Excessive sweating
Hyperhidrosis is a medical complaint, not a cosmetic one. Underarm and palm treatment typically holds for six to twelve months — considerably longer than cosmetic treatment.
Hyperhidrosis is sweating well beyond what the body needs for temperature regulation, and it is a recognised medical condition rather than a cosmetic concern. Primary focal hyperhidrosis is the common form: it affects specific sites, usually the underarms, palms, soles and sometimes the face and scalp, typically appears in adolescence or early adulthood, is symmetrical, and does not occur during sleep. It is not caused by anxiety, though anxiety about it reliably makes it worse, producing a cycle that is a large part of its burden. The functional impact is routinely underestimated by people who do not have it: ruined clothing, avoiding handshakes and touchscreens, choosing outfits by how well they conceal sweat, and declining situations where it might show. Secondary hyperhidrosis is different, being generalised rather than focal, often beginning later and sometimes occurring at night, and it may point to an underlying cause such as thyroid disease, infection or a medication effect. That distinction is made at consultation, because generalised or nocturnal sweating warrants investigation rather than cosmetic treatment.
How we treat it
Where the picture is primary focal hyperhidrosis and topical treatment has failed, botulinum toxin is well established. It is injected intradermally in a grid across the affected area, blocking the chemical signal that activates the sweat glands. The underarm is the most commonly treated site and the most straightforward. Palms are more uncomfortable to treat and require care because of the small muscles of the hand, so a nerve block or strong topical anaesthesia is used. The effect begins within a few days and is usually complete within two weeks. Duration is notably longer than for cosmetic treatment, commonly six to twelve months and sometimes more, because the mechanism differs and the tissue is not under constant muscular load. Where the history suggests secondary hyperhidrosis, generalised sweating or night sweats, the right step is medical investigation first rather than injection. Compensatory sweating elsewhere is uncommon with focal treatment, unlike with surgical sympathectomy.
Medically reviewed by Dr. Sherwin Hariri, MD, Medical Director & Chief Longevity Physician. Last reviewed August 2026.
This page is for information only and is not medical advice. Suitability for any treatment is determined at consultation.
Common questions
How long does treatment for sweating last?
Usually six to twelve months, considerably longer than cosmetic botulinum toxin treatment, and some patients get longer still. The difference comes down to mechanism: blocking the signal to the sweat glands is not subject to the same recovery dynamics as a muscle returning to full contraction.
Is treating the palms different from the underarms?
Yes, in both comfort and technique. Palms are far more sensitive and contain small muscles of the hand that must be avoided, so treatment is done with a nerve block or strong topical anaesthesia and demands more precision. Some patients notice temporary mild weakness in grip, which resolves.
Will I just sweat somewhere else instead?
Compensatory sweating elsewhere is uncommon after focal injectable treatment. It is a well- documented issue after surgical sympathectomy, which is a far more drastic intervention, and the two are often confused. Treating the underarms does not typically redirect sweating to the back or chest.
Does this work if antiperspirants have failed?
Usually, yes. Clinical-strength aluminium antiperspirants work by physically plugging the ducts, whereas injectable treatment blocks the nerve signal that switches the glands on. It is a different mechanism, which is why failure of one does not predict failure of the other. Most patients treated have already exhausted topical options.
Other concerns
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