When underarm sweat dictates your wardrobe, your activities, and your confidence, you start looking for solutions that move the needle. Prescription antiperspirants help some people, and so do tweaks like breathable fabrics or clinical-strength deodorants. For patients with primary axillary hyperhidrosis, especially those who soak through shirts within minutes, Botox injections can be life changing. I say that after years of treating patients who have tried everything from iontophoresis to herbal supplements. Botox, used medically for sweating since the early 2000s, remains one of the most reliable ways to quiet overactive sweat glands without surgery.
This guide lays out what the treatment involves, how it works, who benefits most, what the results look like, and where it fits alongside other options. I will also address real-world questions I hear daily: how much it costs, how many units of Botox are used, how long results last, and how to manage aftercare. If you are already familiar with Botox as a cosmetic treatment for forehead lines, frown lines, crow’s feet, and smile lines, think of medical Botox for underarm sweating as the same medication used for a different target and a different purpose.
How Botox Stops Excessive Underarm Sweating
Sweat glands respond to signals from the sympathetic nervous system. In hyperhidrosis, those signals fire excessively. Botulinum toxin type A blocks acetylcholine release at the nerve ending. When injected superficially in the underarm skin, it interrupts the message to the eccrine glands, reducing sweat production in the treated zone.
This is not the same as reducing body heat tolerance or preventing the body from cooling itself. You still sweat normally elsewhere. The goal is to normalize sweat in a local area where gland activity is disproportionately high, not to shut down your overall thermoregulation.
Patients often ask if using Botox for underarm sweating is “off label.” In the United States, onabotulinumtoxinA has FDA approval for severe primary axillary hyperhidrosis that does not respond to topical agents. Other brands like abobotulinumtoxinA and incobotulinumtoxinA are used in practice as well. The core effect is shared across these formulations, though dosing and diffusion characteristics vary.
Who Makes a Good Candidate
The best candidates have primary axillary hyperhidrosis, meaning sweating is not caused by another medical condition or medication. If sweating started in childhood or adolescence, occurs at least weekly, and interferes with daily activities, you likely fit the picture. If you have night sweats, weight loss, fevers, or new-onset sweating, your clinician should rule out secondary causes first, such as thyroid disease, infections, or medication side effects.
From a practical standpoint, I start with lower-cost and low-risk options if a patient has not tried them. Clinical-strength antiperspirants, particularly aluminum chloride hexahydrate 15 to 20%, can help milder cases. If the skin burns or the effect is short-lived, we consider medical Botox. Patients who avoid social events, carry spare clothing, or feel sweat trickling down their sides even in cool rooms tend to notice the most dramatic improvement.
There is no specific “best age.” I treat both teens and adults when quality of life is impacted and conservative measures fail. Men and women respond similarly. If you are pregnant or breastfeeding, we defer treatment. If you have a history of neuromuscular disorders, we discuss risks carefully and involve your medical team. Allergies to components of the product are rare but would exclude you.
What the Appointment Is Like
A typical Botox appointment for underarm sweating takes about 30 to 45 minutes, including preparation and aftercare instructions. Most of that time is mapping the area and numbing to keep the process comfortable. The injections themselves usually take 5 to 10 minutes per side.
I begin by cleaning the underarm and, when helpful, marking sweat distribution. Some clinics perform a Minor’s iodine-starch test. This is a simple map: an iodine solution is painted on the underarm, then starch is dusted over it. Areas of active sweat turn deep blue or black. It guides us to the highest-yield injection sites. The test is optional but often helpful for first-time treatments or unusual patterns.
Next, we use an ice pack or a topical anesthetic for several minutes. I prefer a fine 30 to 32 gauge needle and shallow intradermal placement, like a series of tiny blebs. Spacing is roughly 1 to 2 centimeters apart, creating a grid that covers the active zone. The sensation feels like quick pinches or mosquito bites. Most patients rate discomfort at 3 or 4 out of 10, and it fades as we progress.
Side-by-side, this looks a lot like how we inject baby Botox for fine lines in cosmetically sensitive areas, except the target is the skin over the axillary vault rather than facial muscles. The technique matters. Injections that are too deep will miss the eccrine glands, and injections that are too superficial can cause more surface irritation and less even coverage. In experienced hands, the procedure is tidy and efficient.
Units of Botox Needed and Injection Pattern
Dose ranges exist because armpits vary in sweat distribution and surface area. For onabotulinumtoxinA, a common protocol is 50 units per underarm, totaling 100 units. Some patients need closer to 60 to 75 units per side if the area is broad, and others do well with 40 units if their active zone is small. For other brands like abobotulinumtoxinA and incobotulinumtoxinA, unit numbers adjust because the units are not interchangeable, so your clinician will calculate based on product-specific potency.
We usually place 10 to 20 small injections per side. Think of a checkerboard that spans from the front fold of the axilla backward toward the hair-bearing skin. If you shave or prefer hair removal, let your provider know. We avoid injecting through irritated or freshly shaved skin, since that stings and can raise the risk of folliculitis. I advise shaving a day or two before the appointment if you want a clean field.
