Excessive sweating looks like a minor nuisance on paper, yet it dictates daily life in quiet, relentless ways. Patients tell me about packing extra shirts, avoiding handshakes, or picking shoes based on their lining rather than their style. When antiperspirants, prescription wipes, and lifestyle tweaks fail, Botox injections become a practical, often liberating option. Most people first associate botox treatment with smoothing forehead lines or softening crow’s feet, but its medical use for hyperhidrosis is one of the most effective and satisfying procedures in clinic.
Below, I’ll walk through how botox for sweating works, what an appointment feels like in underarms, palms, and feet, typical unit counts and dosing patterns, expected results and duration, and the trade‑offs that don’t fit neatly in a brochure. I’ll include context on botox safety, contraindications, aftercare, costs, and how to size up a botox specialist or clinic. If you have tried everything and feel stuck, you may recognize your story here.
Why botox helps with excessive sweating
Sweat glands are activated by sympathetic cholinergic nerves. Botulinum toxin type A, the active ingredient in Botox, blocks acetylcholine release at the neuromuscular junction and at eccrine glands. In plain terms, it quiets the signal that tells sweat glands to fire. When placed intradermally, tiny amounts of botox reduce sweat production in the area injected without changing the body’s temperature regulation overall. You still sweat elsewhere; you just don’t flood your shirt or soak your shoes in one specific zone.
Botox for hyperhidrosis has FDA approval for severe underarm sweating unresponsive to topical treatments. Hand and foot use is off‑label yet well established in dermatology and plastic surgery practices. Outcomes are consistently strong in the axilla, good in palms, and helpful but more variable in soles due to thicker skin and stronger nerves.
Who is a good candidate
The classic candidate has primary focal hyperhidrosis starting in adolescence or early adulthood, with family history common. Sweat appears regardless of temperature or activity, with clear asymmetric patches under the arms or dripping palms that interfere with daily life. Many have tried over‑the‑counter antiperspirants, prescription‑strength aluminum chloride, glycopyrronium wipes, or iontophoresis with incomplete relief. People with stress‑induced flares often do best because the target is a nerve‑driven response in a defined area.
Secondary causes such as thyroid disease, infection, medication side effects, or menopause need to be considered. A simple medical history and sometimes basic labs help rule out systemic triggers. If sweating is generalized over the entire body or started abruptly later in life, address that before reaching for injections.
The consultation: mapping the problem and planning the dose
A good botox consultation feels like a collaborative mapmaking session. We talk about where the sweat shows up, what clothing patterns prove it, and how long it takes to soak through. If you track episodes, even roughly, bring that detail. On exam day, some clinics use a starch‑iodine test. A dilute iodine solution is painted over the area, allowed to dry, then dusted with starch. Active sweat turns it a deep blue‑black, outlining exact zones to treat. It takes a few minutes and helps minimize unnecessary injections.
Dosing is measured in units, and units are not interchangeable across brands. The classic protocol for axillary hyperhidrosis is 50 units of https://www.instagram.com/doctorlanna/ botox per underarm, sometimes 40 to 60 depending on spread and anatomy. Palms often require 50 to 60 units per hand, and soles 100 to 150 units per foot, split into many small blebs spaced about 1 to 1.5 centimeters apart. The number of injection points can seem high on paper, but each is a tiny intradermal placement with a very small needle.
Botox unit price varies widely by region and practice, as does the botox cost model. Some clinics price by the area treated rather than by unit. If you see botox deals or specials online, ask what brand, what dilution, and how many units are included. Discounted offers can be legitimate when clinics run events, but clarity about dosing and technique matters more than a temporary botox price.
What an appointment feels like: underarms, palms, and feet
Underarms are straightforward. The skin is thin and the injections are shallow. Most patients describe the sting as mild and brief, similar to a tiny mosquito bite. If you are sensitive, a topical anesthetic or ice makes it even easier. Marking the grid takes longer than the injections. Front‑to‑back, it is a 20 to 30 minute visit.
Palms and soles are a different story. The skin is thicker and densely innervated, and the needle passes through tougher dermis. Without anesthesia, palm injections hurt. Practices vary; some use topical numbing plus ice and vibration distraction, while many prefer nerve blocks at the wrist or ankle. A proper median and ulnar nerve block can make a palm treatment nearly painless. Patients feel pressure but not the sharp sting. It adds 10 to 15 minutes, and fingers may feel weak or numb for a few hours afterward. Feet can be numbed with ankle blocks. Plan to avoid intense activity until normal sensation returns.
Expect pinpoint bleeding with many small spots, followed by mild swelling that settles within hours. With underarms, you can go back to daily plans immediately. With hands and feet, budget extra time, and do not schedule heavy gripping or long drives right after nerve blocks. If you rely on fine motor tasks at work, organize your calendar accordingly.
The first two weeks: how results unfold
Botox does not switch off sweating the same day. Most people notice a change by day three or four, with full effect at 7 to 14 days. Shirts come home dry. Handshakes feel normal instead of slippery. With feet, socks last longer before they feel damp. Once in a while, a small cluster within the mapped area still sweats at full strength. That is where a 2 to 3 week touch up makes sense. Honor that window; adjusting too early can cause overcorrection and unnecessary units.
