What is underarm Botox and how does it work?
Many small doses of botulinum toxin are injected into the surface layer of the skin in the underarm sweating area. The toxin temporarily reduces the nerve signal that stimulates the sweat glands, so less sweat is produced.
The underarm is one of the areas with a high concentration of eccrine sweat glands. These glands are stimulated by acetylcholine released from nerve endings. When botulinum toxin temporarily blocks this release, the glands produce less sweat. They are not damaged; as the nerve endings recover, sweating gradually returns. That is why this is a temporary treatment that can be repeated at intervals.
Underarm treatment is one of the non-aesthetic uses of botulinum toxin and, unlike facial treatment, targets sweat glands rather than muscle. Because most body odour is linked to apocrine glands and bacteria, the effect on odour varies from person to person. Your expectations, and the situations in which sweating affects you most, are discussed in detail at your consultation so that a realistic goal can be agreed.
Who can be considered for underarm Botox?
It can be considered for underarm sweating that affects daily life, clothing choices or social situations and is not adequately controlled with topical products. If sweating is new or affects the whole body, the cause is investigated first.
Primary axillary hyperhidrosis usually starts at a young age, affects both underarms to a similar degree and can occur regardless of heat or exercise. Visible damp patches, needing to change clothes frequently and avoiding certain colours are common complaints. Topical options such as aluminium-salt antiperspirants may already have been tried without enough improvement.
Sweating that starts in adulthood, occurs as night sweats or comes with weight loss, fever or palpitations may be linked to another cause, such as thyroid disease, infection, a side effect of medication or hormonal changes. In that case the relevant medical assessment comes first. Botox does not treat an underlying cause; it only temporarily reduces the amount of sweat.
Who should not have underarm Botox?
Treatment is not given, or is postponed, during pregnancy and breastfeeding, in neuromuscular conditions, when there is infection or inflamed skin in the underarm and in anyone allergic to the ingredients.
Treatment is not carried out in neuromuscular conditions such as myasthenia gravis, or during pregnancy and breastfeeding. If there is folliculitis, an abscess, a flare of hidradenitis suppurativa or active eczema in the underarm, it needs to be assessed and treated first. Your medicines, particularly antibiotics that may affect nerve-to-muscle transmission, are reviewed, along with any previous underarm treatments or surgery.
If you have recently had laser hair removal or another underarm procedure, or plan to, timing is agreed together. Treatment is not given while the skin is irritated. Whether it suits you is decided at a face-to-face consultation that considers your medical history, how severe the sweating is and your expectations. If you are travelling to Istanbul, you can share your history before your visit.
How is underarm Botox done, and what is the aftercare?
The sweating area is marked, then many small injections are placed in a regular pattern just under the skin; the procedure is usually short. On the day, avoid strenuous exercise, saunas, hammams and massaging the area.
You may be asked to shave beforehand and arrive with clean skin. The sweating area can be made visible with a simple method such as the starch-iodine test, and the skin is marked in a grid. Injections are made with a very fine needle just beneath the skin surface. The underarm is less sensitive than the palm; most people feel a series of brief pinpricks.
Most people return to their day straight away. On the first day, you may be advised to skip deodorant or antiperspirant, avoid massaging the area and avoid strenuous exercise. Sweating usually starts to reduce within a few days, with the full effect at around two weeks. At your review, any small areas where sweating continues can be assessed and repeat timing discussed.
What are the risks, and how long does underarm Botox last?
Common effects are tenderness, small bruises and mild itching at the injection points. For most people the effect typically lasts 4–6 months, sometimes longer; duration varies from person to person.
Most side effects are mild and short-lived. Tenderness, redness and small bruises at the injection points usually settle within a few days. Less often, a temporary feeling of weakness in the arm muscles or itching in the area may be reported. Some people say that, as underarm sweating decreases, they notice sweating in other areas more; it is worth mentioning this at your review.
Underarm treatments often last longer than facial ones, but duration varies with the severity of sweating, the dose and individual factors. When sweating gradually returns, treatment can be repeated. If you notice signs of infection at the injection sites, such as increasing redness, warmth or discharge, contact your doctor; although uncommon, these should be assessed without delay.
Frequently asked questions
Will underarm Botox stop sweating completely?
The aim is to reduce sweating to a level that no longer affects daily life. How much it decreases varies from person to person, and the effect is temporary.
Is it harmful to reduce underarm sweating?
The underarms play only a small part in regulating body temperature. Temporarily reducing sweating there does not usually have a noticeable effect on temperature control.
Should I shave before treatment?
Shaving the day before is usually advised. You may be asked to arrive with clean skin and without deodorant on the day.
Does underarm Botox help with odour?
Because apocrine glands and bacteria play a role in odour, reducing sweat can lessen it, but not to the same degree in everyone.
When does underarm Botox start to work?
Reduced sweating is usually noticed within a few days, with the full effect at around two weeks.
How long should I wait between underarm Botox and laser hair removal?
Underarm Botox and laser hair removal are generally not done on the same day; a gap of a few days to two weeks between them is a common approach. This gives the redness and sensitivity after laser time to settle, and the injection points after Botox time to heal. The right gap depends on the type of laser used and how your skin responds.
When should I get underarm Botox before summer?
Underarm Botox is generally advised at least two to three weeks before the summer months or an important event. The full effect takes around two weeks, which also leaves time for a review of any small areas still sweating. Because the effect lasts 4–6 months or longer for most people, a treatment in late spring can cover much of the summer.
How is underarm Botox different from devices that target the sweat glands?
Underarm Botox temporarily reduces the nerve signal to the sweat glands, and sweating returns gradually after several months. Device treatments that heat the sweat glands with microwave or similar energy aim for a longer-lasting reduction by targeting part of the glands; swelling, tenderness and temporary numbness can persist for a while afterwards. The choice depends on how severe the sweating is and what you expect.
Can underarm Botox harm the lymph nodes or stop my body getting rid of toxins?
Underarm Botox is not expected to harm the lymph nodes; it is injected into the superficial skin layer where the sweat glands lie, not into the nodes. The idea that sweat plays an important role in removing harmful substances is not supported by evidence; the kidneys and liver mainly do this. A new underarm lump or swelling should be assessed separately, whatever the treatment.
Sources (2)
This content is for general information and does not replace a personal medical assessment.