How Many Units of Botox Are Needed to Prevent Sweaty Palms?

Just the palms.

Doctor Answers 20

Botox units for sweaty palms: 100 units per palm

Treatment of sweaty palms takes more effort than something like treating the armpit, because the palms are very sensitive. Usually you have to do a local anesthesia, a so-called wrist block. Sometimes just cooling with ice may be ok as well.

Patients are most happy when they have their sweating reduced with just one treatment. In my experience 100 U Botox per palm is safe and has a good and lasting effect in just one go. The Canadian Hyperhidrosis Committee recommends 100-150 U per palm.

Mainz Dermatologic Surgeon

Botox dosing for hyperhydrosis

You can always tell whether there is a definitive answer in medicine when everyone answers the same way. And if you get lots of different answers, you know that the jury is still out. A couple of years ago, I reviewed your question for my own needs. The bottom line is that the best starting dose is 50 units per palm.

Dilution was not critical, but most studies use either a 4 cc dilution or a 5 cc dilution. Any dose less than that, and you may suffer from incomplete resolution or compromised duration. I also appy a topical anesthetic cream to the area for a half an hour prior, which makes it quite tolerable.

The largest body of literature supports the numbers mentioned above. And as Dr Lupo notes, some patients may still need a little more but it is rare. And in fact has not happened in my practice thus far.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 14 reviews

BOTOX sweaty palms vs sweaty underarms.

Traditionally we place 100 units into each palm under nerve blocks. This is double the amount of BOTOX it takes to treat sweaty underarms.

Dr Steve Weiner has invented a way of delivering less units with less pain. He is a reputable plastic surgeon in the US. His publication will be out shortly. *Dr Weiner is on this forum. 

All the best

Dr Davin Lim 
Laser Dermatologist, Aesthetic Dermatologist
Brisbane, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Hyperhidrosis and the palms

Botox injections can be applied to the palms for hyperhidrosis. The amount needed depends on a careful mapping of your 'hyperhidrosis hotspots' and the severity of your problem. I usually inject between 50 and 150 units per hand. 

Dr. Karamanoukian 
Los Angeles

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


Using botox for palmar hyperhidrosis is an effective way to decrease sweating. The botox prevents the nerves from telling the sweat glands to secrete sweat.
Each palm will need 50 to 100 units depending on the size. The cost depends on the cost per unit in each office. Botox ranges from 10-15 dollars per unit in my area.

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

Botox dosage for hands

I would recommend anywhere from 50-100 units per palm.  I take the following in consideration:

1)  Small hand (lower starting dose)

2)  Budget constraints (lower starting dose)

Ultimately with any Botox treatment (cosmetic, hyperhidrosis, migraines, etc.) you want to customize the treatment and set expectations.  Larger doses typically last longer than smaller doses, but there is a upper max to the longevity with the most one can expect is 6 months.  If a lower starting dose results in a shorter duration of relief, then I would recommend increasing the dose with the next treatment.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 37 reviews

Count on 100 units per palm...the idea of starting with a small dose and working up

isn't something that's worthwhile in treating the fingers and palms...guaranteed you want an effective therapy with the least inconvenience...from the patient's perspective, once your on the treatment table, you don't want to return too often...especially in two weeks...using less than 100 units regularly results in incomplete effects and shorter duration of benefits...and some people actually need 150 units...good luck on your treatment

Ken Landow, MD
Las Vegas Dermatologist
4.6 out of 5 stars 9 reviews

Botox Dosing for Hyerhidrosis of the Palms

I have treated palmar hyperhidrosis for years and have written a book about the subject. I routinely inject 100 units per palm and make sure that I inject the thenar and hypothenar areas of the palms, the palms, the bases of the metatarsals, the fingers and pulps of the fingertips. Typical # of injections are 75-100 with a total of 100 units per palm. Any less is shown not to be effective and places the patient to return sooner for more intervention, i.e. more needlesticks ....

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

Botulinum toxin injections for sweaty palms

I recommend using 50 units per palm, and increasing the dose (or having a 'top-up') if that is not sufficiently effective for you. I recommend to new patients that they return for a review 2 weeks after the injections to assess whether the treatment dose has been sufficiently effective.

Because the hands and fingers are extremely sensitive I recommend having the procedure done with local anaesthetic nerve blocks performed by an experienced practitioner. In the hands of an experienced practitioner the nerve blocks provide excellent pain management for the injections and are safe and reliable.

Jill Tomlinson, MBBS, FRACS
Melbourne Plastic Surgeon

50 units per palm with Botox for hyperhidrosis

About 50 units of Botox is usually required per palm for effective control of excessive sweating.  I usually start with this, then see my patients back in 2 weeks for additional injections.  Since the sweat glands and our hand muscles are in close proximity, it is possible you may have some minor muscle weakness.  The fewer units used, the less likely this will happen.  I would recommend going to an experienced injector who can minimize these side effects.  The process takes about 10-15 minutes with minimal discomfort.

Most patients will notice an improvement in about 2-4 weeks. While results may vary, patients will notice at least 6-7 months of improvement. For my patients with severe hyperhidrosis that has impacted their lives significantly, this treatment is a life changer! My patients no longer have to worry about being embarrassed about shaking other people's hands, and they don't mind going out to meet new people.

Good luck!
-Dr. Margaret Mann

Margaret Mann, MD
Cleveland Dermatologic Surgeon
5.0 out of 5 stars 1 review

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.