Botulinum toxin type A is a safe and effective method for treating focal hyperhidrosis, providing longer-lasting results than topical treatments without the necessity of invasive surgical procedures. The effects of botulinum toxin last for six to 12 months and even more in some cases, and treatment is associated with a high satisfaction rate among patients. Botulinum toxin type A has emerged as an important treatment option for patients plagued with focal hyperhidrosis. The toxin temporarily inhibits the release of acetylcholine, preventing the hyper- stimulation of eccrine sweat glands that leads to excessive sweating. The common sites are armpits, soles of the feet, palms of the hands, forehead and neck.

Patient Selection

Treatment is indicated if conventional topical measures such as deodorants, fail to adequately reduce sweat production and the condition causes the patient considerable distress.


Botulinum toxin injections are not offered to patients who suffer from hyperhidrosis secondary to an underlying disease, who have undergone previous surgical debulking of sweat glands, or who have severe blood-clotting disorders. Patients who have a concurrent infection at the injection site or systemic infection are asked to return to the office after the infection has cleared. We avoid treating patients who have an existing medical condition that may interfere with neuromuscular function, such as myasthenia gravis, Eaton-Lambert syndrome, or amyotrophic lateral sclerosis. Female patients who are pregnant or breastfeeding are excluded from treatment as well.


We generally prefer using Azzalure in these areas due to the smaller molecule size and hence, bigger diffusion area. Please note, there is no specific pattern for the treatment. Intradermal injections are spread out approximately 2 cm apart.

Botox –2.5-5 units per point.

Feet – Approximately 10-50 injection sites on average per foot, 50 units per site.

Hands – Approximately 10-30 injection sites on average per hand.

Underarms – Approximately 10-15 injection sites on average per armpit.


Feet – take care injecting the medial part as paresis may occur in this area.

Hands – take care in the thenar and hypothenar regions as paresis may lead to inability to grasp.

Underarms – this area is pretty much free of complications. May cause hematomas.

Please note, injections can be painful in the feet and hands. Local anaesthesia can be useful to minimise the pain.

Please note, injections can be painful in the feet and hands. Local anaesthesia can be useful to minimise the pain.