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How Many Units of Botox for Hyperhidrosis?

Botox works well for hyperhidrosis, however dosages vary by area and condition.

Botox works well for hyperhidrosis, however dosages vary by area and condition.


Hyperhidrosis, or excessive sweating, affects millions of people worldwide. It can cause significant discomfort and social anxiety, impacting a person’s quality of life. While various treatments are available, Botox (Botulinum toxin type A) has emerged as a highly effective option for managing this condition. Understanding the appropriate number of Botox units required for hyperhidrosis treatment is crucial for achieving optimal results while minimizing potential side effects.

Understanding Hyperhidrosis

Hyperhidrosis can be primary or secondary. Primary hyperhidrosis is idiopathic, meaning its exact cause is unknown, but it typically begins in adolescence or early adulthood. It most commonly affects the axillae (underarms), palms, soles, and face. Secondary hyperhidrosis is usually due to an underlying medical condition or medication and can occur in various body parts.

Botox: Mechanism of Action

Botox, derived from Clostridium botulinum, works by blocking the release of acetylcholine, a neurotransmitter responsible for activating sweat glands. By inhibiting acetylcholine, Botox effectively reduces the activity of these glands, thereby decreasing excessive sweating.

Determining the Number of Units

The dosage of Botox for hyperhidrosis treatment varies depending on the area being treated, the severity of the condition, and individual patient factors. Here, we will explore the typical dosages for different treatment areas and the factors influencing these dosages.

Axillary Hyperhidrosis (Underarm)

The most common area treated with Botox for hyperhidrosis is the axillae. The FDA has approved Botox for this indication, and it has become a standard treatment option.

  1. Typical Dosage: The standard dose for treating both underarms is typically 50 units per axilla, totaling 100 units.
  2. Injection Sites: The Botox is injected into approximately 10 to 15 sites per axilla, spaced about 1 to 2 centimeters apart. This ensures even distribution and effective coverage of the entire sweat-producing area.
  3. Procedure: The treatment is relatively quick, usually taking about 10 to 15 minutes per underarm. A topical anesthetic may be applied beforehand to reduce discomfort.

Palmar Hyperhidrosis (Hands)

Treating palmar hyperhidrosis is more challenging due to the sensitivity of the hands and the need for precise injections.

  1. Typical Dosage: For the palms, the usual dose ranges from 50 to 100 units per hand.
  2. Injection Sites: Multiple injections (around 20 to 30) are administered in a grid pattern across the palm. This thorough approach ensures that the entire surface area is treated.
  3. Procedure: The injections can be painful, so a nerve block or topical anesthetic is often used to minimize discomfort.

Plantar Hyperhidrosis (Feet)

Plantar hyperhidrosis involves excessive sweating of the feet, which can be particularly troublesome for patients.

  1. Typical Dosage: The dosage for each foot ranges from 50 to 100 units.
  2. Injection Sites: Similar to the palms, multiple injections (around 20 to 30) are distributed across the sole of the foot.
  3. Procedure: Due to the sensitivity of the feet, a nerve block or anesthetic cream is recommended to alleviate pain during the procedure.

Factors Influencing Dosage

Several factors can influence the exact number of Botox units required for effective hyperhidrosis treatment:

  1. The severity of Hyperhidrosis: Patients with more severe sweating may require higher doses to achieve the desired reduction in sweat production.
  2. Treatment Area Size: Larger areas may need more units to cover the entire surface adequately.
  3. Individual Variation: Factors such as skin thickness, muscle mass, and personal response to Botox can affect the dosage.
  4. Previous Treatments: Patients who have undergone previous Botox treatments may develop varying degrees of resistance or response, necessitating dosage adjustments.

Injection Technique and Safety Considerations

Proper injection technique is critical for both the efficacy and safety of Botox treatments for hyperhidrosis. Administering the injections correctly ensures optimal results and minimizes the risk of side effects.

Injection Technique

  1. Grid Pattern: A grid pattern of injection sites is commonly used to ensure even distribution. Each site receives a small amount of Botox, effectively covering the entire treatment area.
  2. Intracutaneous Injections: Botox injections are typically administered intracutaneously (just below the skin surface) rather than intramuscularly for hyperhidrosis. This more directly targets the sweat glands.

