Don’t Sweat It…Try Botox!


Hyperhidrosis is a common medical condition whereby a person’s sweat glands become overactive, often producing 4-5 times the amount of sweat than those of unaffected individuals. Patients with hyperhidrosis can experience decreased self-esteem or generalized embarrassment, especially when the sweating occurs in an area of the body that is easily seen or exposed to regular interaction with others – like shaking hands, for example.

The most common “hot spots” for hyperhidrosis include the hands, feet, armpits, face, and scalp; in most patients, more than one of these areas will be affected. Though episodes of sweating can be spontaneous, patients will commonly have a number of possible triggers, including physical activities such as exercise; dietary choices such as coffee, tea, alcohol, and hot/spicy food; hot or cold environmental temperatures; habitual smoking; and emotional stress or anxiety.

So how does one know if he or she has hyperhidrosis – and how is it diagnosed? There are two major types of hyperhidrosis: primary focal and secondary generalized. Primary focal hyperhidrosis accounts for 90% of cases of hyperhidrosis and is differentiated from secondary generalized by sweat not caused by a medication or other medical condition. Patients must have at least a six-month period of focal visible sweating and two of the following symptoms:

● Sweating that occurs on the same area on both sides of the body and with the same           relative amount of sweating
● Sweating that impairs daily activities
● Sweating episodes that occur at least once per week
● Sweating that began before the age of 25
● Sweating that is found in other family members
● Sweating that stops when sleeping

Unfortunately there is no cure for hyperhidrosis, but there are a number of available treatments that can improve symptoms, such as creams, prescription strength antiperspirants, lasers, electromagnetic machines, oral medications, and in refractory cases, sympathectomies. Each of these procedures comes with its own set of risks and benefits, so it is best to see a specialist when entertaining treatment. Alternatively, there is another minimally invasive option that can be used to treat any part of the body suffering from hyperhidrosis: Botox.

In 2004 the FDA approved Botox for axillary hyperhidrosis, and it is now routinely used to treat all forms of excessive sweating.  Contrary to popular perception, Botox does not work directly on muscles, but rather the nerves that cause the muscles to contract.  As a result, Botox treats hyperhidrosis by temporarily blocking the signals that nerves release to control sweat gland function.  Treatment is similar to Botox placed for cosmetic purposes in that a series of injections using low volumes of Botox is administered throughout the areas of greatest sweating.  Nearly painless, the procedure can take between 10-15 minutes, with a significant reduction in sweating appreciated within 1-2 weeks.  On average, results will last for six months, and any missed sweat glands can be treated with a touch-up at 14 days.  The total amount of Botox used will depend on the area of the body treated, but one armpit will normally require 50 units, one hand 50-75 units, and one foot 50-100 units.

As an Emory, Harvard, and University of Pittsburgh-trained, ASPS board-certified plastic surgeon, Dr. Castillo performs all of the injections himself, supplying patients the same level of care that he would give his friends and family.

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