Botox for Axilas – Procedure and Aftercare

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Botulinum toxin injections, commonly known as botox, have emerged as a highly effective treatment for axillary hyperhidrosis, a condition characterized by excessive underarm sweating. This minimally invasive procedure offers significant relief for individuals who struggle with the physical and emotional challenges associated with excessive perspiration.

By blocking nerve signals to the sweat glands, botox injections can dramatically reduce underarm sweating for several months, providing patients with improved quality of life and increased confidence in social and professional settings. While originally known for its cosmetic applications, botox has gained FDA approval for treating severe primary axillary hyperhidrosis, offering a safe and reliable option for those who have not found success with traditional antiperspirants or other conservative measures.

Botox Injection Procedure for Axillary Hyperhidrosis

The botulinum toxin injection procedure for axillary hyperhidrosis is a minimally invasive outpatient treatment. It involves precise injections of the toxin into the underarm area to target sweat glands. The process is relatively quick, typically lasting 30-45 minutes, and requires little to no downtime for patients.

Pre-Treatment Considerations

Medical History and Physical Examination: Before proceeding with botulinum toxin injections for axillary hyperhidrosis, a thorough medical history and physical examination are essential. The healthcare provider will inquire about the patient’s sweating patterns, severity of symptoms, and impact on daily life. They will also review any previous treatments attempted and their effectiveness. The physical examination includes assessing the axillary region for skin conditions or anomalies that might affect treatment. Patients should disclose all medications, supplements, and medical conditions, particularly neuromuscular disorders, as these can influence treatment safety. Allergies, especially to botulinum toxin components, must be discussed. This all-inclusive evaluation helps determine the patient’s suitability for the procedure and allows for personalized treatment planning, ensuring optimal safety and efficacy.

Ruling Out Secondary Causes of Hyperhidrosis: Before proceeding with botulinum toxin treatment for axillary hyperhidrosis, it is crucial to rule out secondary causes of excessive sweating. Secondary hyperhidrosis can be a symptom of underlying medical conditions or medication side effects. Healthcare providers conduct a thorough evaluation, which may include blood tests to check for thyroid disorders, diabetes, or hormonal imbalances. They also review the patient’s medication list, as certain drugs can cause increased sweating. Other potential causes to be considered include infections, neurological disorders, and certain types of cancer. If a secondary cause is identified, treating the underlying condition becomes the priority, as this may resolve the hyperhidrosis without the need for botulinum toxin injections.

Injection Technique

Mapping of Hyperhidrotic Area (Minor’s Iodine-Starch Test): The Minor’s iodine-starch test is a valuable technique used to precisely map the hyperhidrotic area in the axillae before botulinum toxin injection. This method involves applying an iodine solution to the clean, dry axillary skin, followed by dusting the area with starch powder. As the patient begins to sweat, the combination of sweat, iodine, and starch creates a dark blue or purple color, clearly delineating the areas of excessive sweating. This visual mapping allows the healthcare provider to identify the exact boundaries of the hyperhidrotic region, ensuring targeted and efficient treatment. The test not only guides the injection sites but also helps in determining the appropriate dosage of botulinum toxin needed for each patient’s unique sweat pattern.

Intradermal Injections in Grid Pattern: The administration of botulinum toxin for axillary hyperhidrosis involves a series of intradermal injections arranged in a grid pattern. This technique ensures even distribution of the toxin across the entire affected area. The healthcare provider typically marks out a grid on the skin, with injection points spaced approximately 1-2 centimeters apart. Each injection is made just beneath the skin’s surface, targeting the superficial layer where sweat glands are located. The grid pattern approach helps to avoid over-treating any single area while ensuring complete coverage. This method minimizes the risk of compensatory sweating in untreated areas and maximizes the efficacy of the treatment. The number of injection points can vary depending on the size of the hyperhidrotic area, but typically ranges from 10 to 15 injections per axilla.

Dosage and Dilution of Botulinum Toxin: The dosage and dilution of botulinum toxin for axillary hyperhidrosis treatment are critical factors in achieving optimal results. Typically, 50 to 100 units of botulinum toxin are used per axilla, with the exact amount determined by the severity of hyperhidrosis and the size of the affected area. The toxin is usually supplied in vials containing 100 units and requires dilution before use. Standard dilution involves adding 1 to 4 milliliters of sterile saline to the vial, resulting in a concentration of 10 to 2.5 units per 0.1 milliliter. Higher dilutions allow for more precise dosing and better distribution across the treatment area. The healthcare provider carefully calculates the total dose and dilution to ensure effective sweat reduction while minimizing the risk of side effects or over-treatment.

