Safety and Risks Costs and Availability Alternative Treatments The Final Takeaway
There’s a reason Botox has long been the darling of injectables: It has quite the track record as the first FDA-approved botulinum toxin injectable, inhibiting muscle movement to treat fine lines and wrinkles, among other benefits. In fact, Botox is so good at what it does that we tend to use the brand name to describe an entire category of injectable neuromodulators.
But there’s another reason why Botox is so beloved: While other neuromodulators on the market tend to focus more exclusively on aesthetic treatments, Botox is also used to temporarily treat a handful of physical issues like neck spasms and pain, overactive bladders, teeth grinding and TMJ, migraines, and excessive sweating.
And when it comes to the latter, Botox is a particularly effective treatment option—in fact, it’s widely considered one of the best ways to treat excessive sweating in the armpits. But how exactly does it work? And why is it hailed as a sweat-wicking miracle worker? Read on for everything you need to know about underarm Botox, according to the experts.
What Is Underarm Botox?
Underarm Botox is exactly what it sounds like: Botox injected in the underarm area. According to Dr. Smithee, the treatment is meant to address hyperhidrosis (a very scientific word for excessive sweating) by modulating the activity of nerves in the skin that normally trigger the sweating response. The ideal candidate, per Dr. Greco, is someone who sweats excessively from the underarm area and hasn't gotten the appropriate relief from antiperspirants, either over-the-counter or prescription strength. To give a bit of perspective on just how excessive that sweating can be, Dr. Greco points to reports that claim up to 70% of patients who suffer from severe hyperhydrosis change their clothing twice a day due to sweating in the armpit region—so we're not talking about the occasional sweat stain.
Efficacy and Benefits of Underarm Botox
Our experts all agree the foremost benefit of underarm Botox is a marked reduction in sweating. But with that comes a slew of other benefits, like improved quality of life and increased self-confidence.
The effectiveness of underarm Botox really can't be overstated. According to Dr. Greco, Botox treatments have been shown to reduce sweating in greater than 85% to 94% of patients who deal with hyperhidrosis, while Dr. Smithee says most patients report an 80% to 90% reduction in sweating post-treatment. In fact, one 2020 study found a 90% decrease in sweat production just two weeks after Botox injections.
Procedure and Injections
It goes without saying (but bears repeating) that Botox should always be administered by a licensed healthcare provider. This particular treatment consists of a series of injections in the dermis spaced evenly throughout the underarm. Both Dr. Smithee and Dr. Greco say a typical dose is around 50 units of Botox per underarm, for a total of around 100 units to treat both sides. That being said, treatment doses may vary based on the effectiveness of that initial treatment. Patients may experience slight discomfort with the injections—Dr. Greco notes that topical anesthetics may be applied to make the procedure more comfortable for patients—but in general, the treatment tends to be well tolerated. Perhaps best of all, it only takes a few minutes to perform.
Results and Timeline
Dr. Greco says it takes an average of four to seven days to see results post-treatment, though Dr. Smithee tells patients to wait two weeks for full results to kick in (with the caveat that they may notice improvement before then).
And once those effects kick in, they last quite a while. Unlike cosmetic uses of Botox in the face, Botox treatments for hyperhidrosis tend to last longer, around seven months according to Dr. Greco, though studies have shown efficacy for up to one year. That being said, results will vary from person to person.
Dr. Greco suggests patients track their efficacy by monitoring sweat reduction as well as the return of their symptoms. Then, they can work with a doctor to figure out a treatment plan that effectively keeps their hyperhidrosis symptoms at bay. Generally, he says patients may need a secondary treatment between six to 12 months post-procedure.
Safety and Risks
Botox is generally considered a very safe procedure with minimal risk, but there is always the potential for side effects and risks. The most frequent risks, according to Dr. Smithee, are redness, irritation, bruising, and mild pain at injection sites. In extremely rare cases of systemic side effects, patients may experience difficulty swallowing or breathing—Dr. Greco says he's never seen this before, though he does alert patients to watch out for any potential symptoms.
Costs and Availability
According to Dr. Smithee, some insurance plans actually offer coverage for the procedure, but patients should check with their carrier before proceeding. When an insurance carrier does offer coverage, they normally require pre-authorization and documentation that the patient has tried alternate options first, such as topical medication.
If their plan doesn't cover the treatment, patients would have to pay out of pocket for the current price per unit of Botox. Dr. Smithee estimates it could end up costing around $1,200 to $1,400 depending on how many units are used for the treatment, while Dr. Greco estimates somewhere between $1,000 and $2,000 per treatment.
Alternative Treatments
It's important to remember that injections aren't the only treatment option when it comes to managing hyperhidrosis symptoms. Topical, prescription-strength antiperspirants and medications like Qbrexa can help, as well as procedures like Miradry, in which the sweat grands are selectively heated to permanently reduce their activity. Our experts suggest consulting with a board-certified dermatologist to decide which treatment is right for you.
The Final Takeaway
While it's certainly not the only way to treat excessive underarm sweating, Botox is an undeniably effective option to managing symptoms. And given the potential for it to be covered by insurance, it's certainly an option worth exploring. Ultimately, the decision is in your hands (and armpits).
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Stuart ME, Strite SA, Gillard KK. A systematic evidence-based review of treatments for primary hyperhidrosis. J Drug Assess. 10(1):35-50.
