Excessive Sweating / Botulinum Toxin

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Botulinum toxin injection for excessive sweating

Excessive sweating in specific areas of the body, known as “localized hyperhidrosis,” can significantly impact one’s quality of life. While sweating is a normal mechanism for regulating body temperature, localized hyperhidrosis, such as in the underarms or palms, can lead to embarrassment and potentially cause psychological distress or social isolation.

Botulinum toxin is one of the most effective treatments for reducing sweating. It inhibits the release of acetylcholine from nerves, thus suppressing the activity of sweat glands.^3,4 When injected in areas prone to sweating, like the underarms, palms, or soles of the feet, it can provide long-lasting relief from sweating in those areas.

Recommended for：

Those who experience excessive underarm sweating and are concerned about sweat stains on clothing.
Those who are bothered by underarm odor.
Those who have sweaty palms and soles of the feet that cause discomfort.

Flow of treatment

The actual treatment process is as follows. For more information on the formulation and needles used, see the Botulinum toxin treatment page.

STEP

Preparing at Home

If you wish to have underarm injections on the treatment day, please shave your underarm hair one day to two days prior. While it is possible to receive injections with hair, it is smoother if you shave or trim it short.

STEP

Consultation

The doctor will provide explanations about the treatment and potential side effects.

STEP

Anesthesia

We will apply cream anesthesia to reduce discomfort. For the underarms, anesthesia will be applied for about 20 to 30 minutes, and for the palms of the hands and soles of the feet, it will be applied for about 40 to 60 minutes.

STEP

Injections

We will confirm the area where sweat is produced before the treatment. For the underarms, injections will be administered at 20 points on each side, and for the palms of the hands and soles of the feet, injections will be administered at 40 points on each side.

Duration of Effects and Treatment Intervals

Please note that the duration of effects may vary individually. The following are general guidelines:

Treatment Area	Duration of Effects and Treatment Intervals
Armpits	Effects start to appear 3 days after the procedure, reaching their maximum at 2 weeks. The effects last approximately 3-6 months with a 50-unit injection, and 6-9 months with a 100-unit injection. Getting a 100-unit injection once a year in spring can help keep underarm sweating at bay throughout the warmer months. For severe cases, injections twice a year may be recommended.
Palms	Effects start to appear 3 days after the procedure, reaching their maximum at 2 weeks. The effects last about 3 months with a 100-unit injection, and approximately 3-6 months with a 150-unit injection.
Soles	Effects start to appear 3 days after the procedure, reaching their maximum at 2 weeks. The effects last about 3 months with a 150-unit injection, and approximately 3-6 months with a 200-unit injection.

Side effects and precautions

For information on side effects and post-treatment precautions, see Potential side effects of botulinum toxin injections.

Price for excessive sweating treatment with botulinum toxin injection

At our clinic, we use “Coretox” as a botulinum toxin preparation.

Item	Fee (tax included)
Consultation fee	First visit ¥3,850 Revisit ¥1,650
Armpit 50-unit Armpit 100-unit	¥29,700 ¥44,000
Palm 100-unit Palm 150-unit	¥59,400 ¥73,700
Sole 150-unit Sole 200-unit	¥73,700 ¥88,000
Cream anesthesia	¥3,300

Each injection requires a consultation every time. Please be aware that a separate consultation fee will apply.

Frequently Asked Questions About Botulinum Toxin Injections for Excessive Sweating

For general inquiries about Botulinum Toxin injections and post-injection questions, please refer to the “Frequently Asked Questions about Botulinum Toxin Injections.”

How painful is the injection?

In our clinic, we use an ultra-fine 34-gauge needle* after applying cream anesthesia to alleviate any discomfort.

*The gauge (G) of a needle indicates its thickness, with higher numbers denoting thinner needles.

With the combination of anesthesia, the underarms can be treated with minimal to no pain.

However, the palms of hands and soles of feet are highly sensitive areas, so even with anesthesia, you may need to endure some degree of significant discomfort.

How many units do you recommend for the injection?

We recommend 100 units for the underarms, 150 units for the palms, and 200 units for the soles of the feet.

For milder cases, 50 units for the underarms, 100 units for the palms, and 150 units for the soles of the feet may also be suitable.

How long does the effect of Botulinum toxin injections for underarm sweating last?

The duration of the effect varies from person to person, but typically, with a injection of 100 units, the effect can last for 6 to 9 months.

If you undergo treatment once a year, from spring to early summer, you can enjoy a sweat-free and comfortable underarm experience until autumn without worrying about shirt stains.

Which is better, Botox or Coretox?

For hyperhidrosis treatment, we recommend Coretox because it is less likely to develop resistance (antibodies) since higher injection amounts are required.

What is the improvement rate?

Over 95% of individuals experience positive results.

In domestic clinical trials conducted by Allergan using Botox, the percentage of individuals experiencing a reduction in sweating by 50% or more in both armpits at 4 weeks after administration was reported as 96.2% in the Botox group and 45.9% in the placebo group.⁵

List of references/websites

Allergan, “BOTOX onabotulinumtoxinA injection” アクセス 2020.10.23
アラガン・ジャパン, “医療用医薬品：ボトックスビスタ” 添付文書情報2020年8月改訂
A de Paiva et al., “Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals” Proc Natl Acad Sci U S A. 1999 Mar 16;96(6):3200-5. doi: 10.1073/pnas.96.6.3200.
M. Shibasaki et al,. “Botulinum toxin abolishes sweating via impaired sweat gland responsiveness to exogenous acetylcholine” Br J Dermatol. 2009 Oct; 161(4): 757–761. doi: 10.1111/j.1365-2133.2009.09248.x
大嶋雄一郎他, “原発性腋窩多汗症患者に対する A 型ボツリヌス毒素製剤の治療評価” 西日本皮膚科. 2013；75：357-364