Pain Management and Anesthesia Options

Topical Anesthetic Creams: Topical anesthetic creams play a crucial role in pain management during botulinum toxin injections for axillary hyperhidrosis. These creams typically contain lidocaine, prilocaine, or a combination of both, and are applied to the axillary skin 30 to 60 minutes before the procedure. The cream forms a temporary numbing barrier, significantly reducing discomfort from the multiple injections required. The effectiveness of topical anesthetics can vary among patients, but most report a considerable reduction in pain sensation. Some clinics may use occlusive dressings over the cream to enhance absorption and efficacy. While generally safe, patients should be monitored for rare allergic reactions. The use of topical anesthetics not only improves patient comfort but also helps reduce anxiety associated with the procedure, contributing to a more positive treatment experience.

Local Anesthetic Injections: Local anesthetic injections offer a more potent and immediate form of pain management for botulinum toxin treatments in axillary hyperhidrosis. Typically, a small amount of lidocaine or another fast-acting anesthetic is injected directly into the axillary region just before the botulinum toxin administration. This method provides rapid and complete numbing of the treatment area, ensuring maximum patient comfort during the procedure. The anesthetic is usually mixed with epinephrine to prolong its effect and reduce bleeding. While highly effective, local anesthetic injections carry a slightly higher risk of complications compared to topical creams, including potential allergic reactions or systemic effects. Healthcare providers carefully weigh the benefits against these risks, often reserving this option for patients with low pain thresholds or extensive treatment areas.

Post-Treatment Care and Precautions

Proper post-treatment care is crucial for maximizing the effectiveness of botulinum toxin injections for axillary hyperhidrosis and minimizing potential side effects. Patients should follow specific guidelines regarding activity levels, wound care, and monitoring for complications in the days following the procedure.

Immediate Side Effects and Recovery

Redness, Swelling, and Bruising at Injection Sites: Following botulinum toxin injections for axillary hyperhidrosis, patients commonly experience some degree of redness, swelling, and bruising at the injection sites. These reactions are typically mild and transient, usually going away within a few days to a week. The redness is a normal inflammatory response to the injections and often subsides within hours. Swelling may persist for 1-2 days and can be managed with cold compresses. Bruising, while less common, can occur due to minor blood vessel damage during the injection process. It generally fades within 5-7 days. Patients are advised to avoid rubbing or massaging the treated area to prevent the toxin from spreading to unintended muscles. If these symptoms persist or worsen, patients should contact their healthcare provider for further evaluation.

Avoidance of Strenuous Activity and Heat Exposure: After receiving botulinum toxin injections for axillary hyperhidrosis, patients are advised to avoid strenuous physical activities and heat exposure for at least 24-48 hours. This precaution is crucial to prevent the toxin from spreading to unintended areas and to allow it to properly bind to the targeted sweat glands. Strenuous exercise can increase blood flow and muscle movement in the treated area, potentially diffusing the toxin. Similarly, heat exposure, such as hot showers, saunas, or sunbathing, can dilate blood vessels and increase sweating, which may affect the toxin’s distribution and efficacy. Patients are encouraged to maintain a cool, relaxed environment during this initial recovery period. Normal daily activities can usually be resumed after this time, but it’s advisable to gradually reintroduce more intense physical activities over the following week.

Potential Complications and Risks

Infection, Pain, and Hematoma Formation: While rare, infection, persistent pain, and hematoma formation are potential complications of botulinum toxin injections for axillary hyperhidrosis. Infection risk is minimized through proper sterile technique, but patients should monitor for signs such as increased redness, warmth, swelling, or discharge from injection sites. Prolonged pain beyond the initial discomfort of the procedure is uncommon but may indicate nerve irritation or an inflammatory response. Hematomas, or localized collections of blood under the skin, can occur if a blood vessel is accidentally punctured during injection. These typically go away on their own but may cause temporary discoloration or a palpable lump. Patients are advised to contact their healthcare provider if they experience severe pain, signs of infection, or large, expanding bruises. Proper aftercare, including keeping the area clean and dry, can significantly reduce these risks.

