Don’t Sweat It… Try Botox!

In 2004, the FDA approved the use of Botox for hyperhidrosis or severe underarm sweating.

Hyperhidrosis is a medical condition caused by over stimulated sweat glands. People with this condition often produce four to five times more sweat than people who do not suffer from hyperhidrosis.


Hyperhidrosis triggers:

  • exercise
  • heat or cold
  • alcohol, coffee, tea, smoking , hot or spicy food
  • stress , anxiety, strong emotions


How to diagnose Hyperhydrosis?

If there is excessive sweating of at least 6 months duration with at least two of the following characteristics then primary Hyperhydrosis is present and this can be treated with Botox.

  • Bilateral and relatively symmetrical sweating
  • Impairs daily activity
  • At least one episode per week
  • Onset before the age of 25 years
  • Positive family history
  • Cessation of sweating during sleep


What can be done:

BOTOX®  has proven to be an effective hyperhidrosis treatment. When injected into the underarm area, BOTOX® helps to control hyperhidrosis.


How does it work?

A small volume of BOTOX® solution is injected through a very fine gauge needle into the underarm area.  BOTOX® works by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. When these glands no longer receive the chemical signals, the excessive underarm sweating stops. The procedure takes about 5-10 minutes, is relatively painless, and the effects of the treatment have been reported to last 6-9 months (Results vary from person to person and eventually will wear off).  Depending on the severity of the hyperhidrosis, multiple injections may be needed.


Within 1-2 weeks of the initial treatment there will be significant reduction in underarm sweating. There is a possibility that some sweat glands may be missed during BOTOX® hyperhidrosis treatment. If this occurs, underarm sweating may continue from the untreated areas and a touch-up treatment may be needed.


How much does it cost?

For optimal results, 100 units of BOTOX® (50 units under each arm) is needed, which can run anywhere between $1000-$1500.

Pre Treatment Instructions:

  • Shave underarms 24 hours prior to procedure.
  • 2 hours before procedure avoid hot beverages or going to gym (if doing “The Starch Test”).
  • Abstain from use of over-the-counter deodorants or antiperspirants for 24 hours (if doing “The Starch Test”).
  • Do not consume a alcoholic beverages for 24 hours prior to the procedure.
  • Avoid taking Aspirin or Ibuprofen 24 hours prior to the procedure (please check with your Primary Care Physician if you take either medication on a daily basis for an existing condition)

The Starch Test:

The “Starch Test” is sometimes performed to view where the affected areas of perspiration are located.  Not all providers perform this test, as it has been said to be  unnecessary.  Most providers inject into the area of hair growth, since sweat glands lie just next to each hair follicle.


Starch Test Info:

Patients should shave underarms and abstain from use of over-the-counter deodorants or antiperspirants for 24 hours prior to the test. Patient should be resting comfortably without exercise, hot drinks, etc for approximately 30 minutes prior to the test.

Here’s what to expect:

Iodine solution will be painted on.

Starch powder will then be sprinkled and allow to settle for 10 minutes.
A blue-black mark will identify affected area of persperation.
The area will then be circled and marked.
BOTOX® is then injected just beside each pen mark.

Post Treatment Instructions:

  • No deodorant for 12 hours
  • No heavy exercise for 24 hours
  • After Botox injections gently clean and dry your underarm using a mild soap/cleanser.
  • You may begin to experience results within 7 days, full effectiveness is achieved at 14 days.
  • Until the maximum effectiveness of the BOTOX® injection is achieved you can continue to use over the counter antiperspirants.
  • Contact your injector, if you are still experiencing sweating in the treated area after 14 days.



The Botox Stigma

Why does Botox still have a negative connotation?

For some people, hearing the word Botox paints a picture of a plastic woman with a frozen face. Other people think “rat poison”. What’s the reason behind all this negativity?  In my opinion, there are two main reasons:   Reality shows where someone went too far and lack of knowledge.

Hopefully this blog post will alter any negative perspectives out there and turn them into positive ones.

Let’s start with the most basic questions…

What is Botox?
Botox (onabotulinumtoxinA) is a two-chain polypeptide protein and neurotoxin produced by a purified form of bacterium Clostridium botulinum.
“Purified” being the key word here…

How does Botox work?
Botox works to relax the contraction of muscles by blocking nerve impulses, resulting in muscles that can no longer contract, causing dynamic wrinkles (wrinkles that appear temporarily when a muscle contracts during facial expression) to relax and soften. It usually takes 2-14 days to see cosmetic improvement and the effects can last 3-6 months.

Side-note: Botox is not as effective on static wrinkles (wrinkles at rest). Static wrinkles are better treated surgically or with dermal fillers.

