Treatment of localized hyperhidrosis with botulinum toxin—better known as Botox®—is a reference therapeutic option when conventional solutions prove ineffective or poorly tolerated. Recommended to reduce excessive sweating in the underarms, hands, feet, or face, this technique relies on a precise, safe, and well-established protocol. But what does a Botox injection session actually involve in the context of hyperhidrosis treatment ?
Before any injection, a thorough medical consultation is essential. It allows for a precise diagnosis, determination of the indication, exclusion of any contraindications, and detailed patient information on the procedure, expected benefits, and potential side effects.
The physician :
In some cases, a Minor test (application of iodine and starch) may be performed to map active sweating areas, especially if sweating is diffuse or irregular.
On the day of the injection, the patient is received under strict medical conditions, ensuring safety and comfort. No hospitalization or general anesthesia is required. Careful preparation precedes the actual injection. The area to be treated is first disinfected with an antiseptic solution, usually chlorhexidine-based. If necessary, especially in the underarm area, local shaving may be performed to facilitate access and reduce the risk of skin microtrauma. The physician then precisely marks the injection points, using visual marking or a dermographic pencil, maintaining a regular spacing of about one to two centimeters.
For the most sensitive areas, such as injections in the palms or soles, local anesthesia may be offered, either as a topical anesthetic cream or via a nerve block, to limit patient discomfort. This preparatory phase, essential for the proper conduct of the treatment, lasts on average between 15 and 20 minutes, depending on the treated area and the personalized protocol.
Botulinum toxin is reconstituted according to laboratory standards and injected in very small amounts (units) using very fine needles, intradermally (and not subcutaneously as in the treatment of upper facial wrinkles). The total number of injections depends on the surface area of the zone to be treated, the activity level of the sweat glands, and the expected response.
For example, underarm treatment generally involves between ten and fifteen injection points per side, corresponding to a total of 50 to 100 units. The palms often require twenty to thirty points, distributed symmetrically. A similar approach is used for the soles of the feet, although this area is often more uncomfortable. For areas such as the forehead or scalp, injections are spaced to avoid any interference with the muscles responsible for facial expression.
The entire procedure lasts on average 30 to 45 minutes. No prolonged monitoring is required, and the patient can resume daily activities immediately after the session, unless otherwise instructed by the physician.
Botulinum toxin injection for the treatment of hyperhidrosis is a medical procedure that must be performed by a trained and experienced physician. Unlike aesthetic Botox injections, which target the muscles responsible for expression wrinkles, the use of botulinum toxin for hyperhidrosis targets the sweat system. Specifically, the eccrine sweat glands located in the dermis are targeted to reduce excessive sweat production.
This indication requires specific technical skill, demanding a thorough knowledge of the skin and vascular anatomy unique to each treated region—whether the underarms, palms, soles of the feet, or scalp. Precision is paramount: the injection must be intradermal, with a regular and even distribution of points to ensure uniform efficacy across the area. The physician must also adjust the dose based on the intensity of sweating and the size of the area to be treated, requiring a personalized assessment for each patient.
Only a specifically trained physician can ensure this level of rigor. They will know how to adjust protocols when treating multiple areas, anticipate potential side effects, and account for anatomical particularities, such as thin skin or proximity to deep muscles.
Although Botox uses the same active ingredient in both indications, the injection protocol for excessive sweating is fundamentally different from that used for aesthetic purposes.
These fundamental differences fully justify a specific medical approach for the treatment of hyperhidrosis, with a dedicated protocol, rigorously distinct from the cosmetic use of Botox.
Immediate resumption of work activities is possible after a Botox injection session for excessive sweating. It is an outpatient procedure, without general anesthesia, without social withdrawal, and requiring neither rest nor prolonged monitoring.
However, certain precautions must be observed in the hours following the injection.
During treatment of the hands or feet, temporary functional discomfort may occur (stiffness, slight muscle fatigue), without contraindicating a return to work. Similarly, when the face or scalp is treated, usual activities can be resumed immediately, provided that makeup or excessive hairstyling is avoided during the first 24 hours. In practice, except for particularly physical professions or those exposed to hot and humid environments (kitchens, gyms, industrial workshops), returning to work after a session is possible immediately and without risk.
The duration of a botulinum toxin injection session depends mainly on several factors, such as the area(s) to be treated, the possible use of local anesthesia—particularly recommended for the hands or feet—and the prior performance of a Minor test to accurately map areas of excessive sweating. On average, a complete session lasts between 15 and 30 minutes. It begins with a preparation phase, usually lasting 10 to 15 minutes, including thorough disinfection of the area, marking of injection points, and, if necessary, identification of active sweating zones. The injection itself is quick but precise, taking only a few minutes, with small doses distributed according to an even grid. Finally, a short period of rest or post-procedure observation—typically 5 to 10 minutes—may be offered, although it is not always necessary. Underarm treatment is the quickest procedure. In contrast, more sensitive or complex areas, such as the hands, feet, or scalp, often require more time, especially when local anesthesia is used to improve patient comfort. In all cases, the physician ensures that each step of the protocol is followed carefully, without rushing, to guarantee safety, efficacy, and comfort throughout the session.
Botox injections for the treatment of hyperhidrosis are generally well tolerated, although they may cause some discomfort depending on the area being treated.
The pain is brief and localized, not requiring post-procedure medication for relief.
Article written by Dr Romano Valeria
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