Products"I keep a second shirt in my desk drawer." Some version of that sentence is how many people first describe underarm sweating to me. Botox for sweating is FDA-approved for severe underarm sweating, and a short office visit usually reduces that sweating for 4-6 months.
You keep a mental list of fabrics and colors you can't wear, with gray and silk at the top. You choose the seat in a meeting where you won't need to raise your arm. On a good day, antiperspirant helps for an hour or so.
Hyperhidrosis is excessive sweating, more than your body needs to cool itself. It often happens in a cool room while you're sitting still. Treatment ranges from prescription-strength antiperspirants to injections and the other options we offer. Before any injection, I check for other causes, so your treatment fits what's actually causing the sweat.
Regular sweating versus hyperhidrosis
Regular sweating cools you down and stops when you do. Hyperhidrosis keeps going. You sweat in an air-conditioned office, usually on both sides equally and often through your clothes, and for many people it started in their teens.
Primary hyperhidrosis isn't caused by another condition. It tends to run in families. It's also focal, which means it stays in a few areas, such as the underarms, palms or feet. Doctors call underarm sweating axillary hyperhidrosis. Secondary hyperhidrosis comes from something else, such as a medication, an overactive thyroid, low blood sugar, menopause, or an infection. Secondary sweating is more likely to cover the whole body, to begin in adulthood, or to happen during sleep.
That difference is why I evaluate before I treat. If your sweating started recently, wakes you at night, or arrived with weight loss or a racing heart, the next step is a medical evaluation that may include bloodwork. Treating only the underarms would miss the real medical problem.
How excessive sweating affects your day
Excessive sweating costs you money and changes how you act around people. You replace shirts because the stains won't wash out, and the dry-cleaning bill climbs. You keep a jacket on through a summer meeting, and you avoid handshakes and hugs.
It also takes up your thoughts. During a presentation, part of your mind is checking whether sweat shows, and worrying about sweating tends to bring on more of it.
The International Hyperhidrosis Society's Hyperhidrosis Disease Severity Scale grades the condition by how much it interferes with your daily activities rather than by how much sweat you produce. The scale runs from 1 to 4. A 1 means you never notice your sweating, and a 2 means it's tolerable but sometimes interferes with your day. A 3 means it's barely tolerable and often interferes, and a 4 means it's intolerable and always does. If you plan your clothes and your day around it, it may be worth seeing a dermatologist.
How Botox Works for Excessive Sweating
Botox reduces underarm sweating by blocking the nerve signals that stimulate the sweat glands. When I inject it just beneath the skin of the underarms, it temporarily interrupts these signals, decreasing sweat production in the treated areas. The sweat glands aren't damaged; they receive fewer signals to produce sweat.
After 4-6 months, the nerve endings recover and sweating gradually returns.
The effect is limited to the treated area. Your body still cools itself normally. Treating your underarms also doesn't reduce sweating in your hands or feet.
The FDA has approved Botox for adults with severe underarm sweating that antiperspirants and other skin treatments haven't controlled. The Botox prescribing information sets the dose at 50 units per underarm. Treating the palms, feet, or face is off-label, which means the label doesn't cover those areas. Before treatment, I review your medications, any nerve or muscle conditions, and any reaction you've had to Botox before. You can also read who should not get Botox before your visit.
What to Expect During a Botox Treatment Appointment
- Confirming the diagnosis. If this is your first visit, I evaluate your pattern and medical history to determine whether it fits primary hyperhidrosis.
- Bring a list of your medications and supplements. Some medicines can cause sweating and change the treatment plan. Treatment often starts with an antiperspirant, and some people need a prescription-strength formulation. Botox may be an option when topical treatments have not controlled the sweating.
- Mapping the treatment area. The area that sweats often isn't the same shape as the area where hair grows. The Botox prescribing information calls for mapping it before injection, often with a starch-iodine test: iodine is painted on and dusted with starch, and sweating skin turns dark blue-black.
- The injections. I administer very shallow injections across each underarm. I determine the dose and pattern after I evaluate you. There are more injection points than most people expect.
- How long it takes. The procedure typically takes 15 to 20 minutes.
- Afterward. Downtime is minimal, and most people go straight back to work.
I place every injection myself because even coverage is important to achieving a consistent result.
When Botox Starts Working and How Long it Lasts
- The first week or so: most people notice less sweating within 7 to 10 days.
- The first couple of weeks: the full effect usually settles in.
- The plateau: this typically lasts 4-6 months, longer than Botox lasts for wrinkles.
- The gradual return: sweating comes back slowly. When sweat starts to show on your clothes again, it's time to schedule.
Results usually last four to six months, and some patients go longer. Many patients schedule their treatment before summer so the effect covers the warmest months. In my experience, repeat treatments continue to provide good results.
The Cost of Botox at Our Office
At my practice, Botox for excessive underarm sweating is offered as an elective, self-pay procedure. We do not bill insurance or process insurance claims for this treatment.
If you are considering Botox for hyperhidrosis, I will evaluate your sweating pattern, review your medical history, and discuss whether this treatment is appropriate for you.
FAQ
Does Botox stop underarm sweating completely?
Usually not completely. Sweating typically drops enough that clothing stops showing it, though a little moisture often remains. The full effect usually takes a couple of weeks.
Will I sweat more somewhere else?
Usually not in a way people notice. The heavy sweating elsewhere that people describe online is mainly linked to sympathectomy, a surgery that cuts nerves. With injections, the Botox prescribing information reports that a small share of people in clinical trials noticed more sweating elsewhere.
Does underarm Botox hurt?
Most people feel a quick pinch with each injection. The injections are very shallow and each one takes about a second, so the discomfort is brief, and many patients find it easier than they expected. We use a topical cream anesthetic and a Zimmer Chiller to cool the skin.
How long does it last?
Usually four to six months. The return is gradual, so you have time to schedule your next treatment before sweating is back to where it was.
Your first visit for underarm sweating
Your first visit starts with finding the cause. I ask when the sweating began, which areas it affects and what you've already tried, and I look for signs of a secondary cause. Then I map where you sweat. It helps to write your questions down before you come in.
If Botox isn't the right next step for you, I'll tell you. For example, another treatment may need to come first, or another cause may need to be checked.
If you're tired of planning your clothes around sweat, call or request an appointment. The office is at 931 5th Ave on the Upper East Side, and I place every underarm injection myself. I've injected Botox in New York City since 1992.