Rare Occurrences of Muscle Weakness and Compensatory Sweating: While generally safe, botulinum toxin injections for axillary hyperhidrosis can occasionally lead to rare side effects. Muscle weakness in the surrounding areas, though uncommon, can occur if the toxin spreads beyond the intended treatment site. This may result in temporary difficulty in arm movement or weakness in nearby muscles, typically resolving within a few weeks. Compensatory sweating, where increased sweating occurs in untreated areas of the body, is another rare but possible side effect. This phenomenon is thought to be the body’s attempt to regulate temperature when sweating is reduced in the treated axillary region. While usually mild, compensatory sweating can be bothersome for some patients. Both of these side effects are typically temporary and resolve as the effects of the botulinum toxin wear off.

Follow-Up and Retreatment

Assessing Treatment Response and Patient Satisfaction: Following botulinum toxin injections for axillary hyperhidrosis, healthcare providers conduct thorough follow-up assessments to evaluate treatment response and patient satisfaction. This typically occurs 2-4 weeks post-treatment, allowing sufficient time for the full effects of the toxin to manifest. During these follow-up appointments, providers use objective measures such as gravimetric sweat production tests or the Minor’s iodine-starch test to quantify the reduction in sweating. Equally important is the subjective assessment of patient satisfaction, often gauged through quality of life questionnaires or patient-reported outcome measures. These evaluations help determine the treatment’s success in addressing both the physical symptoms of hyperhidrosis and its impact on the patient’s daily life and emotional well-being.

Timing of Subsequent Injections (Minimum 16-Week Intervals): The timing of subsequent botulinum toxin injections for axillary hyperhidrosis is crucial for maintaining optimal results while minimizing the risk of antibody formation against the toxin. A minimum interval of 16 weeks between treatments is generally recommended. This timeframe allows for the full duration of the toxin’s effect, which typically lasts 4-6 months, and provides a buffer period before retreatment. The 16-week guideline also helps prevent the development of neutralizing antibodies that could reduce the effectiveness of future treatments. However, the exact timing may vary based on individual patient response and the gradual return of sweating symptoms. Some patients may require retreatment at around 6 months, while others might maintain results for up to a year. Healthcare providers work closely with patients to determine the most appropriate retreatment schedule based on symptom recurrence and patient preferences.

Frequently Asked Questions

How long does it take for botox to work on axillary hyperhidrosis?

You will usually begin to notice a reduction in sweating within 2-4 days after the treatment, with the maximum effect occurring around two weeks post-injection.

Is botox treatment for axillary hyperhidrosis painful?

The procedure involves multiple small injections and may cause minor discomfort. Most patients describe the sensation as a series of tiny pinpricks. Topical or local anesthetics can be used to enhance comfort during the procedure.

Can botox injections for axillary hyperhidrosis cause compensatory sweating in other areas?

While compensatory sweating is a rare occurrence, it is possible. This means that you might experience increased sweating in other body areas as a response to reduced sweating in the treated region.

How often do I need to repeat botox injections for axillary hyperhidrosis?

Typically, patients require repeat treatments every 4-12 months to maintain the results. The exact frequency depends on individual response and the duration of effectiveness.

Are there any long-term side effects of botox treatment for axillary hyperhidrosis?

Long-term side effects are rare but can include localized muscle weakness or allergic reactions. Most side effects are mild and temporary, subsiding as the toxin's effects wear off.

Can I use deodorant or antiperspirant after botox injections for axillary hyperhidrosis?

Yes, you can use deodorant or antiperspirant after the procedure. However, it is advised to avoid these products for at least 24 hours post-treatment to reduce the risk of irritation.

Is botox treatment for axillary hyperhidrosis covered by insurance?

Coverage for botox treatment varies by insurance provider and policy. It is best to check with your insurance company to determine whether this treatment is covered under your plan.

How much does botox treatment for axillary hyperhidrosis cost?

The cost of botox treatment for axillary hyperhidrosis can vary, typically ranging from $500 to $1000 per session. Prices depend on the clinic and the number of units required.


Botox injections offer a highly effective and non-invasive solution for managing axillary hyperhidrosis. Patients can expect significant reductions in underarm sweating, improving their quality of life and confidence. While minor side effects like redness, swelling, and rare occurrences of muscle weakness might occur, the overall safety profile of Botulinum toxin for this condition is well-documented. Regular follow-up and maintenance treatments ensure long-term benefits, making botox a viable and dependable option for those struggling with excessive underarm sweating. Always consult a healthcare provider for personalized advice and treatment plans adapted to your specific needs.

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de Almeida, A. R., & Montagner, S. (2014). Botulinum toxin for axillary hyperhidrosis.

Heckmann, M., Ceballos-Baumann, A. O., Plewig, G., & Hyperhidrosis Study Group (2001). Botulinum toxin A for axillary hyperhidrosis (excessive sweating).

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.