How Much Botox is Safe to Use in One Appointment?

I have finally saved up enough money for treatment of my hyperhidosis. I will be getting treatment for my underarms. I am also considering getting my forehead done at the same time. My question is getting this large amount, is it safe? Thank you for your time.

Doctor Answers 12

Botox safety

You should have no safety concerns about this. Usually, 50 units is placed into each axilla (arm-pit) and 6-15 units in the forehead. This is well below the 2500-3000 units, which is said to be a toxic dose.

I am curious, however, that you are saving up money for the procedure. Most insurance companies do cover BOTOX. They would like another treatment modality be attempted first for the control of hyperhidrosis.

Usually, this means a trial with medical grade aluminum chloride or an anti-cholinergic medication. Then they give approval and pay for the Botox and its administration. You would have to pay for the forehead treatment unless you have hyperhidrosis in this area.

Good luck and I hope I save you some money.

Virginia Beach Dermatologist
4.7 out of 5 stars 14 reviews

Botox dose = upper limit, toxic dose

Typical Botox injected is 2 or 3 bottles if large areas are treated for hyperhidrosis. To give you an idea, it means 200 - 300 units. The toxic dose would be 30 bottles. No one in their right mind would inject that amount and it is unnecessary, impractical, and very costly.

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

Botox quantity for injection often not toxic

The quantity of Botox for hyperhidrosis is highly variable and dependent on the type and severity of the hyperhidrosis, the area of the treatment region, and the past experience with Botox.

The quantity necessary for Botox injection are not enough to cause complications or toxicity to a patient. However, the injection amount should be titrated to the area in order to minimize the cost and the overall amount of Botox used.

In some patients, requiring increased amounts of Botox compared to norms, Myobloc may be an alternative.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

One Botox session for underarms and forehead is safe

For the average sized person, the toxic dose of Botox is 2500-3000 units. The typical dose of Botox for the underarms is 50 units per side, and that of the forehead is about 15 units. So to answer your question, yes, I believe it is safe.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Dose of Botox

Doses that we use in cosmetic medicine for Botox are dwarfed by other on-label, FDA indications that use 400 units at a time. 

Botulinum toxin was first isolated in the 20s, was first used therapeutically in 1968, and became approved in 1989 for eye issues. It has been used heavily for cosmetic use since 2002, and it was the first aesthetic drug ever approved.  All that is to has a lot of safety data behind it. Recent evidence (coming out this week) proves that botulinum toxin does NOT enter your brain as it's distant cousin tetanus toxin does, which is where that theory came from. 

Botox, Dysport and Xeomin are the 3 botulinum toxins approved for cosmetic use in the US. They all work in the same way, at the presynaptic terminal blocking the release of acetylcholine - making the nerve temporarily unable to communicate with the muscle. It is broken down as a protein in our body with liver metabolism. Effects are temporary, and repeated use serves to take tension off of your skin, relaxing lines and wrinkles.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.

Cameron Chesnut

#realself500 Physician

Cameron Chesnut, MD, FAAD, FACMS
Spokane Dermatologic Surgeon
4.9 out of 5 stars 105 reviews

Botox for hyperhydrosis

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. 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.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 38 reviews

Botox is safe

The typical dosage for treating underarm hyperhidrosis is 100 units per side.  The average number of units to treat the forehead is 10.  You can very safely use this amount of Botox in one appointment. 

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 22 reviews

Botox to each armpit

I usually place about 50 units in each armpit. This is well under the toxic dose at any one time.  I would't worry too much.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Are high doses of Botox safe?

As the other panel members stated, your concerns (although appropriate) should be relieved in knowing that it would take much more Botox than what you are contemplating to cause concern.  Botox is routinely administered in much higher doses for medicinal purposes.

Being that you are making a large financial investment in treating hyperhidrosis (sweaty underarms) with Botox, you may want to have the forehead treated first if you need reassurance about your reaction to Botox.  Other than needing peace of mind and reassurance, your combined treatment is not unusual and is considered safe.

See the link below for further information on the use of Botox for hyperhidrosis.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

200 units is safe

Typical cosmetic uses of Botox Cosmetic uses 50 to 100 units. However, it is safe to use more Botox per session. You will be fine if you receive 200 units of Botox. We often use even more Botox for non-cosmetic (medical) conditions without any problems. Good luck with your injections.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 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.