How Soon Botox Works and What Results to Expect
Patients often feel drier within 2 to 4 days, with full effect around 1 to 2 weeks. On follow-up, most report an 80 to 90% reduction in sweat volume within the treated area. Shirts stay dry through meetings, workouts feel manageable, and the constant thought loop about sweat drops away.
The effect is strong but not absolute. If you wear a gray shirt on a summer day, you might see faint dampness at the edge of the treated zone or from neighboring regions that were not injected. That is predictable and easy to handle by slightly extending the grid at your next visit. If we have done the iodine-starch map once, we rarely need to repeat it unless your pattern changes.
Patients sometimes worry about compensatory sweating, meaning sweat increases in other areas. That phenomenon is mainly associated with surgical sympathectomy. With Botox, the vast majority of patients do not experience a meaningful increase elsewhere. Your body maintains its cooling function through normal sweating outside the treated field.
How Long Does Botox Last for Underarm Sweating
The duration sits in a practical range of 4 to 7 months for most patients, sometimes up to 9 or 10 months in lighter sweaters. The first session can be shorter as your nerves “learn” the new pattern. Repeat sessions often extend longevity, which I see frequently after the second or third treatment. If your schedule is seasonal, some patients time sessions ahead of summer or big life events like weddings, travel, or sports seasons.
You can maintain results with twice-yearly treatments if your symptom return lands around six months. Others prefer three times per year if they live in hot climates or have high-intensity jobs. The maintenance cadence is flexible and personalized.
Safety, Side Effects, and What to Expect After
Botox for underarm sweating is generally well tolerated. The most common effects are minor and short lived: small bruises, tenderness, or pinpoint swelling for a day or two. The underarm skin can feel itchy for a few hours, especially if we used topical anesthetic or if your skin is sensitive. Some patients notice a transient feeling of heaviness where the blebs were placed, which normalizes within 24 to 48 hours.
Infections are rare if the skin is cleaned thoroughly and the clinic maintains good technique. Systemic side effects are uncommon at the doses used for axillary hyperhidrosis. If you have a history of reactions to botulinum toxin or certain neuromuscular conditions, disclose this during your Botox consultation so we can assess risk appropriately.
I am often asked whether this treatment affects odor. Since odor arises when skin bacteria metabolize sweat, reduced sweat volume usually decreases odor as a secondary benefit. You will still want a light deodorant for freshness, but many patients find they no longer need aluminum-heavy antiperspirants.
Aftercare and What Not to Do After Botox
Immediate aftercare is simple. Keep the area clean and dry for several hours. Skip vigorous workouts, hot yoga, or saunas until the next day. Do not massage the injection sites. Avoid applying strong antiperspirants or exfoliants that night. The next day, you can resume usual routines, including deodorant use and bathing. Swimming is fine after 24 hours.
If you experience more than mild redness or tenderness, a cool compress helps. For any hives, spreading redness, or fever, call your clinic. These are uncommon, but we take them seriously.
Cost and How Clinics Price Treatment
Pricing varies by region and clinic experience. Two main models exist: per unit or per area. Per unit pricing for onabotulinumtoxinA often ranges from about 10 to 20 USD per unit, which means 100 units could land around 1,000 to 2,000 USD. Per area pricing for both underarms combined may fall in a similar total range. Some practices offer Botox package deals for hyperhidrosis or a membership model that lowers per-unit cost for repeat patients. If insurance covers medical Botox for severe axillary hyperhidrosis, the cost may be reduced substantially, though coverage rules vary.
If you see promotions like “Botox near me for wrinkles,” remember that cosmetic deals rarely apply to medical indications. Ask for a clear estimate before your Botox appointment and confirm whether you will be billed per unit or per area. In the right hands, cheaper is not always better. For a medical treatment like hyperhidrosis Botox, experience and technique drive both comfort and results.
Comparing Botox to Other Options
For many patients, Botox sits in the middle of the treatment spectrum. Topicals are the first rung. Prescription aluminum chloride is inexpensive, but skin irritation limits use in a significant subset. Glycopyrronium cloths can help mild to moderate cases, though they may cause dry mouth or blurred vision. Systemic anticholinergics like glycopyrrolate or oxybutynin reduce sweating everywhere, which is useful for multi-site hyperhidrosis. The trade-off is side effects like dry mouth, constipation, and sometimes cognitive fog, which many patients find hard to tolerate long term.
Iontophoresis, a device therapy that uses mild electrical current in water trays, excels for hands and feet. Underarms are harder to treat with this approach, and outcomes vary. Microwave thermolysis devices target sweat glands thermally, aiming for a more permanent reduction but with higher up-front cost, more downtime, and potential swelling or numbness. Endoscopic thoracic sympathectomy is surgical and reserved for severe, refractory cases given the risk of compensatory sweating.
Botox slots in as a minimally invasive, clinic-based, same day procedure with a solid safety profile and predictable results. The main trade-offs are that it requires maintenance and carries ongoing cost. The upside is strong: rapid relief, little downtime, and high patient satisfaction.
