Botox for excessive sweating (Botulinum toxin injections for hyperhidrosis)
Small injections of botulinum toxin into the skin to calm overactive sweat glands when sweating is heavy enough to affect daily life, most often used in the armpits.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Injections temporarily reduce sweating in the treated area, most reliably under the arms, but they do not cure the underlying tendency to sweat.
- The effect is not permanent: it usually starts within about 2 weeks and wears off over several months, so treatment normally needs repeating.
- It is usually offered after stronger antiperspirants and other measures, and an underlying cause for the sweating should be considered first.
- Choose a clinician who can explain realistic benefits, who treats your area regularly, and what happens when the effect wears off.
- Make sure your practitioner is appropriately qualified and uses a licensed, genuine botulinum toxin product; unlicensed or counterfeit products carry extra risk.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can markedly reduce sweating in the treated area for several months
You are pregnant, breastfeeding or trying to conceive, when treatment is usually avoided.
You can usually go straight back to normal activities. The small needle marks may be slightly red or tender. Avoid heavy exercise, very hot baths and...
Clear written warning signs (such as swallowing or breathing problems) and an urgent contact route.
You can usually go straight back to normal activities. The small needle marks may be slightly red or tender. Avoid...
Any minor bruising or redness settles. You may not notice much change in sweating yet, which is normal. This is...
Sweating in the treated area usually reduces and reaches its full effect. If one part is still sweating, tell the...
The effect gradually wears off and sweating returns. Many people choose to repeat the treatment at this stage.
What is Botox for excessive sweating?
Excessive sweating (hyperhidrosis) means sweating much more than the body needs to cool down. It can soak clothing, make hands or feet slippery, and affect work, relationships and confidence. Botulinum toxin injections (often called Botox, which is one brand) are a treatment for this, most often used under the arms.
The medicine is injected into the skin in many small spots across the area. It works by temporarily blocking the nerve signals that switch on the sweat glands, so the treated area sweats much less for a few months.
This is a treatment that controls a symptom. It does not cure hyperhidrosis, and the sweating returns as the effect wears off, so injections usually need repeating. It is normally tried after antiperspirants and other measures rather than as a first step.
The armpits respond well and are the most studied area. Hands, feet and the face can also be treated, but these areas can be more uncomfortable to inject and may carry slightly different risks, so they need a clinician experienced in treating them.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Common options for heavy sweating
| Option | What to know |
|---|---|
| Antiperspirants (including stronger ones) | Usually tried first; cheap and easy but can irritate the skin |
| Iontophoresis | Passing a weak electric current through water; mainly for hands and feet; needs repeating |
| Botulinum toxin injections | Reduces sweating in the treated area for several months; needs repeating |
| Tablets that reduce sweating | Affect the whole body; can cause a dry mouth and other side effects |
| Surgery | A last resort; can cause heavy sweating elsewhere on the body that may be permanent |
There is no single best option for everyone. The right choice depends on which body part is affected, how severe it is, and what you have already tried. Discuss this with your clinician.
Preparing for your procedure
- Have your sweating assessed first, including whether a medical cause (such as a thyroid problem or a medicine) might be contributing.
- Tell the clinician what you have already tried, such as stronger antiperspirants, and whether they helped.
- List all your medicines and any bleeding tendency; mention if you are pregnant, breastfeeding or trying to conceive, as injections are usually avoided then.
- Tell the clinician about any nerve or muscle condition (such as myasthenia gravis), as botulinum toxin may not be suitable.
- Check that your practitioner is appropriately qualified and that the botulinum toxin they use is a licensed, genuine product, as unlicensed or counterfeit products are unsafe.
- Avoid shaving the armpits for a day or two before treatment if asked, and do not apply antiperspirant on the day.
- Ask whether a starch-iodine sweat test will be used to map the area.
- Plan for the injections themselves to sting a little; for hands or feet, ask how the area will be numbed.
What happens
The clinician cleans the area and may paint on a starch-iodine solution that turns dark where you sweat, helping them target the injections. Using a very fine needle, they inject a small amount of the medicine into many spots a short distance apart across the area.
For the armpits this usually takes around 20 minutes and most people find it uncomfortable rather than painful. For hands and feet, which are more sensitive, numbing cream, cooling or a nerve block is often used and the appointment takes longer.
There is no recovery time for armpit treatment, and you can usually drive yourself home and return to normal activities. You will be told how to look after the small needle marks and when to expect the effect.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You are pregnant, breastfeeding or trying to conceive, when treatment is usually avoided.
- You have a condition affecting nerves or muscles, such as myasthenia gravis or a similar disorder.
- You have an active skin infection or significant skin problem in the area to be treated.
- Your heavy sweating is generalised over the whole body or may be due to an unaddressed medical cause or medicine, where a different approach is needed first.
- You are looking for a permanent cure rather than a treatment that needs repeating.
Delay or rearrange if…
- You have an active infection in or near the area to be treated.
