Botox for sweating: comfort and confidence in any weather

Botulinum toxin is known as a treatment for expression lines, but it has a second, more mechanical use: temporarily switching off the sweat glands in the treated area. The method has been approved by regulators for severe underarm hyperhidrosis since 2004.

Antiperspirants act from the outside: aluminium salts narrow the ducts of the glands. For ordinary sweating that is enough. In hyperhidrosis it is not: the glands receive excessive nerve stimulation and keep working at full power regardless of temperature or activity. A topical product cannot reach the cause, which is the signal coming from the nerve endings.

The product is injected intradermally and blocks the release of acetylcholine, the messenger the nerve endings use to instruct the sweat glands. The gland receives no signal, so almost no sweat is produced in the treated area. Three things are worth knowing:

• the effect is local and limited to the injected zone;
• overall thermoregulation is not affected: the underarms account for only a small share of total sweating;
• the effect is reversible: after several months the nerve endings restore their connection with the glands.

It starts with a consultation: the doctor assesses the severity of the sweating and rules out contraindications. If the sweating appeared recently and suddenly, the doctor may suggest a check-up first. Secondary hyperhidrosis can be a symptom of an endocrine condition, and masking it with injections without a diagnosis is the wrong order of things.

The treatment itself takes 15 to 20 minutes: a series of micro-injections with a fine needle, following a marked grid in each underarm. It feels like light pinches; a cooling gel or numbing cream is available on request. You can go straight back to your day afterwards: no deodorant for 24 hours, and one or two days without the gym, sauna or hot baths.

The first changes appear within 3 to 7 days, with the full effect by the end of the second week. After that you get four to six months of dryness, and longer for some patients. In the Dubai climate many people repeat the treatment twice a year, while others do it once, before the hottest season or an important event: a wedding, a holiday, a run of business meetings.

• The method does not cure hyperhidrosis for good; it switches the symptom off for months. For most people that is the solution: repeat once or twice a year.
• Pregnancy, breastfeeding, disorders of neuromuscular transmission such as myasthenia and inflamed skin in the area are contraindications.
• Palms and feet can also be treated, but there the procedure is less comfortable and the effect is shorter. That is discussed separately at the consultation.

How botulinum toxin works on expression lines, and why the frozen face is a myth about overdosing, is covered in our article on botox myths and dosages.

Does botox in the underarms hurt?
It is one of the most comfortable areas: thin skin, a fine needle and superficial injections. It feels like a series of light pinches over a couple of minutes on each side. Cooling or a numbing cream is available if you prefer.

How long does it last and how often should I repeat it?
Four to six months on average, and up to eight or nine for some patients. You can repeat it as the sweating returns, usually once or twice a year.

Will I stop sweating completely?
In the treated area sweating drops so noticeably that deodorant becomes unnecessary. The rest of the body sweats as usual: thermoregulation is not affected.

Can I exercise afterwards?
Yes, after one or two days. Right after the injections it is better to avoid intense exercise, saunas and hot baths so the product settles evenly.

Is it safe?
The doses used for the underarms are small and act locally. The method has been approved for underarm hyperhidrosis since 2004. What matters is the doctor and an original product, and in a DHA-licensed clinic both are verifiable.