A patient sits down and the first thing out of their mouth is: "Doctor, I had bromhidrosis surgery once before — how do I still smell?" Ask a little more and there's usually a second line: "My friend had it done and came out with almost no smell. Why not me?"

It's all called bromhidrosis surgery, and the results are this different. Most people's first thought is "maybe the machine wasn't good enough" or "maybe I need a pricier method." But from what I've seen over the years, what decides the result is usually not which machine was used. It's something very basic, and very time-consuming: how thoroughly the glands that make the smell were actually cleared.

Bromhidrosis is a "yes or no" problem, not a "how many percent" problem

Let me start with an idea I care a lot about. Nearly every method on the market says it "can treat" bromhidrosis. But look closely and the amount they bring the smell down by varies wildly — some drop it twenty or thirty percent, some fifty, some claim close to fully clear. That gap is exactly what patients feel in real life.

From the patient's side, bromhidrosis is closer to a "yes or no" question. Whether you still worry when you raise your arm, whether you dare stand close to people in summer, whether there are still yellow stains and a smell at the underarm of your shirt — none of that is solved by "brought down thirty percent." So for over twenty years my goal has stayed the same: clear the smell away, not just take a little off it.

Why "cleared thoroughly" directly decides how far the smell drops

The logic isn't complicated. Underarm smell comes from the apocrine glands. As long as those glands are still there, they keep secreting and keep fermenting into odor. So how much smell is left at the end corresponds largely to how much gland was left un-cleared.

That's why thoroughness of clearance matters so much. If only part is cleared in one round, the rest keeps working, and of course the smell only fades rather than disappears. After a while some people even feel it slowly comes back — not necessarily a "recurrence," but a batch of glands that were never reached in the first place, still sitting there working. This is the real reason so many people "had it done once and still smell."

Put differently: the same machine, the same technique, cleared to seventy percent versus cleared to near-complete — those are two different results to the nose.

What I think decides it are two very basic things

So what counts as cleared thoroughly? Plainly put, what decides it isn't some advanced technical term. It's two things — whether you're willing to put in the work.

First, whether you're willing to spend the extra time to clear across the whole area where apocrine glands are distributed, rather than doing the middle and calling the edges good enough. Apocrine glands don't only grow dead center; the area has to be cleared wide enough that nothing slips through.

Second, whether you're willing, before closing the wound, to carefully confirm there's no residue. Finishing clearing isn't the same as having cleared it clean — you go over it region by region, confirm nothing's been missed, and only then close up. This step takes time, but without it, however careful the clearing was, it can still come to nothing.

As for how you actually judge how far you've cleared, and how thin is just right — that's more a feel built up case by case over the years, and hard to pin down in a single sentence. Based on my own twenty-plus years of clinical follow-up, treating complete removal of the apocrine glands as the goal, the clearance rate can be brought very high (it varies with individual condition and aftercare). How different methods compare on this point I've laid out separately in the comparison table on the axillary bromhidrosis page.

So, is "cleaner is always better"?

Reading this, you might think — so is cleaner always better, more aggressive always better? Not that either. The cleaner you clear, the thinner that layer of skin becomes; too thin, and it actually struggles to heal. So the real skill is judging the balance between "cleared thoroughly enough" and "leaving enough healthy skin." I'll write about that part separately; here I'm just flagging it.

Common questions

I had bromhidrosis surgery once and still smell. Is my case just especially hard to treat?

Not necessarily. What I see more often in clinic is that the glands weren't cleared thoroughly enough the first time, or a batch of residue never got reached. Underarm smell comes from the apocrine glands, and as long as glands remain, they keep secreting and fermenting into odor. So if you still smell after surgery, don't be quick to blame yourself. The more useful question is how much gland is left, and where.

Does the result of bromhidrosis surgery depend on which machine is used?

The machine usually isn't what matters most. From what I've seen over the years, what decides the result is how thoroughly the apocrine glands were actually cleared. With the same machine and the same technique, clearing only part versus clearing to near-complete are two different results to the nose. I think it comes down to two basic things: whether the surgeon is willing to spend the time to clear the whole area where the glands are distributed, and whether they're willing to check region by region for residue before closing.

The smell faded after surgery, then slowly came back. Is that a recurrence?

Not necessarily. If only part of the glands is cleared in one round, the rest keeps working, so the smell only fades rather than disappears. When some people feel it coming back after a while, it's often a batch of glands that were never reached in the first place, still sitting there working. This is the real reason so many people "had it done once and still smell."

So is cleaner always better, and more aggressive always better?

Not that either. The cleaner you clear, the thinner the remaining layer of skin; too thin, and it struggles to heal. The real skill is balancing "cleared thoroughly enough" against "leaving enough healthy skin." How far to clear and how thin is just right is a feel built up case by case, and everyone's condition is different, so it's hard to pin down in one sentence.

If the first surgery didn't clear it properly, can it still be treated?

It often can. If the glands weren't cleared thoroughly the first time, or a batch of residue was missed, that situation can be worked on again. I first look at which glands are left and where they sit, then clear the areas where they remain. Individual condition and aftercare differ, and results vary from person to person, so it's best to be assessed in person before deciding the next step.

Back to that line, "how do I still smell"

I usually answer like this: it isn't necessarily that your case is especially hard to treat, and it isn't necessarily a machine problem. The more common situation is that the glands weren't cleared thoroughly enough the first time, or there was a batch of residue that never got reached. And that situation can often be worked on — first look clearly at what's left, then clear it out properly.

If you're also stuck on "had it done and still smell," don't be quick to blame yourself. Whether bromhidrosis surgery actually works, and why some people say it doesn't, I discuss more fully in a piece on our sister site: Does bromhidrosis surgery really work? Why some people say it doesn't. To find out where you stand now and how much was left un-cleared, you can also book an assessment and look at it clearly in person before deciding the next step.

This article is educational. Individual situations require in-person consultation; actual treatment and results vary from person to person.