Hyperhidrosis usually starts in a very early age. There are some patients who will tell us that one of their parents had the initial presentation as a youngster but that it got better with time. For those patients who have a very clear genetic history (parents) with this ailment usually their hyperhidrosis does not improve with time. Genetic history has been tied to more than 50% of the patients with this condition. Excessive hand sweating and excessive feet sweating can be noticed first and later on in life armpit or axillary hyperhidrosis can develop into a level that is bothersome. We do not have any idea why the presentation of those sites can come in different times and the only available explanation now is that the maturation of the sweat glands in different parts of the body can be different. Nowadays with the increased need for hand dexterity (phones, tablets, laptops, even driving) makes severe hyperhidrosis a very challenging task on a daily basis. Due to the failure or the unsuccessful success rate for the conservative measures, the surgical method is still the best way to deal with those problems.