Botox for Hyperhidrosis - Didn't Work for Me 3 Times. Why?

I think most people respond very well to Botox, but not everyone responds the same way.  I am assuming that you had a good treatment with:1) the Botox placed in the area of the densest sweat production (starch-iodine test helps with this component)2) enough units of Botox (usually about 50 units per side)3) Botox placed into the right plane (subdermal)The other thing to consider is whether botox reduced, but did not eliminate your sweating.  Finally, I agree with the other physicians - consider miraDry as an alternative.  This typically reduces sweat by greater than 80%, but will not completely eliminate your ability to sweat.

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.

If Botox doesn't work for you try miraDry. MiraDry is a clinically proven and safe FDA-approved solution for significantly reducing underarm sweat. It’s an outpatient procedure performed in your physician’s office. It is not surgery so doesn’t involve surgical incisions. miraDry delivers controlled electromagnetic energy to the arm pit, eliminating the underarm sweat (eccrine) glands.Two procedures are typically recommended. Each occurs approximately three months apart for best results.Other  surgical options involve superficial liposuction or excision of sweat gland skin poses additional risks and leave scars.

If you have had a treatment failure, you likely did not have enough Botox injected.  You say that you had 40 units injected total.  To have a positive effect, you likely need at least 50 units injected per side for a total of 100 units.  

 

Good Luck.

There are surgical options for hyperhiudrosis that invoive severing the sympathetic nerves thar stimulate the production of sweat.

Botox is injected superficially and about 50 units per axilla (undearm). After the treatment, a starch iodine test can reveal the persistent areas that still produce sweat and these areas can be retreated. If none of the areas respond, then there truly is something unique about your metabolism and sweat production. You should then see a board certified dermatologist.

I'm not sure why you didn't get any response to underarm Botox. Just about everyone I've treated loves the result that tends to last up to 6 mos.

Check with your doctor how many units of Botox you received. I use a total of 100units for both underarms.

If other deodorants are not helpful, try a salt-stick (Potassium alum). These are available at Whole Foods. After you shower, you apply the salt stick and this kills most odor causing bacteria.

I hope this is helpful for you.

Hi Aud,

I know, it's the pits!  Botox is usually very effective at treating hyperhidrosis.  Hopefully you have gone to three different physicians, in which case you may be resistant.  If you have been to the same physician, then I would question the technique and the dosage of Botox units used.  You should get 50 units into each arm pit.  In the meantime, buy a few bars of Irish Spring soap, for that strong stench that other soaps can't touch.  Good luck and be well.

Dr. P

I do not inject Botox or Dysport for sweating, but I have a lot of experience with both for wrinkle reduction. There are some people who do not respond to Botox. The first thing to check is if everyone who was treated with the vial used is having the same problem. If so the problem is with the vial not the patient. 

If everyone else who was treated with the same vial has good results, then the problem may be with resistance in the patient. Some patient require higher doses, and retreatment at a higher dose may be helpful.

I have had a few patients though the years who do not respond to Botox at any (reasonable) dose. When Dysport was approved, I invited them to the office for a trial. So far, every resistant patient who has tried the Dysport has responded favorably at normal Dysport doses.

Botox is processed so that all the molecules are the same size. Dysport has a variation in size. Perhaps this explains why some patients have no response with Botox, but respond normally to Dysport. For the average patient, Botox and Dysport seem fairly equivalent. Some individuals have better results with one over the other, but most get similar results with both. Both are extremely effective for the vast majority of patients.

You may be one of those individuals who are resistant to Botox. At this time only Botox is approved for sweating, and I have no experience I can share in this area. I can't recommend the off label use of Dysport for sweating; however, it may be worth asking around if any trials are ongoing in your area.

Three strikes and you are out.  Cellulaze Sidelaze will treat hyperhydrosis in one treatment with immediate results, mild swelling and discomfort.

Please consult in person with a Board Certified Plastic Surgeon prior to making any treatment decisions.