The Experience Curve: First Time Botox vs Maintenance
First time Botox for underarms comes with a learning period. You get to know your body’s response, the exact timeline to dryness, and any hot spots we need to extend at the next session. By session two, we usually tighten the map and fine tune the dose. Patients who start ahead of summer often say the second treatment lasts noticeably longer.
Maintenance is straightforward. Re-treatment before the old effect fully wears off can carry you smoothly through seasons. If you wait until sweating is fully back, you can still restart. There is no penalty for pausing, but planning ahead gives you better continuity.
Real-World Case Notes
A software engineer in his mid-30s came in after years of cycling through antiperspirants that stained shirts and irritated his skin. He changed clothes twice daily and carried spare undershirts to the office. We did 50 units per side. Four days later he emailed that he had gone through a full day at work in a pale blue shirt with no marks. At six months, he felt 70% of the sweat had returned and chose to repeat. After his third treatment, he reliably made it eight months between visits.
A college athlete wanted to compete without worrying that sweat would be visible through her uniform. We mapped widely using the iodine-starch test and treated 60 units per side. She had mild pinpoint bruising that resolved in two days and reported near-complete dryness during practice within a week. She now times sessions before tournament season.
These experiences are typical, not miraculous. Hyperhidrosis is a chronic tendency, and Botox offers a strong brake pedal. The key is matching the plan to your lifestyle and budget.
Frequently Asked Practical Questions
How does Botox for underarm sweating differ from Botox for wrinkles on the forehead or crow’s feet? The target and depth. Cosmetic Botox aims at facial muscles to soften dynamic lines like frown lines and smile lines. Underarm treatment aims at sweat glands in the dermis. The same vial, different purpose. Some patients see both a cosmetic and a medical provider or choose one clinic that does both Botox cosmetic treatment and therapeutic Botox to simplify scheduling.
Will it affect my workouts? Only on day one, when I ask you to skip strenuous exercise. After that, you can lift, run, or play without restriction. Many athletes find they can train more comfortably without constant moisture and chafing.
What about odor control and clothing care? Less sweat means less bacterial breakdown and less odor. Light deodorants, breathable fabrics, and washing botox shirts promptly keep things clean. Many patients report fewer underarm stains.
Can I combine treatments? Yes. If you also get masseter Botox for jaw clenching or TMJ Botox treatment, we schedule sessions to suit your calendar. Some combine underarm Botox with cosmetic treatments like a Botox brow lift, lip flip Botox, or baby Botox for subtle facial rejuvenation. Each area has its own dosage and technique, and a good clinic will create a customized Botox treatment plan that respects your goals and budget.
Is there a rebound after it wears off? No rebound. Nerve endings slowly resume signaling, and sweating returns to your baseline pattern. If you prefer to taper off treatment, you can extend intervals and see how you feel.
Picking a Provider: Technique and Judgment Matter
The best Botox clinic for hyperhidrosis prioritizes mapping, even coverage, and patient comfort. Look for a clinician who treats hyperhidrosis regularly, can discuss units of Botox needed for your pattern, and will adjust placement after seeing your results. Reviews help, but a thorough Botox consultation is better. Bring a list of situations when sweat is worst, photos of sweat marks if you have them, and details of what you have tried.
Beware of clinics that only quote rock-bottom Botox deals without clarifying dosing. Under-treating is common when price is the sole focus. On the flip side, more units are not always better. Precision beats volume. In a measured grid, 50 units per side is often the sweet spot.
What It Feels Like to Get Your Life Back
People downplay sweating because it is invisible until it is not. When sweat dictates which seat you pick in a meeting or how you cross your arms to hide circles, it erodes confidence in quiet ways. The first dry week after treatment, I often hear the same line: I didn’t realize how much brain space this took. That is why medical Botox for excessive sweating remains one of the most satisfying procedures in my practice. Quick visit, minimal downtime, and a tangible lift in daily comfort.
If you are deciding between waiting it out or trying a session, consider a trial on a single area. The before and after contrast is clear within two weeks, and the data point helps you choose a long-term plan. For many, twice-yearly maintenance becomes as routine as dental cleanings, just with drier shirts and less stress.
Key Takeaways and Next Steps
- Botox is a proven, minimally invasive hyperhidrosis treatment that reduces underarm sweating by blocking nerve signals to sweat glands. Expect relief in 2 to 14 days and results that last about 4 to 7 months. Typical dosing is around 50 units per underarm for onabotulinumtoxinA, adjusted to your mapped sweat pattern. The procedure takes under an hour with little downtime. Side effects are usually mild and local. Aftercare is simple: keep it clean, avoid intense exercise for 24 hours, and skip strong topicals that night. Costs vary with geography and practice model, commonly 1,000 to 2,000 USD for both underarms. Some insurance plans may cover medical Botox for severe primary axillary hyperhidrosis. Choosing an experienced provider and a personalized plan yields the most natural, durable results, whether you also pursue cosmetic goals like natural looking Botox for fine lines or focus solely on sweating.
If underarm sweating has shaped your choices for years, you deserve a solution that meets you where you are. Ask detailed Botox consultation questions, look for a clinician who listens, and test the waters. The distance between distrusting your shirt and not thinking about sweat at all can be as short as one well planned appointment.