- You have not yet had simpler measures or a check for an underlying cause.
- You are unwell or your medicines have recently changed in a way that needs review.
- You think you might be pregnant.
- You cannot arrange to contact the clinic if you notice unexpected symptoms afterwards.
Alternatives to discuss
- Stronger antiperspirants, usually tried first.
- Iontophoresis, especially for the hands and feet.
- Tablets that reduce sweating, which act on the whole body.
- Treating any underlying medical cause or adjusting a contributing medicine.
- Surgery as a last resort, accepting that it can cause heavy sweating elsewhere that may be permanent.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can markedly reduce sweating in the treated area for several months
- Often improves comfort, confidence and clothing choices
- Quick to have done, especially for the armpits, with little or no time off
- Can be repeated when the effect wears off
- May help when antiperspirants and other measures have not been enough
Risks & complications
- Stinging or pain during the injections
- Small needle marks, redness or minor bruising that settle in a few days
- Sweating that returns as the effect wears off, so treatment needs repeating
- Increased sweating in other areas of the body (compensatory sweating) in some people
- Uneven results, with some areas still sweating
- Headache or a flu-like feeling for a short time
- Temporary weakness of small muscles when the hands are treated, which can affect grip or fine movements
- Less effect from a particular session than hoped
- Infection at an injection site
- Allergic reaction to the medicine
- Spread of the toxin effect beyond the treated area — a rare but serious reaction, sometimes called iatrogenic botulism, causing problems such as severe drooping of the eyelids, slurred speech, difficulty swallowing or breathing, and weakness that spreads through the body. These signs usually appear about 4 to 8 days after treatment but can develop up to around 4 weeks later, and need emergency medical help straight away
The most relevant downsides for most people are that the effect is temporary and that some people develop more sweating elsewhere. When the hands are treated, ask specifically about the chance of temporary hand-muscle weakness. Although serious spread of the toxin is rare, you should know the warning signs — such as severe eyelid drooping, slurred speech, or difficulty swallowing or breathing — which can appear from a few days up to about 4 weeks after treatment and need emergency medical help.
Published figures to discuss
Hyperhidrosis injections are generally well tolerated, and most reported problems are minor and temporary, such as injection-site discomfort. Reliable numbers come mainly from armpit studies; figures for the hands, feet and face are less consistent. Compensatory sweating elsewhere is reported but varies between studies, and individual response and how long the effect lasts differ from person to person, so we describe most risks in words rather than precise percentages.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Meaningful reduction in armpit sweating | Most suitable patients improve; controlled trials show substantially greater sweat reduction than placebo | The strongest evidence is for primary axillary hyperhidrosis. Results for palms, feet and face are less predictable and need more careful counselling. | Guide sourcesClinical context |
| Duration of benefit | Commonly several months; many patients need repeat treatment about every 4-9 months | A shorter first response does not necessarily mean the treatment has failed, but frequent top-ups should trigger a review of dose, technique and alternatives. | Guide sourcesClinical context |
| Injection pain, bruising or tenderness | Common but usually short-lived | This is normally managed with local measures. Palms and soles can be much more painful than armpits and may need regional anaesthetic planning. | Guide sourcesClinical context |
| Temporary hand weakness after palmar treatment | Recognised; uncommon to common depending on dose and technique | This matters for surgeons, musicians and manual workers. It is much less relevant for standard underarm treatment. | Botulinum toxin type A in primary axillary hyperhidrosis: randomised controlled trial — PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no real recovery period for armpit treatment. The main thing to understand is the timeline: the effect builds over a couple of weeks, lasts months, and then fades, rather than being permanent.
- Tender or slightly red needle marks for a day or two
- A little bruising at some injection sites
- No change in sweating for the first several days
- A gradual return of sweating after some months as the effect fades
Aftercare
- Avoid strenuous exercise, hot baths, saunas and sunbeds for the rest of the day if advised.
- Try not to rub or massage the treated area hard for a day or so.
- Keep injection sites clean and watch for signs of infection.
- Wait until the full effect at about 2 weeks before judging the result.
- Note how long the effect lasts so you and your clinician can plan any repeat treatment.
- Keep using simple measures, such as breathable clothing, that help alongside the treatment.
- Contact the clinic if you notice anything unexpected, and know who to call out of hours.
- A note of what you have already tried for the sweating
- Your full medicine list ready to share
- Comfortable, loose clothing for the day of treatment
- Knowledge of how the area will be numbed if hands or feet are treated
- A plan for who to contact if you have any concerns
- A realistic expectation that the effect is temporary
- A way to track how long the benefit lasts
Scars and how they heal
There are no surgical cuts and no scars. Treatment leaves only tiny needle marks, which may look like small red dots and sometimes bruise a little. These usually fade within a few days.
