Is it uncommon for botox for hyperhidrosis to not work the first time?

Botox is a very effective treatment in those areas and can provide months of relief.  Too little may have been injected or areas may not have been treated.Kenneth Hughes, MDBeverly Hills, CA

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.

I am a national expert on hyperhidrosis and have co-written a book on the subject. There are many alternatives to hyperhidrosis treatment and an examination and discussion is a good first step. Best, Dr. Karamanoukian Los Angeles

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.  Better and cheaper than botox.

Thank you for your question. I am sorry to hear that you are currently disappointed with your Botox treatment. Botox definitely works on a spectrum for people, some are incredibly sensitive and require low dosing, while others are more resistant and require higher dosing, or changing to one of the other muscle blocking agents.  It does sound as if you received some improvement, speak to your dermatologist about your options.

Botox is great for hyperhydrosis but in some patients, especially with severe sweating, more of the product is needed. Also, it needs to be precisely injected in the areas that sweat and not in the areas that do not sweat. Freshly reconstituted Botox works so please see your doctor and see if this can be fixed.I hope that helps

You should consider waiting 6 months, so the sweating goes to baseline, then trying Botox again with another physician.  It might be the way your doctor injected it.  If it happens with another doctor, then it's more your biology that is resistant to Botox.

The main question to ask is what amount was used for the reatment. The more sweat you have, the higher the amount of botox is needed. I often use 200 units per session to get the best results that are long lasting. ·      
Studies have shown that the duration
of the effect is usually six to eight months, with 25% of patients achieving reduction of sweating
for over one year. 91% of Botox patients achieve at
least a 50% reduction in axillary sweating, measured 4 weeks post injection. 














Occasionally, in a very small number of people, the injection does not
work as satisfactorily or for as long as expected. In some cases, there
is no improvement and another form of treatment may be required (1-2% do not
respond at all). Over time, some patients (3-5%) may develop resistance to
repeated uses of toxin injection or the effect may not last as long as previous
treatments. 

A great question.  I can only speak from my own experience as an injector of Botox for hyperhidrosis patients.  I have had a few patients where the sweating has reduced somewhat after 50U of Botox on each axilla (arm pit area).  But then needed more.  A carefully planned approach to the remaining excessive sweat areas by using a simple starch test or even just observation, could help direct perhaps another 25 units into each side.  That's what I've done with some success in my own practice in Modesto California where it does get over 100 degrees F in the summers.  I think that 1 in 5 of my patients would benefit from a higher amount.  I've also worked with excessive sweating in the palms/feet which can be a lot higher in dose.You've shown that it works with the reduction you noticed, and now it just needs more - probably because everyone is different.  And perhaps if you had to wait 6 months - it might work even better because I think there would be some overlap.My practice doesn't accept insurances, so I totally understand that the cost can be a concern.  But many of my patients think that it is "a new lease on life" as some of my patients claim.Thank you for your question.
Without having seen you in person, I'm answering the best I can without
physical examination info. My comments
are meant for a general public discussion to help others who may have similar
concerns. I'm also using my answers to
build up library of information for my own patients and also to see how my
answers compare with other doctors.
There is always much for us to learn from each other. My answers are generalized medical
information only, not directed medical advice.
For medical advice please see your doctor/surgeon in person.I hope my own experience as an injector helps.Calvin Lee, MDModesto, California

Most patients respond to the recommended dose of 50 units per underarm; however, some require more.  Trying more Botox would be a reasonable next step.  However, your physician is right that it may be difficult to get covered.  It is not impossible, though,and it is worth a try.