Botox longevity in hyperhidrosis usually exceeds cosmetic areas. For axillae, 4 to 7 months is common, and a meaningful minority enjoy 8 to 9 months before noticing a return. Palms hold 3 to 5 months on average. Soles, again, are variable, often 2 to 4 months, sometimes longer. Biology, activity level, and dose all matter. Athletes and physically demanding jobs tend to metabolize faster.
What success looks like and what it does not
People ask about botox before and after photos, and while images help for facial wrinkles, sweat is better measured by life changes. When the treatment works, you stop bringing a backup shirt, you pick the lighter‑colored blouse, or you stop avoiding leather chairs. With palms, you can play the piano, sign documents, or hold hands without thinking about slipping. In the feet, the improvement is practical rather than photogenic; shoes last longer, and skin maceration and odor improve.
What it does not do: it does not cure hyperhidrosis permanently. It does not make you stop sweating everywhere. You may still sweat during intense exercise or heat, but the tide that once soaked a circle through your shirt usually recedes to a faint dampness or disappears entirely.
Side effects, safety, and trade‑offs
The most common side effects are localized and short‑lived: injection site tenderness, tiny bruises, and temporary swelling. Small lumps at injection points flatten within a day. With palms, temporary hand weakness can occur, especially pinch strength between the thumb and index finger if some toxin diffuses deeper than intended. When blocks are used and technique is intradermal, clinically significant weakness is uncommon, but it is a known risk. It resolves as the botox wears off.
Botox migration outside the targeted skin is rare when doses are split into small superficial blebs and the area is not aggressively massaged afterward. For underarms, compensatory sweating elsewhere is not typical after botox. That phenomenon belongs to sympathectomy surgery, not injectables.
Contraindications include pregnancy and breastfeeding due to limited safety data, certain neuromuscular disorders, and active skin infection in the treatment area. Some medications, like aminoglycoside antibiotics, theoretically potentiate botulinum toxin effects. If you have myasthenia gravis, Lambert‑Eaton syndrome, or motor neuron disease, botox risks outweigh benefits here.
Long‑term safety data for repeated treatments are reassuring. Antibody formation that reduces botox effectiveness is rare at the doses used for hyperhidrosis, especially with reasonable intervals between sessions. If treatments become less effective, options include adjusting units, changing technique, or switching brands such as Dysport or Xeomin. Each has its own unit equivalency and diffusion characteristics. A careful discussion of botox vs dysport vs xeomin is sometimes relevant if response shifts over time, though most patients stay on the original product.
Preparing for the appointment and caring for the area afterward
A few small steps make the day smoother. Shave underarms 24 to 48 hours in advance to reduce irritation, not the morning of the visit. Skip harsh antiperspirants that day. Avoid ibuprofen, aspirin, and high‑dose fish oil for a couple of days beforehand if your doctor agrees, since they can increase bruising. Hydrate well. If you are treating palms or soles, plan your ride home if nerve blocks will be used, because your grip or pedal control can be numb for a short window.
Aftercare is minimal. Keep the area clean and dry for the rest of the day. Skip intense workouts, saunas, and hot tubs for 24 hours. Do not massage or manipulate the treated skin. You can resume antiperspirants after a day if desired, though many no longer need them. If a small bruise appears, a cool compress helps. Any localized swelling or itch settles quickly. If pins‑and‑needles sensations linger longer than expected after hand or foot blocks, call the clinic. That is usually anesthetic related, not the botox itself.
How it compares with other options
The hyperhidrosis toolkit has grown. Prescription wipes with glycopyrronium can help mild cases, particularly in the underarms or face, but skin irritation and systemic anticholinergic effects limit some users. Iontophoresis works well for palms and soles, especially for patients who commit to routine sessions. Microwave thermolysis (for example, miraDry) can permanently reduce axillary sweat by targeting glands with heat, trading upfront downtime and cost for lasting results. Surgical sympathectomy works, but the risk of compensatory sweating elsewhere is substantial, and I rarely recommend it for underarms unless everything else fails.
Botox sits in the practical middle. It is minimally invasive, precise, and reversible. It carries ongoing cost and maintenance but provides high satisfaction, especially for underarms. For palms, the conversation is more nuanced: injections are effective, but pain management and temporary weakness are the real trade‑offs. For soles, realistic expectations and a plan for repeat sessions are essential.
Cost, units, and value over time
No universal price exists. In the United States, treating both underarms commonly ranges from the high hundreds to around a couple of thousand dollars depending on geography, units used, and whether the clinic bills per area or per unit. Hands and feet often cost more due to higher dosing and longer appointment time. If someone quotes a surprisingly low botox price, ask how many units are included. The botox unit price and the clinic’s dilution protocol matter because watery dilution can look like more volume without delivering sufficient units to each point.
When estimating long‑term value, factor the duration. If underarm results reliably last 6 to 7 months, you may only need two sessions a year. If palms last 4 months, you are looking at three. Weigh that against dry cleaning bills, ruined shoes, or the daily friction of managing sweat with band‑aids and backups. For many, the math is not just financial, it is about gaining headspace.
