Botox for Hyperhidrosis: Underarms, Palms, and Feet Treatment

Sweat keeps us cool and protects the skin, but when glands fire nonstop, life gets smaller. Shirts soak through before meetings, pens slip during interviews, leather shoes turn slick. I have seen confident professionals avoid handshakes and teenagers carry extra hoodies even in July. Medical terms call it primary focal hyperhidrosis, yet the day-to-day reality is simpler: too much sweat in places where it matters most. Among the tools we have, Botox has earned a steady place for underarms, palms, and soles. It is not hype, and it is not for everyone. Done well, it can be a practical, repeatable way to reach dry.
What hyperhidrosis really means
Hyperhidrosis comes in two broad forms. Primary focal hyperhidrosis is the classic pattern: healthy people with overactive sweat glands in specific areas such as the armpits, hands, feet, scalp, or face. It often begins in adolescence, runs in families, and flares with stress or heat but can show up in a cold room too. Secondary hyperhidrosis has a cause, anything from thyroid disease to certain medications, infections, menopause, or neurological disorders.

The underarms, palms, and soles matter because sweat there affects function and confidence. Axillary sweat ruins clothing and creates odor. Palmar sweat compromises grip and electronics. Plantar sweat leads to blisters, sliding in shoes, and sometimes fungal infections. If you have tried strong antiperspirants, absorbent clothing, gloves, powders, and lifestyle workarounds without relief, medical therapy is the next step.
How Botox tamps down sweat glands
The drug in Botox, onabotulinumtoxinA, blocks acetylcholine at the neuromuscular junction and at sympathetic nerve endings that stimulate eccrine sweat glands. When a trained injector places tiny amounts into the skin where sweating happens, the glands go quiet. This is not the same as Botox for wrinkles. Cosmetic injections sit in facial muscles to soften expression lines. Hyperhidrosis treatment targets the dermis and superficial subcutis where sweat glands live, not deep muscle. The goal is to reduce sweat by 70 to 90 percent in the treated zone, often within a week.

Clinically, the effect arrives in stages. First, damp patches shrink. Then shirts last longer. For palms, patients notice better grip and fewer water droplets beading on the skin. On feet, socks stay dry and friction blisters botox Ann Arbor https://www.tiktok.com/@cosmediclasermd become less frequent. Results vary, but the signal is clear when it works: you stop having to plan life around sweat.
Who is a good candidate
Most healthy adults with primary focal hyperhidrosis of the underarms, palms, or soles qualify. Teens can be candidates as well, though consent and comfort with injections matter. I look for a few things during a Botox consultation. First, whether sweating occurs during the day, affects daily tasks or social interactions, and persists despite aluminum chloride antiperspirants. Second, whether there is a medical cause that should be addressed first, such as hyperthyroidism or medication side effects. Third, whether the person understands maintenance. Botox is a non-surgical treatment with a temporary effect, so a plan for touch ups every several months keeps results consistent.

Certain conditions need discussion. Neuromuscular disorders, pregnancy, breastfeeding, and active skin infections in the treatment area are reasons to postpone or avoid the procedure. People on anticoagulants can be treated but should expect more bruising. Those who rely on fine motor strength with prolonged grip, like professional musicians or elite climbers, may prefer underarm treatment first and approach palmar therapy cautiously, since some transient hand weakness can occur when injections are deep.
Preparing for a session
Preparation is simple. Avoid shaving the underarms for 24 to 48 hours before treatment to reduce skin irritation. Skip blood-thinning supplements like fish oil, high-dose vitamin E, and ginkgo for a week if your doctor agrees, since they can increase bruising. Show up clean, without deodorant, lotions, or topical anesthetics on the treatment area. Tell your botox provider about any neuromuscular conditions, recent antibiotic use (particularly aminoglycosides), and previous Botox services for either cosmetic or medical reasons. If you used botox cosmetic injections for wrinkles recently, spacing treatments is usually safe, but your injector will plan total dose thoughtfully.

