How Many Units of Botox Are Needed to Prevent Sweaty Palms?

Just the palms.

Doctor Answers 17

Botox units for sweaty palms: 100 units per palm

Treatment of sweaty palms takes more effort than something like treating the armpit, because the palms are very sensitive. Usually you have to do a local anesthesia, a so-called wrist block. Sometimes just cooling with ice may be ok as well.

Patients are most happy when they have their sweating reduced with just one treatment. In my experience 100 U Botox per palm is safe and has a good and lasting effect in just one go. The Canadian Hyperhidrosis Committee recommends 100-150 U per palm.

Mainz Dermatologic Surgeon

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Botox dosing for hyperhydrosis

You can always tell whether there is a definitive answer in medicine when everyone answers the same way. And if you get lots of different answers, you know that the jury is still out. A couple of years ago, I reviewed your question for my own needs. The bottom line is that the best starting dose is 50 units per palm.

Dilution was not critical, but most studies use either a 4 cc dilution or a 5 cc dilution. Any dose less than that, and you may suffer from incomplete resolution or compromised duration. I also appy a topical anesthetic cream to the area for a half an hour prior, which makes it quite tolerable.

The largest body of literature supports the numbers mentioned above. And as Dr Lupo notes, some patients may still need a little more but it is rare. And in fact has not happened in my practice thus far.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.5 out of 5 stars 10 reviews

Botox dosage for hands

I would recommend anywhere from 50-100 units per palm.  I take the following in consideration:

1)  Small hand (lower starting dose)

2)  Budget constraints (lower starting dose)

Ultimately with any Botox treatment (cosmetic, hyperhidrosis, migraines, etc.) you want to customize the treatment and set expectations.  Larger doses typically last longer than smaller doses, but there is a upper max to the longevity with the most one can expect is 6 months.  If a lower starting dose results in a shorter duration of relief, then I would recommend increasing the dose with the next treatment.

Count on 100 units per palm...the idea of starting with a small dose and working up

isn't something that's worthwhile in treating the fingers and palms...guaranteed you want an effective therapy with the least inconvenience...from the patient's perspective, once your on the treatment table, you don't want to return too often...especially in two weeks...using less than 100 units regularly results in incomplete effects and shorter duration of benefits...and some people actually need 150 units...good luck on your treatment

Ken Landow, MD
Las Vegas Dermatologist
5.0 out of 5 stars 8 reviews

Botox Dosing for Hyerhidrosis of the Palms

I have treated palmar hyperhidrosis for years and have written a book about the subject. I routinely inject 100 units per palm and make sure that I inject the thenar and hypothenar areas of the palms, the palms, the bases of the metatarsals, the fingers and pulps of the fingertips. Typical # of injections are 75-100 with a total of 100 units per palm. Any less is shown not to be effective and places the patient to return sooner for more intervention, i.e. more needlesticks ....

Botulinum toxin injections for sweaty palms

I recommend using 50 units per palm, and increasing the dose (or having a 'top-up') if that is not sufficiently effective for you. I recommend to new patients that they return for a review 2 weeks after the injections to assess whether the treatment dose has been sufficiently effective.

Because the hands and fingers are extremely sensitive I recommend having the procedure done with local anaesthetic nerve blocks performed by an experienced practitioner. In the hands of an experienced practitioner the nerve blocks provide excellent pain management for the injections and are safe and reliable.

Jill Tomlinson, MBBS, FRACS
Melbourne Plastic Surgeon

50 units per palm with Botox for hyperhidrosis

About 50 units of Botox is usually required per palm for effective control of excessive sweating.  I usually start with this, then see my patients back in 2 weeks for additional injections.  Since the sweat glands and our hand muscles are in close proximity, it is possible you may have some minor muscle weakness.  The fewer units used, the less likely this will happen.  I would recommend going to an experienced injector who can minimize these side effects.  The process takes about 10-15 minutes with minimal discomfort.

Most patients will notice an improvement in about 2-4 weeks. While results may vary, patients will notice at least 6-7 months of improvement. For my patients with severe hyperhidrosis that has impacted their lives significantly, this treatment is a life changer! My patients no longer have to worry about being embarrassed about shaking other people's hands, and they don't mind going out to meet new people.

Good luck!
-Dr. Margaret Mann

Margaret Mann, MD
Cleveland Dermatologic Surgeon
5.0 out of 5 stars 1 review

50 units of Botox to start with for each palm for excessive sweating

50-100 units per palm is a typical dosage for hyperhidrosis of palms. It is better to start with the lowest dose you need to achieve satisfactory relief from excess sweating to minimize expense but also to prevent any subtle effect on fine motor movements, which would be relevant for a violin or piano player.

William Ting, MD
Bay Area Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Sweaty palms treatment with Botox

The standard usage of Botox in sweaty palms is 50 units per palm, with a total of 100 units per patient. Very rarely would someone need more units.

The trick is to map the areas with more sweating & make sure they get enough of the medication. Results usually last 5-9 months.

Khaled El-Hoshy, MD
Detroit Dermatologic Surgeon

Botox for Palmar Hyperhidrosis

For palmar hyperhidrosis, I typically start with 50 units of Botox per hand. If that is not sufficient, then I add more after a week or so. 

For the average patient I have found 50 units to greatly reduce sweating with minimal risks.

Jason R. Lupton, MD
San Diego Dermatologist
4.5 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.