Safety Considerations

  1. Qualified Practitioners: Only trained and experienced practitioners should perform Botox injections for hyperhidrosis to ensure safe and effective results.
  2. Pre-Treatment Assessment: A thorough medical history and assessment should be conducted to identify any contraindications or potential risks.
  3. Post-Treatment Care: Patients should follow post-treatment care instructions, such as avoiding strenuous activities and heat exposure for 24 hours, to ensure the Botox is properly absorbed and to reduce the risk of complications.

Patient Experience and Expectations

Understanding what to expect before, during, and after the procedure can help patients feel more comfortable and prepared.

Before the Procedure

Patients should:

  1. Avoid Blood Thinners: To minimize bruising, avoid taking aspirin, ibuprofen, and other blood-thinning medications for a few days before the procedure.
  2. Shave the Treatment Area: Patients should shave the area 24 hours before the procedure if treating the underarms to reduce the risk of infection.

During the Procedure

Patients can expect:

  1. Minimal Discomfort: While injections can be slightly uncomfortable, the use of topical anesthetics or nerve blocks can significantly reduce pain.
  2. Quick Procedure: The treatment typically takes less than 30 minutes, making it convenient for most patients.

After the Procedure

Patients should:

  1. Avoid Strenuous Activity: For 24 hours after treatment, refrain from intense physical activity and exposure to heat (such as saunas or hot showers).
  2. Monitor for Side Effects: Watch for any unusual side effects, such as muscle weakness or difficulty breathing, and contact the practitioner if these occur.

Onset and Duration of Results

It usually takes a few days to a week for the effects of hyperhidrosis treatment with Botox to become noticeable. Full effects usually show up within two weeks, and patients typically notice a considerable decrease in sweating.

Duration of Effect

The results of Botox treatment for hyperhidrosis generally last 4 to 6 months. Over time, the effects gradually diminish as the body metabolizes the toxin, and repeat treatments are necessary to maintain the reduction in sweating. Some patients may find that the duration of the effect extends with repeated treatments.

Potential Side Effects and Risks

Hyperhidrosis treatment with Botox is generally safe, but there are a few risks and side effects to be aware of:

  1. Pain and Bruising: Mild pain and bruising at the injection sites are common but typically resolve within a few days.
  2. Muscle Weakness: Due to the proximity of the injections to muscles, temporary muscle weakness can occur, especially with palmar and plantar hyperhidrosis.
  3. Allergic Reactions: Rarely, patients may experience an allergic reaction, including symptoms such as itching, rash, or difficulty breathing.
  4. Compensatory Sweating: Some patients may experience increased sweating in other areas of the body as a compensatory response.

Maximizing Treatment Success

To ensure the best outcomes, both patients and practitioners should adhere to the following guidelines:

For Practitioners

  1. Thorough Consultation: Assess the patient’s medical history, severity of hyperhidrosis, and treatment goals. Discuss potential risks and set realistic expectations.
  2. Precision in Injection: Use the appropriate dosage and technique for each individual. Ensure injections are placed correctly to target the intended areas.
  3. Continuing Education: Stay updated on the latest Botox techniques and safety protocols.

For Patients

  1. Choose a Qualified Provider: Select a practitioner with extensive experience in administering Botox for hyperhidrosis.
  2. Follow Pre- and Post-Treatment Instructions: Adhere to guidelines provided by the practitioner to minimize side effects and optimize results.
  3. Communicate Concerns and Preferences: Clearly express desired outcomes and any concerns to the practitioner during the consultation.


Botox is a highly effective treatment for managing hyperhidrosis, with typical dosages varying depending on the treatment area and individual patient factors. For axillary hyperhidrosis, the standard dosage is usually 50 units per underarm, while palmar and plantar hyperhidrosis may require 50 to 100 units per hand or foot. Proper injection technique and a thorough understanding of the patient’s condition are crucial for achieving safe and effective results. By following best practices and maintaining clear communication between patient and practitioner, Botox can significantly improve the quality of life for those suffering from excessive sweating, providing relief and increased confidence.

The Dentox training program for medical and aesthetic professionals teaches injecting Botox in a safe, effective, and waste-minimizing manner. Contact Dr. Howard Katz if you want to know more about Dentox programs. There are also seminars that you may attend in person at several venues around the US, as well as live online or on-demand courses. Visit to access Botox training courses online, and visit to access live courses with actual patients.


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