During a botox appointment, we often map the sweat pattern. The starch-iodine test is still the workhorse. Iodine goes on dry skin, then cornstarch dusting. Areas that sweat turn deep purple. This shows the true boundary of your sweat zone, which can be irregular, and it helps avoid under-treating sparse islands that cause visible wet spots later.
The procedure, area by area
Underarms. This is the easiest and fastest. After cleaning, I mark a grid across each axilla, typically spacing injection points 1 to 1.5 centimeters. We use a fine needle and place tiny blebs intradermally at each point. You feel pinpricks and mild pressure, more annoying than painful. Most people do not need numbing, though we can use a topical anesthetic or a chiller device. The full botox procedure for underarms takes 10 to 15 minutes.

Palms. Hands require more thought. The dermis is thicker, and the density of nerves makes injections more uncomfortable. For comfort, I use regional nerve blocks at the wrist or numbing creams combined with vibration anesthesia and cold. Marking follows the same grid concept, with tighter spacing in the central palm and lighter dosing near the thenar and hypothenar eminences to reduce the risk of transient grip weakness. Expect the visit to last 30 to 45 minutes when blocks are included.

Feet. Plantar skin is even thicker and tender in spots. Nerve blocks at the ankle help significantly. We distribute injections more densely in weight-bearing areas and lighter across the arch, mapping to where sweat is worst. People who stand all day may need post-procedure padding or a day of lighter activity.

Across all areas, the technique aims for intradermal placement, not deep into muscle. The pattern matters as much as total units. Even coverage reduces the chance of a dry patch surrounded by damp edges. When done correctly, the surface looks like a field of tiny, raised dots that settle over the next hour.
Dosing, results, and how long it lasts
Dose ranges depend on area size and severity. For underarms, typical total dose per side falls between 50 and 75 units, sometimes up to 100 units for larger fields. Palms often require 50 to 70 units per hand, and soles can approach 80 to 100 units per foot due to thicker skin and broader coverage. These are common ranges, not rigid rules. A botox specialist judges response and tailors subsequent visits, sometimes lowering dose after a strong first result.

Most people notice a change within 3 to 7 days, with full effect by 2 weeks. The underarms respond quickest and most predictably. Palms and soles can take a day or two longer. Clinical trials and day-to-day experience align on duration: underarm results last 4 to 7 months on average, sometimes longer for people who repeat treatment on a schedule. Palms and soles tend to last on the shorter side, 3 to 5 months, likely due to higher mechanical stress and differences in gland density.

You do not stop sweating everywhere. The body does not “compensate” by turning other areas into new geysers in most cases, though some people notice existing sweat in other zones feels more obvious once the main problem spot is quiet. True compensatory excessive sweating is unusual with localized botox shots for hyperhidrosis, far less common than after sympathectomy surgery.
Safety, side effects, and the rare outliers
Botox has a long track record as a botox medical treatment for excessive sweating. Side effects are mostly local and temporary. Expect small bumps for an hour or two, redness, and occasional bruising. Underarm injections can cause mild soreness for a day. Palmar treatment sometimes brings transient hand weakness if the toxin diffuses into small intrinsic muscles. This shows up as fatigue opening tight jars or pressing heavy door handles and usually resolves within 2 to 4 weeks if it occurs. Plantar treatment can leave the soles tender for a couple of days.

Allergic reactions are very rare. Systemic side effects like widespread weakness or flu-like symptoms are also rare at the doses and techniques used for hyperhidrosis. Spreading beyond the target is unlikely when injections are intradermal and dosing is conservative along the edges. If you have a history of neuromuscular disease or prior unusual reactions to botulinum toxin, discuss it thoroughly with your botox doctor.

From a safety perspective, sterile technique, correct depth, and thoughtful spacing matter more than any shortcut. I have seen complications when providers inject too deep into palm muscles or cluster too many units at one point. That is why choosing an experienced botox clinic for this particular indication pays off.
How it feels afterward and what to do
You can drive, work, and return to daily life right away. Skip saunas and intense workouts with heavy friction or gripping for the rest of the day, since heat and pressure can, in theory, increase diffusion. Keep the area clean, avoid deodorant in newly treated underarms until the next morning, and moisturize if the skin feels tight. For palms and soles, consider a rest day if your job involves heavy manual tasks. Most people do not need pain medication, but acetaminophen is reasonable if tender.