⚠ Get urgent help if…
- Trouble swallowing, slurred speech or a hoarse voice after treatment
- Difficulty breathing or shortness of breath
- Muscle weakness that spreads beyond the treated area, or generalised weakness through the body
- Severe drooping of the eyelids, double or blurred vision, or a noticeable change in facial movement
- These 'toxin spread' signs most often begin about 4 to 8 days after treatment but can appear up to around 4 weeks later; if they do, get emergency medical help immediately (call 999 or go to A&E) and say you have recently had botulinum toxin injections
- Spreading redness, heat, swelling or pus at an injection site
- A widespread rash, swelling of the lips or face, or feeling faint (possible allergic reaction)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result means the treated area sweats much less, usually within about two weeks, making daily life more comfortable. The armpits tend to respond most reliably. It is normal for some sweating to remain or for one part of the area to respond less well.
The result is temporary by design. It does not change the underlying tendency to sweat, and sweating returns as the medicine wears off over several months. It also cannot guarantee that you will not sweat more somewhere else on the body.
The effect typically lasts several months, often around four to seven months for the armpits, though this varies from person to person and between body areas. Some people find the benefit lasts a little longer with repeated treatments over time. Because it is not a cure, most people who continue with it have repeat sessions when sweating returns.
Related tests, treatments or support
Botulinum toxin is often used alongside simpler measures such as stronger antiperspirants and breathable clothing. For hands and feet, some people also use iontophoresis. If sweating is widespread rather than limited to one area, tablets that reduce sweating may be discussed instead of, or as well as, injections.
Follow-up & long-term care
You may be reviewed at around two weeks to check the effect and to offer a small top-up if part of the area is still sweating. After that, follow-up is usually arranged when the effect wears off and you are considering repeat treatment. Report any unusual symptoms straight away rather than waiting.
- Plan for repeat injections every several months if you want to maintain the effect.
- Keep using antiperspirants and breathable clothing between treatments.
- Mention any new medicines or health changes before each session.
- Track how long each course lasts so timing can be tailored to you.
Repeat, follow-on and what comes next
- Because the effect is temporary, repeat injections every several months are the norm rather than a sign that something went wrong.
- If part of the treated area is still sweating, a small top-up is sometimes given after review.
- How long the benefit lasts can differ each time and between body areas.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written warning signs (such as swallowing or breathing problems) and an urgent contact route.
- A review at about two weeks to check the effect and offer a top-up if needed.
- A realistic plan for when and how often repeat treatment may be wanted.
- Advice on simple measures to use alongside the injections.
- Honest discussion of what to do if sweating appears elsewhere on the body.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Which body area is treated and how large it is (armpits, hands, feet or face)
- How many injection sites and how much medicine are needed
- The clinician's training and experience, especially for hands, feet or face
- Whether numbing cream, cooling or a nerve block is required
- Whether a sweat-mapping test is done
- Whether a review and possible top-up are included
- How often you choose to repeat treatment over time
- The clinician's fee and their experience with your specific area
- The clinic or facility fee, if separate
- Any charge for numbing or a nerve block
- Whether a follow-up review and top-up are included, and for how long
- What happens if the result is uneven or wears off quickly
- Whether repeat courses are quoted separately
- The cancellation policy and who to contact with concerns
On the NHS? Injections for heavy armpit sweating are sometimes funded by the NHS when other treatments have not helped, but criteria and the number of courses vary by area, so many people use private care for speed or choice.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being told it is a permanent cure rather than a temporary treatment that needs repeating.
- No discussion of the chance of increased sweating elsewhere on the body.
- No mention of temporary hand-muscle weakness when the palms are treated.
- No check for an underlying medical cause before treatment.
- No clear written instructions on warning signs and who to contact.
Marketing red flags
- Claims of a permanent or guaranteed cure for sweating.
- "Completely usually not painful" or "no-risk" injection claims.
- Pressure to treat several areas at once without a clear assessment.
- No mention that the effect wears off and needs repeating.
- Treatment offered without considering simpler measures or an underlying cause.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is my sweating likely to have an underlying cause that should be checked first?
- How many injection sites will you use, and will you map my sweating beforehand?
- How long is the effect likely to last for me, and how often would I need it repeated?
- If you treat my hands, what is the chance of temporary muscle weakness?
- What should I do, and who do I contact, if I notice any swallowing or breathing problems afterwards?
- What can I realistically expect if some sweating remains or appears elsewhere?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I get Botox for sweating on the NHS?
Does it hurt?
How long does it last?
Will it stop me sweating completely?
Is it safe?
Should anything be checked before I have it?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Excessive sweating (hyperhidrosis) British Association of Dermatologists — Hyperhidrosis patient leaflet Botulinum toxin type A in primary axillary hyperhidrosis: randomised controlled trial — PMC Duration of efficacy with repeated botulinum toxin A injections in axillary hyperhidrosis — PubMed Treatment of primary axillary hyperhidrosis with botulinum toxin type A: case series — PMC MHRA — botulinum toxin type A: updated warnings on iatrogenic botulism (July 2026)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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