BOTOX for Hyperhidrosis

A pubic forum questions which I decided to answer using my own experience in Modesto, California as an injector of Botox for this problem of excessive sweating in the axilla (arpits).  The question comes from Kansas City, MO.

Is it uncommon for botox for hyperhidrosis to not work the first time?

I’ve had hyperhidrosis since age 13. I finally had botox treatments about three weeks ago, and was sure that this would be my answer. The sweating has improved some, but I still get sweat marks. Which, for the price I had to pay, is incredibly disappointing. I don’t know if it’s worth it to try again or not. My dermatologist’s office said insurance wouldn’t even allow me to get another treatment until it had been 4-6 months. They also said nobody had ever had the botox NOT work for them. Help!

My Botox and Hyperhidrosis Answer

A great question.  I can only speak from my own experience as an injector of Botox for my Modesto hyperhidrosis patients.  I have had a few patients where the sweating has reduced somewhat after 50U of Botox injected in each axilla (arm pit area).  But then they needed more.  A carefully planned approach to the remaining excessive sweat areas by using a starch test or even just observation, could help direct perhaps another 25 units of Botox into each side.  That’s what I’ve done with some success in my own practice in Modesto California where it does get over 100 degrees F in the summers.  I think that 1 in 5 of my patients would benefit from a higher amount.  I’ve also worked with excessive sweating in the palms/feet which can be a lot higher in Botox dose.

​You’ve shown that it works with the reduction you noticed, and now it just needs more – probably because everyone is different.  And perhaps if you had to wait 6 months – it might work even better because I think there would be some overlap of the Botox injections.

​My practice doesn’t accept insurances, so I totally understand that the cost can be a concern.  But many of my patients think that it is “a new lease on life” as some of my patients claim.
​Thank you for your question. Without having seen you in person, I’m answering the best I can without physical examination info. My comments are meant for a general public discussion to help others who may have similar concerns. I’m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor/surgeon in person.

​I hope my own experience as an injector helps.

Calvin Lee, MD

two surgeons working at the same time - Crop
Dr. Tammy Wu and Dr. Calvin Lee operating together in Oakdale, California