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  • Revival Clinic Bangkok

Botox for Underarm Hyperhidrosis

The Minor Test

Some may administer the Minor’s starch iodine test to determine the location of the sweat glands in the axilla, which provides a template for treatment. In our practice, we rarely apply the starch iodine test; instead, we define the hyperhidrotic area of each axilla according to the hair- bearing area, which is delineated with a marking pen prior to administering a betadine prep.

Injection Technique

We inject botulinum toxin in the axillary area with a 26- or 30-gauge needle on a TB syringe. In most patients, 40 evenly-distributed injection sites are placed subdermally in each axilla (20 injections per milliliter of injection solution), with the injection sites approximately 8 mm apart. The needle is inserted at a 45-degree angle, approximately 2 mm. The injection should be performed in one smooth motion to reduce trauma to the area. The total injection volume per axilla is 50 U of reconstituted BoNT-A, which was found to be the minimal dose necessary to cause anhidrosis in healthy volunteers.In most patients, these 50 U is diluted in 2 mL of normal saline, but in patients with larger axillae, up to 3 mL is occasionally used to reconstitute 50 U.