Objective To analyze the effect of small axillary crease incision for subcutaneous dissection on hyperhidrosis severity in patients with bromhidrosis. Methods A total of 89 patients with bromhidrosis diagnosed and treated in our hospital from May 2022 to May 2025 were selected, and they were divided into the control group (n=44) and the observation group (n=45) by the random number table method. The control group received negative pressure suction curettage, and the observation group received small axillary crease incision for subcutaneous dissection. The hyperhidrosis severity, clinical efficacy, pain intensity, scar aesthetics and complication rate were compared between the two groups. Results The HDSS score of the observation group at 3 months after surgery was lower than that of the control group (P<0.05). The total effective rate of the observation group (95.56%) was higher than that of the control group (75.00%) (P<0.05). The VAS score of the observation group at 24 hours after surgery was higher than that of the control group (P<0.05). However, there were no statistically significant differences in VAS scores between the two groups at 48 and 72 hours after surgery (P>0.05). There was no statistically significant difference in scar aesthetics between the two groups (P>0.05). The incidence of complications in the observation group was lower than that in the control group (P<0.05). Conclusion The application of small axillary crease incision for subcutaneous dissection in the treatment of bromhidrosis can improve clinical efficacy and effectively alleviate local hyperhidrosis symptoms. Meanwhile, it can well maintain the scar aesthetic effect of minimally invasive surgery, without significantly increasing the short-term postoperative pain of patients, and help to reduce the incidence of related complications.