Choosing a provider and asking smart questions
A skillful injector makes all the difference, especially for palms and soles. Look for a clinic that treats hyperhidrosis routinely, not as an occasional add‑on to cosmetic days. Training and experience count more than whether the setting is a medical spa, dermatology office, or plastic surgery clinic. A board‑certified physician or an experienced nurse injector under physician supervision is the right fit. If you are searching “botox near me,” filter by clinicians who discuss hyperhidrosis openly on their site or during a phone call, not only botox for wrinkles, forehead lines, frown lines, or crow’s feet.
Bring your own checklist and keep it concise. Good consultation questions include:
- How many units do you recommend for my underarms or palms, and why? Will you use a starch‑iodine test to map the area before injection? What is your approach to pain control for palms or feet, and do you perform nerve blocks? What does aftercare look like, and when should I return for a touch up if a spot still sweats? If results change over time, do you adjust technique or consider switching from botox to Dysport or Xeomin?
That is one list. Keep the rest of the visit conversational. You are looking for clarity, not a sales pitch. If you hear only generic promises, keep shopping.
Technique notes most patients never see
The best outcomes come from intradermal placement with even spacing and modest volumes per bleb. I prefer a 30 or 32‑gauge needle with small aliquots, often 0.05 to 0.1 mL per site depending on dilution, to limit diffusion into deeper structures. In axillae, I avoid hair‑bearing follicles densely to reduce irritation, though the map trump’s hair distribution. In palms, I reduce dosing near the thenar and hypothenar eminences to protect pinch strength while still treating the sweat‑heavy central zone. With soles, I aim slightly more superficial and accept that a touch up is more likely due to thicker stratum corneum and robust innervation.
The starch‑iodine test improves precision in real time. If you have ever seen someone treat the entire axilla with a few big deposits, that is a red flag. You are paying for detail work. Even spacing prevents islands of sweat that slip through. This is where technique meets art.
Expectations and maintenance without disappointment
A mature plan treats hyperhidrosis like orthodontics for sweat. It is not a one‑and‑done; it is a maintenance schedule. Most of my underarm patients settle into a rhythm of twice yearly visits. Palms may require three sessions per year. If life events disrupt the schedule, nothing is harmed. You simply return when sweating becomes noticeable again. The body does not become dependent on the toxin; it just resumes baseline signaling when the effect wears off.
If you are new to injectables and hesitant because of what you read from botox reviews focused on overdone cosmetic results, remember this is not a brow lift, a lip flip, or baby botox for fine lines. We are not altering facial expression. We are working in the skin to quiet glands. The botox benefits here are practical and private, and the botox risks are largely localized and manageable.
Where this intersects with other concerns
Some patients come in for hyperhidrosis and end up asking about botox for migraines or masseter botox for jaw clenching or TMJ symptoms. These can be addressed in the same practice, though the techniques, dosing, and goals differ. If your clinic also offers fillers, the comparison of botox vs fillers is irrelevant to sweat, since fillers add volume while botox reduces neuromuscular signaling. Ask to keep the plans separate to avoid confusion, and be cautious about bundling “botox offers” that blend cosmetic and medical indications unless each is properly indicated.
For those who already receive cosmetic botox for facial wrinkles, adding an axillary session on the same day is common and safe. Total dose matters, but most adults can receive the combined units without issue. Your injector will document the botox average dosage used at each site and schedule follow‑ups accordingly.
Practical tips you will actually use
- Schedule in the morning if possible, so any brief swelling or numbness has settled by evening. Wear a dark tee to the visit, not because of stains, but because iodide testing can mark the fabric. Bring a thin cardigan or button‑up if you prefer to skip deodorant that day. For palms and feet, plan a lighter workday. Typing is fine after blocks wear off, but heavy lifting can wait. Mark your calendar at day 12 to self‑check. If a small zone still sweats, call the clinic before day 21 for a precise touch up.
That is the second and final list. The rest is routine.
The bottom line
Botox for hyperhidrosis does not make headlines like cosmetic makeovers, yet it is one of the most gratifying procedures we offer. Strong evidence, predictable technique, and high satisfaction converge here. Underarms respond best, with clean results and long duration. Palms require respect for pain control and the risk of temporary weakness, but deliver real relief when planned correctly. Soles help patients who suffer maceration and shoe damage, though expectations must be measured.
If you are on the fence, consider a single‑area trial. Start with axillae. See how your day changes when you do not check your shirt before a meeting or bring a spare blouse in your bag. Measure the effect in minutes saved and choices regained. That is the clearest “before and after” you will find.
As for safety, botox is FDA‑approved for underarm hyperhidrosis and has decades of clinical use. Done well, it is precise, repeatable, and quietly life‑changing. Find a qualified botox doctor or nurse injector, ask clear consultation questions, understand the dose and map, and follow the simple aftercare. Maintenance is part of the deal, but so is relief. When sweating is no longer steering your decisions, you realize how much space it occupied. That is the point.