Treatment of localized hyperhidrosis with botulinum toxin—commonly known as Botox®—is now considered one of the most effective solutions for controlling excessive sweating that resists conventional treatments. Its efficacy is well documented, as is its excellent safety profile. However, a common question in consultations is: “Are the injections painful?”
It is entirely reasonable for any patient to wonder about the sensation caused by a medical procedure, especially when it involves multiple injection points in sensitive areas of the body. The perception of pain depends on several factors, including the anatomical area being treated, individual sensitivity, the injection technique, and the support provided by the physician.
Botox injections for hyperhidrosis are well tolerated by the majority of patients and do not cause significant pain. They are superficial intradermal injections, performed with very fine needles, similar to those used for skin allergy tests or mesotherapy.
Each injection point is quick, taking only a few seconds, and the discomfort felt is comparable to a mosquito bite or a minor scratch. The area may experience a slight transient burning sensation or tingling, but the pain generally does not last more than a few minutes. This high tolerance is partly due to the shallow depth of the injection, which does not reach muscles or nerves.
Not all areas of the body have the same sensitivity during injection. Pain perception largely depends on the density of nerve endings in the skin, making injections in certain regions more tolerable than in others.
The underarms are by far the most commonly treated area and also the most comfortable for patients. The skin is soft and lightly innervated, and injections cause very mild discomfort. In most cases, no local anesthesia is required. Many patients describe the procedure as only slightly uncomfortable, sometimes even completely painless.
In contrast, the hands and feet, treated for palmar or plantar hyperhidrosis, are significantly more sensitive. Their richness in tactile receptors and nerve fibers can make injections unpleasant or even painful, especially when a large number of points are treated. To improve comfort, local anesthesia with a lidocaine-based cream is often offered. For particularly sensitive patients, loco-regional anesthesia—such as a nerve block—can be performed in the medical office, allowing an almost painless session without compromising treatment efficacy.
Tolerance can also vary when treating localized hyperhidrosis of the face or scalp. Injections on the forehead generally cause moderate discomfort, while the scalp is more sensitive. Applying a topical anesthetic cream beforehand significantly reduces discomfort. Adapting the protocol to each location and each patient is essential, ensuring not only therapeutic effectiveness but also the most comfortable experience possible.
Pain management does not depend solely on the treated area: it also relies on preparation, the physician’s technique, and patient support. An experienced doctor will use very fine, single-use needles to minimize pain, adjust the injection speed and depth to avoid discomfort from excessive pressure, employ distraction or breathing techniques if the patient is anxious, and anticipate sensitivity with local anesthesia when indicated.
Furthermore, the patient is reassured during the consultation: no prolonged or disabling pain is to be expected after the procedure. It is possible to resume professional and social activities immediately.
In the hours following the session, it is common to observe mild local side effects, which are not strictly considered pain: increased sensitivity to touch, a feeling of tension or warmth, or slight swelling, more frequent in sensitive areas such as the palms or feet. These manifestations are temporary and resolve spontaneously within 24 to 48 hours. They do not require specific treatment. Analgesics are generally not necessary, except possibly taking paracetamol if needed.
In both aesthetic and functional medicine, the quality of the patient’s experience is central to care. This includes clear and precise information, a well-prepared session in a reassuring environment, and a physician attentive to the patient, adjusting their technique according to individual sensitivity. Patients who fear needles or pain often benefit from tailored psychological support, combining guided breathing, verbal reassurance, and a gradual approach. In practice, patient feedback is very positive. The functional benefit achieved—particularly the significant reduction in sweating—far outweighs the brief discomfort experienced during the injection. This lasting efficacy, combined with a marked improvement in quality of life, leads the vast majority of patients to continue treatment and repeat sessions without hesitation.
It is natural to wonder whether tolerance to Botox injections varies according to sex, especially for functional treatments such as hyperhidrosis. Although perceived pain is primarily subjective and multifactorial, physiological and behavioral differences may exist between men and women, influencing the treatment experience.
Biologically, women’s skin is generally thinner and more vascularized, which can make it more sensitive to superficial injections. In addition, certain phases of the menstrual cycle—particularly the luteal (pre-menstrual) phase—are associated with increased pain sensitivity due to hormonal fluctuations, notably progesterone.
However, in clinical practice, women are often observed to have greater emotional tolerance to discomfort than men, partly because they are more accustomed to aesthetic care (hair removal, dermatological treatments, cosmetic injections). Men may experience the procedure with particular intensity, especially in sensitive areas or regions involved in fine motor functions, such as the hands, feet, or face.
The difference between men and women remains moderate in the context of hyperhidrosis. Discomfort primarily depends on the anatomical area treated, the patient’s level of apprehension, and the physician’s expertise. Proper preparation, clear information, and adaptation of the protocol (local anesthesia if necessary) allow everyone to benefit from the treatment under optimal conditions, regardless of sex.
Article written by Dr Romano Valeria
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