Surg 40:440–444CrossRefGoogle Scholar
  7. 7.
    Choi MS, Kim WS, Kim HK, Bae TH (2010) A clinical case of axillary web syndrome after glandular tissue and skin removal for axillary osmidrosis. J Korean Soc Plast Reconstr Surg 37:301–303Google Scholar
  8. 8.
    Yoo JW (1995) The comparative clinical and histological study of manual and inaba method in osmidrosis axillae. J Korean Soc Aesthet Plast Surg 1:227–232Google Scholar
  9. 9.
    Tung TC, Wei FC (1997) Excision of subcutaneous tissue for the treatment of axillary osmidrosis. Br J Plast Surg 50:61–66CrossRefGoogle Scholar
  10. 10.
    Yim YM, Choi JW, Kim GH (2005) The treatment of osmidrosis axillae by use of modified Skoog’s method. J Korean Soc Plast Reconstr Surg 32:245–249Google Scholar
  11. 11.
    Ahn SY (2005) Surgical treatment of axillary osmidrosis. J Korean Med Assoc 48:653–660CrossRefGoogle Scholar
  12. 12.
    Liu X, Mao T, Lei Z, Fan D (2010) A simple and practical method for axillary osmidrosis resection. J Plast Reconstr Aesthet Surg 63:e420–421CrossRefGoogle Scholar
  13. 13.
    Liu Q, Zhou Q, Song Y, Yang S, Zheng J, Ding Z (2010) Surgical subcision as a cost-effective and minimally invasive treatment for axillary osmidrosis. J Cosmet Dermatol 9:44–49CrossRefGoogle Scholar
  14. 14.
    Ding Z, Zheng J (2013) A comparison of two different sub-dermal trimming techniques for the treatment of axillary osmidrosis. J Plast Reconstr Aesthet Surg 66:1569–1574CrossRefGoogle Scholar
  15. 15.
    Zhao H, Li S, Nabi O, Hu L, Gao X, Luo F (2016) Treatment of axillary bromhidrosis through a mini-incision with subdermal vascular preservation: a retrospective study in 396 patients. Int J Dermatol 55:919–925CrossRefGoogle Scholar
  16. 16.
    Shin JY, Roh SG, Lee NH, Yang KM (2017) Negative pressure wound therapy as effective and comfortable management after treatment of osmidrosis. Aesthet Plast Surg 41:121–125CrossRefGoogle Scholar
  17. 17.
    Han X, Li F (2013) Percutaneous ethanol injection for treatment for axillary osmidrosis. Clin Exp Dermatol 38:484–488CrossRefGoogle Scholar
  18. 18.
    Kim HG (2014) A new osmidrosis procedure, the scrape and suction technique: review of 4,322 patients. Aesthet Plast Surg 38:282–287CrossRefGoogle Scholar
  19. 19.
    Ou LF, Yan RS, Chen IC, Tang YW (1998) Treatment of axillary bromhidrosis with superficial liposuction. Plast Reconstr Surg 102:1479–1485CrossRefGoogle Scholar
  20. 20.
    Tung TC (2001) Endoscopic shaver with liposuction for treatment of axillary osmidrosis. Ann Plast Surg 46:400–404CrossRefGoogle Scholar
  21. 21.
    Li H, Wang B, Zhang Z, Ke MS, Yang S (2009) A refined surgical treatment modality for bromhidrosis: double w incision approach with tumescent technique. Dermatol Surg 35:1258–1262CrossRefGoogle Scholar
  22. 22.
    Lim DW, Park J, You YC, Yang WY, Lee W (2005) The effectiveness of fibrin glue using dermal shaving at osmidrosis. J Korean Soc Aesthet Plast Surg 11:93–98Google Scholar
  23. 23.
    Bisbal J, del Cacho C, Casalots J (1987) Surgical treatment of axillary hyperhidrosis. Ann Plast Surg 18:429–436CrossRefGoogle Scholar
  24. 24.
    Wu WH, Ma S, Lin JT, Tang YW, Fang RH, Yeh FL (1994) Surgical treatment of axillary osmidrosis: an analysis of 343 cases. Plast Reconstr Surg 94:288–294CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryChungbuk National University College of MedicineCheongjuKorea

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