It just stops. Just like that. Most patients will have absolute cessation of sweating. Others will have a decrease of 50 to 80%. Don’t worry, you have lots of sweat glands elsewhere, hence reducing 3% of sweat output will not overheat your body. 

Rebound sweating has been reported in the literature, I have not seen a case. As a guide I have performed at least 5000 cases over the past two decades.

The excessive sweating areas are marked out with a wee bit of help from you. I can normally see the follicular units (even though you may have had laser hair removal).

Occasionally I mark the outline, but in most cases I free hand inject between 10-20 sites in each armpit. Following Medicare guidelines, I use 50 units of Botox into each armpit. Medicare only covers Botox & not Dysport or Xeomin. 

After injections the areas are compressed for a few minutes, and that’s it! You are right to perform your daily duties, and even exercise a few hours later.

The truth? Injections are tolerated by most. The needle is very small, & I inject 10-20 spots into each armpit. It is all over in 90 seconds. Each needle feels like an ant bite (medium size green ant not big ass fire ant).

I give the patients the option of a pain free injection method- this consists of numbing cream applied to the treated area 30 minutes before the injections. I combined it with a Zimmer Skin Cooler & ice packs. This is well tolerated, even in children (over the age of 12 as per Medicare guidelines).

*Medicare rebate applies for the treatment of severe underarm sweating not responding to Aluminium Chloride application. This treatment will need to be performed by a Dermatologist. A rebate cannot be claimed for non-specialist use. Medicare approves up to 3 hyperhidrosis injections per year.

It is actually much cheaper to have this done under a specialist as most patients will have a Medicare rebate. I charge half the price of most cosmetic physicians, simply because Medicare & the PBS subsides this treatment.

*Applies to severe underarm sweating refractory to clinical strength aluminium hexahydrate.

Yes! Anti-sweat injections can be used to treat the following areas:

• Excessive sweating of the scalp and forehead area.
• Excessive sweating of the hands & feet.
• Compensatory or rebound sweating.

NOTE: for excessive sweating of the hands and feet, the preferred method of treatment is Iontophoresis. Botox in the hands and feet last between 3-4 months before wearing off, and Medicare does not reimburse this treatment. Injections in the hands and feet can have temporary side effects such as the weakening of small muscles. This is not seen with injections in the armpit area.

Anti-sweat injections are safe, in fact this procedure has been performed in the United States for the past 20 years, however Australia has only started to approve this treatment under Medicare since June 2012*.

Side effects are exceedingly rare & include –

• Bruising- less than 2%
• Rebound sweating- less than 0.0001%
• Contraindications to Botox include pregnancy, allergic reactions & some rare medical conditions & medications.

*Under Medicare & PBS.

Call up reception to schedule a treatment with myself. A referral is a must as I am a specialist.

As a guide, you should try more cost-effective treatments such as clinical grade antiperspirants. They have a very low chance of working, but you need to cross the red tape that is Medicare (injections are only subsided if you have tried, failed or have intolerance to aluminium chloride hexahydrate).

Fundamentally the costs. Botox is the most expensive, followed by Dysport & then Xeomin.

In the context of efficacy, there are no studies comparing all three neuromodulators. In the context of Medicare & PBS rebates in Australia, the Allergan branding is the only one that is subsidized.

As a guideline, the Medicare rebate is amazing. Patients are out of pocket less than what it takes to buy a bottle of botulinum toxin type A.

For axillary hyperhidrosis, there are a few surgical & procedural options. These options are more costly, with more risks & side effects, including downtime. Regardless they can be considered in patients who are recalcitrant to Botox.

Miradry is a microwave ablation of the sweat glands. I did use this treatment for over five years. I do think it can be effective, however the side effects are too high for my mode of practice. A newer model is just around the corner. It should offer better results with added safety.

Radiofrequency is another option. This can be delivered via needles or via a probe. I frequently combine this with liposuction of the eccrine glands.

ETS surgery is best reserved for cases that have associated palmar or hand involvement. This treatment is highly effective, however patients should be aware of rebound sweating.

Iontophoresis involves electric current therapy to block transmission of the sweat glands. This electric current is delivered by a safe medically prescribed piece of equipment appropriately named an ‘iontophoresis machine”. This treatment is best used as a first-line treatment for excessive sweating of the hands and feet, however, special pads may be used for sweating of the armpits. In actual practice this treatment is effective in only 20-30% of patients with axillary sweating.

Having a referral means you can partially claim the consult & treatment fees through Medicare. A referral will also enable us to provide a treatment plan to your GP, and keep them up to date with your progress.

*As a guide, your out of pocket without a referral is around $1450, if you have a referral, the out of pocket costs is around $570. Big difference right?

Injections are reserved for patients in whom other treatments do not work, or in patients who have side effects to antiperspirants. Side effects include a rash that stops you from applying more. Medicare is somewhat fair & does not expect you to push through irritant dermatitis. Here are some hints in regard to application of aluminium chloride hexahydrate. Start with a high strength of 20%.

• Apply to areas of excessive sweating- it may take 7-10 days before you notice an improvement.
• Aim for application after a shower, best at night.
• Attempt to apply on dry skin. I recommend using a hair dryer on the cool setting- make sure as much moisture is gone before application.
• Aim for 3-4 nights a week and increase as tolerated. Remember to wash off in the morning. Do NOT aim for more frequent application as you will eventually develop skin irritation
• If skin irritation develops (red, itchy, burning skin), you can try to decrease the amount & frequency.
• If you experience skin irritation, you can apply some Hydrocortisone Cream (get the strongest percentage from your local pharmacist). Apply in the morning, and skip application that night.
• If this fails (which is often the case in 80% of patients with excessive armpit sweating), then the next stage are Botox injections. You are entitled to a Medicare rebate for this procedure, providing you have a referral.

You can try the following –

Glycopyrrolate wipes. Be resourceful- you can get them from the United States or via Canada. They contain glycopyrrolate 0.5 to2% They can reduce sweating by up to 25%. They are not available in Australia.

Tablets can help. Pills are classed as anticholinergic medications can help decrease sweating however these tablets are associated with side effects such as sedation, constipation, and dry mouth. Speak to your General Practitioner about propantheline bromide. I recommend you take one tablet at night, and if you don’t experience side effects, increase to 2-3 tablets per day. Discuss with your doctor the potential side effects and interactions of tablets.

Natural remedies are discussed on another page. You can give it a go. Be guided by your naturopath & the power of Doctor Google. They are harmless. The worst that can happen is that you will lose some weight.