Botox for Hyperhidrosis - Worked Just for 2 Weeks. Normal?

I had botox injected 3 weeks ago and at first it looked very promising. 2-3 days after injection sweating was minimal but it did not last long. Increased perspiration was clearly visible after 2 weeks and after 3 weeks sweating is so excessive as if i did not have any botox. I was full of hope and now I am devastated. Why it did not work? Should I do it once again? Thank you in advance for your advice. Maggie

Doctor Answers 23

Botox for hyperhidrosis is normally very effective

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Botox for excessive underarm sweating is normally very effective. Most of my patients have a success rate of over a year of effectiveness, and some even 18 months. I am unsure how many units were injected, what the dilution ratio was, and where the injections were placed. All of this largely determines the effectiveness of Botox for underarm sweating. I would suggest at minimum, you see your injector for an evaluation and discussion.

Failure rates seen with BOTOX for underarm sweating

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Yes, having performed this procedure for well over a decade, I have come across this several time. The fact is this- BOTOX works for 96% of patients, unfortunately you fall in the 4% that it fails. There are many reasons for this including anti-bodies, medication interactions, stress factors etc... 

Options you have-

1. Ensure correct dose of BOTOX was administered for underarm sweating 100 units
2. Ensure correct area treated- starch iodine
3. Re treat the middle of the armpit or areas guided by starch iodine. 
4. Investigate for other causes- rare disorders, meds., stress, thyroid etc...
5. Consider miraDry or liposuction of sweat glands.
6. Consider CBT if stress is a problem. 
7. ETS as last resort. 

Video below shows how BOTOX should be administered to sweaty underarms. 

All the best

Dr Davin Lim
Laser and aesthetic dermatologist
BRISBANE, Australia. 

Botox for excessive sweating

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There are no cookie cutter answers. I have coauthored a book on hyperhidrosis and have seen patients with resistance to Botox. I would suggest an alternate neurotoxin. 

Dr. Karamanoukian 
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Botox for hyperhydrosis

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Thank you for your question. Botox is a very effective treatment for hyperhidrosis (armpit, hands, feet, scalp/face, etc). The dosing is typically based on areas treated but can vary around 50 - 100 units per side depending on how large the treatment area. Duration also depends on dose and technique, but can vary from 3-6 months. It would helpful to know what dosage was used and actually observe the technique.  I often find that injecting at the wrong depth can cause most of the botox  to go deeper than the sweat glands. For the armpit region, you may also want to consider miraDry as it provides a longer lasting relief and in the long run is more cost-effective.

Try miradry instead

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Our office specializes in Miraday. Miradry just got FDA clearance for elimination of all hair colors under the arm. It also has clearance for the elimination of underarm sweating and odor.  Much cheaper than botox and permanent.

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Botox for Hyperhidrosis - Worked Just for 2 Weeks. Normal?

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Its best to follow-up with your provider, he/she would know how many units were applied and the dilution. You may have been under dosed and would require more units

Usually lasts 4-7 months.

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i have had very good results using botox. it is unusual for it to last such as short period of time. ask your dr about the number of units injected per side.

i would suggest you see a plastic surgeon who is using the cellulaze laser by cynosure for treating axillary hyperhidrosis. it is a 30 minute procedure that only requires one very tiny incision per armpit and you can return to work the next day. results can last for years and may be permanent (as far as i know there are no follow ups beyond 3 years yet). this will be more expensive than botox but will not need to be redone, possible ever.

david berman md

plastic surgeon, northern va

Botox For Hyperhidrosis

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Typically results last between 3-6 months for hyperhidrosis and in some cases longer.  You should speak with your injector to see how many units were used and what dilution.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 179 reviews

Botox for Excessive Sweating

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Botox is generally a great option for patients living with hyperhidrosis. Without knowing the amount of Botox that was injected, it is hard to say exactly why your results did not last. The number of units injected and placement of the injection may be the cause of your short-term results. I would suggest you seek treatment from an expert Botox injector to ensure optimal results.

Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 26 reviews

Botox for hyperhidrosis-underarms

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Hi Maggie! While I haven't had this experience with my patients, I have heard of this happening. It is likely that your Dr was conservative in the units of Botox used and more may be necessary. Dilution of Botox is also an important component. When done to full correction, it is a great option for this problem. I wish you best of luck in resolving your problem! - Dr. Boris

George T. Boris, MD, FRCS - Account Suspended
Los Angeles Facial Plastic Surgeon

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.