What is the maximum recommended Botox dose for palmar hyperhidrosis?

I typically use an average of 50 Units of Botox per hand for excessive sweating. Occasionally increased doses may be required. This is an advanced injection technique, and is different from injecting into the muscle. If you are not getting results after 100 Units per hand then I would make sure the injections are being delivered into the appropriate layer. Best wishes.

Based on our experience 50 units per hand is more than enough to improve hyperhidrosis. Adding more should not much of a difference with the duration of the effects of the Botox. After a certain point it won’t make much of a difference.

Thank you for your question princesssnow. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.Excessive sweating, a condition known as hyperhidrosis can be a serious concern for some people. Excessive sweating can occur even when it is not hot. It sometimes occurs when a person is nervous. This can become very embarrassing for a person, especially when it happens frequently. The most common areas of concern include the underarms, palms of the hands, and soles of the feet. Fortunately, Botox is an easy and effective treatment for excessive sweating. These areas are more sensitive and therefore numbing cream is usually applied on the area for about 15 minutes prior to the treatment. To determine exactly where the sweat glands are, sometimes a test is performed called the starch iodine test. Iodine is placed on the area of the skin which will be treated. The areas with more sweat glands will appear dark. This allows the provider to know exactly where to place the product. Despite this, typically the entire area is treated and the product is placed to cover the entire area. Usually 50 units of Botox are used on each side. Some people enjoy their results for six months or more. Similar to when Botox is used for cosmetic purposes, periodic maintenance treatments are required.
In rare cases, some people are resistant to a certain neuromodulator such as Botox. In this case the treatment can be repeated using a different neuromodulator such as Dysport or Xeomin.
If I had a patient with the concern described here I would recommend trying a different neuromodulator such as Dysport or Xeomin rather than further increasing the dose. A dose of 100 units per hand should provide improvement for at least three months.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

Thank you for your inquiry. In my experience 50 units of Botox per hand is enough to achieve the desired result. In rare case more might be necessary but I would not keep increasing the dose to 100 units or 150 units. See a qualified cosmetic doctor and consider getting a second opinion during a consultation to determine your next steps.
Best Regards, Dr. Bector 

The amount of Botox that is required for treating hyperhidrosis of the hands should not generally speaking exceed more than 50 units per hand. Injecting more Botox than that will result in some muscle issues and weakness of the hand.

While some people use 50u of Botox per hand/palm, I believe 100u of Botox to be the optimal dose in most(e.g. 85-90%) patients. That said, I'd say maybe 10-15% of my patients benefit from 150u per palm, and very rarely 200u per palm.

Highest dose I have used is 150 units per palm. But I find that it can cause weakness in the fingers for a week or two. I have had situations where the  Botox wears off sooner than expected. I strongly further medical testing to see if there are any other causes of hyperhidrosis. 

There are several possibilities to explain your rapid wearing off of the Botox.  One is that you need more.  Another is that you work out a lot and often, and therefore neurotoxins break down faster.  Another is that your body is reacting to the protein of the bovine serum attached to Botox's active portion..... which has been the case with more than a dozen patients of mine over the years...and in all those patients, injections with "purified Botox," aka Xeomin, has been effective at working better and lasting longer than the Botox.

The amount of Botox that is required for treating hyperhidrosis of the hands should not generally speaking exceed more than 50 units per hand. Injecting more Botox than that will result in some muscle issues and weakness of the hand. Good luck from New York City