To investigate the safety, feasibility, success rate, complication rate and side-effects of staged single-port thoracoscopic R2 sympathicotomy in the treatment of severe facial blushing. Facial blushing is considered a benign condition, however severe facial blushing can have a major impact on quality of life. When nonsurgical options such as medication and psychological treatments offer no or insufficient relieve, surgical treatment with thoracoscopic sympathicotomy should be considered. All

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... tients who underwent a staged thoracoscopic sympathicotomy at level R2 for severe facial blushing between January 2016 and September 2021 were included. Clinical and surgical data were prospectively collected and analyzed. A total of 16 patients with low operative risk (American Society of Anesthesiologists class 1) were treated. No major peri-operative complications were encountered. One patient experienced a post-operative unilateral Horner's syndrome, which completely recovered after one week. Two patients experienced compensatory hyperhidrosis. Success rate was 100%. One patient experienced slight recurrence of blushing symptoms after three years, not interfering with quality of life. All patients were satisfied with the result and had no regrets of having undergone the procedure. Staged single-port thoracoscopic R2 sympathicotomy is a reproducible, safe and highly effective surgical treatment option with low compensatory hyperhidrosis rates and the potential to significantly improve quality of life in carefully selected patients suffering from severe facial blushing. We would like to increase awareness among health-care professionals for debilitating facial blushing and suggest timely referral for surgical treatment.