Who is Botox good for?
Botox is FDA approved for men and woman from ages 18-65. Although most think that Botox is for older people… It’s actually extremely preventative.  More and more, people are starting to realize this wonder.  For example, take a look at your mother, father, or any other older person you may encounter… Do you see any permanent wrinkles in between their eyes? Those wrinkles are caused by the corrugator muscle contracting over and over again. This contraction causes collagen breakdown every time the muscle contracts. So, the earlier you start getting Botox the less wrinkling you’ll get later in life. The older you get, the more you’re doing it just to treat those wrinkles, the younger you are, the more you’re doing to prevent them from occurring.

How much does Botox cost?
Average cost is $200-$400 per area and should be repeated every 3-6 months for optimal long-term results.  (I usually spend this amount every time I visit the supermarket)…  Perspective?

Botox timeline of events:
1895 – Emile van Ermengem, Belgian bacteriologist, found the producer of the botulin toxin was a bacterium, which he named Clostridium botulinum.

1928 – P. Tessmer Snipe and Hermann Sommer for the first time purified the toxin.

1949 – Arnold Burgen discovered that botulinum toxin blocks neuromuscular transmission through decreased acetylcholine release.

1960’s – Alan Scott, M.D., a San Francisco ophthalmologist, and Edward Schantz were the first to work on a standardized botulinum toxin preparation for therapeutic purposes.

1973 – Scott (now at Smith-Kettlewell Institute) used botulinum toxin type A (BTX-A) in monkey experiments.

1980 – Botox was officially used for the first time in humans to treat strabismus “crossed eyes”, and “uncontrollable blinking”, blepharospasm.

1989 – The cosmetic effect of BTX-A on wrinkles was originally documented by a plastic surgeon from Sacramento, California, Dr. Richard Clark, and published in the journal Plastic and Reconstructive Surgery.

1993 – Discovered that botulinum toxin could be used for the treatment of achalasia, a spasm of the lower esophageal sphincter.

1994 – Dr. Khalaf Bushara of Southend Hospital in England, showed that botulinum toxin injections inhibit sweating. This was the first demonstration of non-muscular use of BTX-A in humans.

December 21, 2000 – Botulinum Toxin Type B (BTX-B) received FDA approval for treatment of cervical dystonia.

April 12, 2002 – The FDA announced regulatory approval of botulinum toxin type A (Botox Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines)

June 2009 – Its use for treating hypertonic muscles helped an Australian man to walk again. He had required a wheelchair for mobility following a stroke 20 years prior

October 15, 2010 – Received FDA approval for treatment of chronic migraines.

Clearly, throughout the years, Botox has gone through many discoveries and has truly done and continues to do amazing things cosmetically and medically. To add on to this, here’s a full list of its cosmetic and non-cosmetic reported uses:

Cosmetic uses:


Glabella (frown lines between eyes)



Horizontal forehead lines



Crow’s feet



Bunny lines (horizontal lines on the bridge of nose)


Eyebrow lift



Upper and lower vertical lip lines



Gummy smile (excessive amount of gums showing while smiling)


Corners of the mouth that turn downward


Chin dimples “peach pit”



Platysmal bands of the neck

Non-cosmetic uses:
Muscle spasms
Cervical dystonia or spasmodic torticollis (a neuromuscular disorder involving the head and neck)
Blepharospasm (excessive blinking)
Severe primary axillary hyperhidrosis (excessive sweating)
Strabismus (crossed-eyes)
Achalasia (failure of the lower oesophageal sphincter to relax)
Chronic focal neuropathies
Migraine and other headache disorders
Idiopathic and neurogenic detrusor overactivity
Pediatric incontinence
Incontinence due to overactive bladder
Incontinence due to neurogenic bladder
Anal fissure
Vaginismus (to reduce the spasm of the vaginal muscles)
Movement disorders associated with injury or disease of the central nervous system including trauma, stroke, multiple sclerosis, Parkinson’s disease, or cerebral palsy
Focal dystonias affecting the limbs, face, jaw, or vocal cords
TMJ pain disorders
Diabetic neuropathy
Wound healing
Excessive salivation
Vocal cord dysfunction (VCD) including spasmodic dysphonia and tremor
Reduction of the Masseter muscle for decreasing the apparent size of the lower jaw
Painful bladder syndrome
Detrusor sphincter dyssynergia and benign prostatic hyperplasia

The amount used for cosmetic purposes is an average of 15-30 units per area…
The amount used for non-cosmetic purposes is between 50-360 units per area…

The non-cosmetic amount is 12 times more than cosmetic amount used!

So as you can see, Botox offers a variety of solutions for a multitude of problems.  Its hard to believe that people still have negative beliefs about this product. To all of you still holding on to this opinion, I ask you … What’s so wrong with looking and feeling your best and better yet, what’s so wrong with helping the less fortunate person with one of the disorders listed?

I know I look and feel my best!

BTW… crow’s feet, forehead lines, frown lines, and lip lines all have been injected with Botox!  I love the results and trust that you will too!