Follow up is practical. A check at two weeks catches any islands that still sweat. If a small pocket remains active, a few touch-up injections can even it out, often with a very small additional dose. Track your own experience. Note how long shirts stay dry, whether you changed fewer socks, or whether the steering wheel stays dry during a stressful commute. That record guides dose adjustments.
How Botox compares to other options
Medical hyperhidrosis care lives on a spectrum. For underarms, aluminum chloride antiperspirants often help mild cases at very low cost. Glycopyrronium cloths or topical anticholinergics can cut sweat but sometimes cause dry mouth or eye irritation. Iontophoresis is a device-based therapy that moves ions through the skin using a mild current. It works best for palms and feet, with sessions several times a week at the start, then maintenance once weekly or biweekly. It demands time and routine. Oral anticholinergics like glycopyrrolate or oxybutynin are effective for some, but the trade-offs include dry mouth, constipation, and occasional blurry vision. Energy-based devices such as microwave thermolysis focus on underarm sweat and odor glands, often with durable reduction after one or two sessions, though cost and access vary.

Botox sits in the middle. It is targeted, reversible, and repeatable. For underarms, it can be the most straightforward next step after antiperspirants. For palms and soles, it competes with iontophoresis and oral medication. I often suggest a combined approach: iontophoresis for hands or feet at home with periodic botox injections during high-stakes seasons, like summer or exam blocks for students who sweat onto papers.
Cost, insurance, and value
Botox pricing is a mix of units used, the setting, and the expertise of the injector. The botox cost for underarm hyperhidrosis at a specialty practice often ranges from the mid hundreds to over a thousand dollars per session, depending on region and total units. Palms and soles can cost more because dosing is higher and appointment times are longer. Some insurers cover medical botox for axillary hyperhidrosis after documented trials of prescription antiperspirants. Palmar and plantar coverage is less consistent. Clinics sometimes offer botox packages or seasonal botox specials for hyperhidrosis patients, but the key is transparency: a clear quote for units, fees, and anticipated maintenance.

As for value, I ask patients to weigh expense against reclaimed time and confidence. One engineer told me he stopped switching shirts at lunch and stopped avoiding dark colors. A pianist described dry keys for the first time in years. Objective measures help too: fewer antiperspirant purchases, fewer laundry cycles, shoes that last longer. If budget is tight, underarm treatment offers the best cost-to-impact ratio, and spacing visits to match peak seasons makes sense.
What a typical year looks like with treatment
Most people settle into a rhythm. Underarms get treated twice a year, sometimes three times in hot climates or high-stress jobs. Palms and soles run more like three times per year. The first two sessions set the baseline. If the first visit uses higher units to fully quiet the zone, the second may use fewer to maintain. With repetition, some find the effect lasts a bit longer, perhaps because the local nerve endings take time to regenerate signaling, though this is not universal.

Maintenance is simpler when you track your own average duration. If underarms regularly last five months, book the next botox appointment at four and a half. That way you avoid a return of symptoms. A botox follow up at two weeks after the first session makes dose refinement efficient. After that, most follow ups are quick check-ins unless something changes.
Special considerations: hands and feet in detail
Palmar injections attract the most questions. People worry about pain and the possibility of weak hands. The pain we can manage with effective nerve blocks. The risk of weakness we manage with technique and dose. Careful intradermal placement, lighter dosing near the thenar mound, and spreading units across the grid reduce diffusion to muscles. In my practice, when weakness occurs, it has almost always been mild, described as fatigue rather than frank loss of function, and it resolves before the next maintenance visit.

On the soles, the goal is function. Runners, chefs, nurses, and retail workers who stand all day benefit when socks stay dry. Reduced moisture also lowers the burden of athlete’s foot. Expect a little soreness along weight-bearing points after injections, which typically responds to a cushioned insole for a day or two. If you have calluses or fissures, treat those proactively with urea creams or gentle debridement before your botox appointment so mapping is accurate and comfort is better.
Choosing the right botox provider
Skill shows up in mapping, dosing, and patient coaching. Look for a botox specialist who treats hyperhidrosis regularly, not only cosmetic lines. Ask how they manage palmar pain, whether they perform a starch-iodine test at least during the first session, and how they handle touch ups. A botox clinic comfortable with both cosmetic botox and medical botox is fine, but experience with hands and feet matters. Check that sterile technique is routine, and that they track outcomes beyond “how does it feel” by noting sweat reduction and duration.

