Everything You Need to Know About Botox for Sweating
By Carol Bender, NP Posted July 3, 2020
What is botox?
Botox injections are used to treat a variety of medical and cosmetic conditions. Botox, Dysport, and Juveau are all neuromodulators, or injections that are used to temporarily “press pause” on the movement of a muscle. They are very safe if used appropriately by a medical professional.
Did you know that botox was first used in the early 1980s as a medical treatment for strabismus (“cross-eyed”) and other muscle spasms of the face? The more familiar cosmetic uses of botox came in the 1990s, where it became approved to smooth facial wrinkles by temporarily paralyzing muscles.
Medical providers also use neuromodulators like Botox, Dysport and Juveau to treat neuromuscular conditions such as migraines, muscle spasms, and hyperhidrosis.
Hyperhidrosis is the medical term for excessive sweating. Individuals with hyperhidrosis may find themselves sweating when it’s not hot, dripping sweat, or soaking through their clothing. They find that traditional deodorants and antiperspirants don’t work for them.
Botox injections are a relatively new treatment for excessive sweating. You may be a candidate for botox if your sweating fails to improve with prescription antiperspirants. Botox has been FDA-approved for individuals who sweat excessively from their armpits. Botox, Dysport and Jeuveau may also be used “off-label” to reduce sweating in other areas, such as the hands, feet, and face.
Off-label use refers to the use of a medication for an indication other than what it was approved to treat. In this case, it means that Botox, Dysport and Jeuveau haven’t gone through the same amount of rigorous testing to confirm its effectiveness for treating excessive sweating in other areas of the body.
How does Botox work for sweating?
Botox works by blocking the nerves responsible for activating your sweat glands. Normally, when your body temperature rises, your nervous system activates your sweat glands, to cool yourself automatically. In people with hyperhidrosis, however, the nerves that signal the sweat glands are overactive.
When you receive Botox injections directly into the area of your body that commonly sweats, your overactive nerves are essentially paralyzed. When your nerves can’t signal your sweat glands, you don’t sweat. Botox only prevent sweating in the specific areas where it’s injected, and the results can last from 3 to 6 months.
Where is Botox used?
Currently, Botox has only been approved for the treatment of underarm sweating. Studies as recent as 2015 have shown Botox and Dysport to be extremely effective in reducing armpit sweating. Medical providers can use it “off-label” to treat sweating of the hands, feet, face and back as well.
In fact, studies have found that Botox successfully treats sweaty palms in 80 to 90 percent of cases. The effects on the palms don’t last quite as long as in the underrarms, however. Botox has also been shown to reduce forehead sweating by 75 percent for about five months.
Researchers believe that Botox could help with sweating on the soles of the feet, however few studies have been done. While injections in the feet are considerably more painful than other areas, your medical provider may be able to do some pre-procedure nerve blocks under ultrasound guidance to enable a painless procedure.
What’s it like to get Botox injections?
Botox, Dysport, and other neuromodulator injections work best when given by an experienced practitioner. Injections don’t take long and can be completed during an office visit. Your provider will inject the Botox medication just below the surface of the skin, using a fine needle. You’ll receive several injections that form a grid pattern around your area of concern. Your doctor may give you something to prevent pain, like ice or a numbing agent.
You can return to work and normal life as soon as you’re done with your Botox injections. Your provider may ask you to schedule a follow-up appointment to check in and touch up any missed spots.
How do I prepare for the procedure?
Botox and Dysport injections are often termed ‘lunch break’ procedures because you can walk in and out in less than an hour. You’re advised to avoid shaving your armpits for two or three days prior to your appointment. If you take blood thinners, you may need to ask your primary care provider if you can stop for a few days prior to your injections, to prevent bruising. Tell your provider about any medications you’re taking, and don’t stop taking any medications unless your provider tells you to.
How much does it cost?
The cost of these injections varies greatly depending on your circumstances and where you live. If you need several areas of your body done, the costs can be substantial. The typical cost for two underarms is roughly $1,000. Fortunately, many flexible spending accounts like FSAs or HSAs cover all or part of the cost.
What are the risks and side effects?
Many studies have been done evaluating the safety of Botox. Most people tolerate it well. Possible side effects include:
- pain or bruising at the injection site
- flu-like symptoms
- droopy eyelid (for facial injections)
- eye dryness or tearing (for facial injections)
Serious side effects of Botox injections are extremely rare. Serious side effects happen when the Botox affects your entire body. This can happen hours, days, or weeks after your injections. Rare but serious side effects include:
- muscle weakness in the entire body
- trouble seeing
- difficulty breathing
- loss of bladder control
What to expect after treatment
While you can return to work and normal activities immediately after your procedure, you will not want to lay flat for 4 hours after or exercise for up to 24 hours after your procedure. It will take between two and seven days for you to stop sweating in the treated area, and up to two weeks for total dryness.
The effects of Botox are temporary, which means you’ll need more injections in the future. For underarm sweating, dryness can last anywhere from 4 to 14 months. Results may not last as long for the hands and feet, and you may need to repeat your treatment in about 6 months.
You should check in with your provider for a follow-up appointment two weeks after your initial procedure, once the botox is in full effect. At this appointment, your doctor can perform any “touch ups” of missed spots.
Botox is an effective treatment for excessive sweating. While sometimes costly, these injections can drastically improve one’s quality of life.
Kreyden OP, Scheidegger EP. Anatomy of the sweat glands, pharmacology of botulinum toxin, and distinctive syndromes associated with hyperhidrosis. Clin Dermatol. 2004;22(1):40-44. doi:10.1016/j.clindermatol.2003.12.029
Schlereth T, Mouka I, Eisenbarth G, Winterholler M, Birklein F. Botulinum toxin A (Botox) and sweating-dose efficacy and comparison to other BoNT preparations. Auton Neurosci. 2005;117(2):120-126. doi:10.1016/j.autneu.2004.11.005
Shibasaki M, Davis SL, Cui J, Low DA, Keller DM, Crandall CG. Botulinum toxin abolishes sweating via impaired sweat gland responsiveness to exogenous acetylcholine. Br J Dermatol. 2009;161(4):757-761. doi:10.1111/j.1365-2133.2009.09248.x
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