If you are new to injectables, a pre-visit botox consultation helps set expectations. Bring a list of prior treatments, including iontophoresis schedules or medications. Note any previous botox shots for wrinkles or for migraines, since total exposure informs planning. Ask about botox risks specific to your job or sport, particularly if grip strength is essential. A candid conversation avoids surprises.
My practical playbook
I approach hyperhidrosis with a simple ladder. Start with clinical mapping. Begin underarms unless hands or feet are the main problem. For axillary hyperhidrosis, expect high odds of success with minimal downtime. Palms and soles require more planning, so I discuss nerve blocks upfront, book a slightly longer slot, and schedule a two-week check. I keep units proportional to the area and do not chase the last droplet with heavy clustering. If needed, small top-ups refine the result.

Between visits, I pair treatment with supportive habits rather than promises of miracles. Breathable fabrics, antiperspirants used properly on dry skin at night, moisture-wicking socks, and shoe rotation make botox results feel stronger. For heavy palm sweaters who type all day, a soft keyboard cover reduces friction. For athletes, moisture-wicking insoles and a spare sock ritual during long days keep feet comfortable.
Common questions, answered plainly How long does botox last for sweating? Underarms average 4 to 7 months, palms and soles 3 to 5 months, with individual variation. Is botox safe for hyperhidrosis? For most healthy people, yes. Side effects are local and temporary. Choose an experienced injector to minimize risks. Will I stop sweating completely? No. The treated area will sweat far less, often by 70 to 90 percent, but your body still regulates temperature using other areas as needed. Does it hurt? Underarms are quick and tolerable. Palms and soles can hurt without numbing, so we use effective blocks or topical anesthesia to keep it manageable. What if it does not work for me? Rare, but it happens. We can adjust dose, refine mapping, or combine with iontophoresis or topical anticholinergics. When botox fails despite good technique, we reassess for secondary causes or consider alternative procedures. Where cosmetic botox fits in the picture
People often ask whether botox for wrinkles conflicts with hyperhidrosis care. It does not, as long as total dosing is coordinated and injection schedules are spaced reasonably. Cosmetic botox for forehead or frown lines stays in facial muscles. Hyperhidrosis treatment sits in skin elsewhere. It is common for someone to have botox cosmetic injections a few times a year for facial rejuvenation and separate sessions for sweating. If you prefer subtle botox or baby botox approaches cosmetically, tell your provider, but this does not affect sweat control strategy.
A note on expectations and mindset
Hyperhidrosis is not a character flaw, and it is not poor hygiene. It is physiology. When patients find relief, the biggest shift is not the dry shirt; it is the mental space they get back. You stop thinking about sweat every hour. Your bag gets lighter because you no longer carry spare layers, powders, and paper towels. Meetings feel simpler. Weekends feel freer. That is the real endpoint.

If you are exploring your first time botox for sweating, start with a clear goal. If you want to shake hands without worry, palms may be worth the extra logistics. If clothing is the main issue, underarms offer the most straightforward win. Work with a provider who treats hyperhidrosis routinely, discuss botox pricing and maintenance upfront, and set reminders for botox follow up based on your own timeline. Thoughtful, consistent care beats heroic, one-off sessions.
Final practical checklist for your next step Track one week of sweat patterns: time of day, triggers, and clothing changes. Bring the notes to your botox appointment. Ask your botox provider whether they use mapping tests, what units they expect to use, and how they manage pain for palms or soles. Plan a two-week follow up for possible touch up, then pencil the next botox maintenance visit based on your average duration. Pair treatment with small habits: nighttime antiperspirant on dry skin, breathable fabrics, and moisture-wicking socks or liners. Budget for care by area. Underarms typically cost less and last a bit longer than palms or soles, and some insurance plans cover axillary treatment.
Botox therapy is not the only answer for hyperhidrosis, but it is one of the most dependable when the target is clear and the technique is sound. Underarms, palms, and feet each demand a slightly different playbook. With a good map, measured dosing, and honest follow up, the result is simple, steady control. Dry enough to get on with your life, which is the point.