Excessive Sweating

Beautiful woman with thick eyebrows, leaning her head on her arms

Hyperhidrosis: Excessive Sweating

While it’s perfectly normal to sweat in hot weather, during strenuous activities, and in response to certain situations, it’s not normal to sweat excessively for no apparent reason. Approximately 2 – 3% of Americans suffer from excessive sweating, which is known as hyperhidrosis. These individuals are most likely to experience excessive wetness in the underarms, palms of their hands, and/or soles of their feet.

Hyperhidrosis can be extremely inconvenient and cause the sufferer much embarrassment. Clothes can become soaked through, requiring the individual to change his/ her shirts throughout the day or risk social embarrassment. This can impact self-esteem and hinder their professional standing and romantic relationships. Those who suffer from sweating on their palms may find it difficult to grip objects and driving may become unsafe. They may also feel too embarrassed to offer a handshake when meeting new people.

Hyperhidrosis is a medical condition and should be treated accordingly. With treatments available today, there is no reason to continue suffering from excessive sweating. Our New York dermatologist, Dr. Paul Jarrod Frank, specializes in the treatment of excessive sweating and offers the most cutting-edge treatments to his NYC patients.

Causes of hyperhidrosis

Most cases of hyperhidrosis occur in patients who are otherwise healthy. In some cases, hyperhidrosis can be linked to other diseases. Occasionally heat and emotions cause hyperhidrosis. Most people who suffer from hyperhidrosis, however, sweat heavily at all times, regardless of activity level, emotions or the weather.

Doctors and scientists have yet to uncover the cause of primary hyperhidrosis. They are aware that certain factors, including diet, caffeine, emotional state, and substance abuse, can trigger or worsen primary hyperhidrosis, but it has been difficult to identify the originating cause of the condition.

Diagnosing hyperhidrosis

When assessing patients for treatment, Dr. Frank will first review their medical histories to reduce the possibility that any systemic diseases or conditions are causing hyperhidrosis. Next he will assess the amount of sweat that is produced by the individual to determine if it is considered normal or excessive. This is done by examining the areas of the body that sweat excessively and, if necessary, performing tests to determine the amount of sweat produced. Then Dr. Frank will recommend the best course of medical treatment for excessive sweating, along with any modifications to diet or behavior that may help improve hyperhidrosis.

Treatments for excessive sweating

Traditionally, topical or oral prescription medications were the go-to treatment for hyperhidrosis. In less severe cases, medication can be used to control hyperhidrosis, but it may not work for all individuals. Many of these medications also cause skin irritation and cannot be used long term as a result.

When recommending treatment for hyperhidrosis to his NYC patients, Dr. Frank prefers to identify solutions that will provide long-term results with few side effects. Among these, he has identified VASER® Hyperhidrosis Therapy and Botox injections as the best treatments for excessive sweating.

VASER® Hyperhidrosis Therapy

VASER® is a treatment for underarm hyperhidrosis that utilizes ultrasonic energy to alter the activity of sweat glands beneath the skin’s surface. The treatment is performed in our state-of-the-art New York City facility using only a local anesthetic. Dr. Frank makes a tiny incision in the underarm skin and then inserts a thin wand through the incision to target the axillary sweat glands. The results of VASER® therapy for hyperhidrosis are long lasting*. The patient is able to resume normal activities after 24 hours*.

Before the development of VASER® Hyperhidrosis Therapy, Dr. Frank frequently recommended Botox to treat excessive sweating. Botox, however, requires ongoing treatment – if the patient stops receiving injections, the sweating will return.

Botox for hyperhidrosis

For individuals who cannot undergo VASER® or are unwilling to try this treatment, Dr. Frank may recommend Botox. The active ingredient in Botox inhibits the release of sweat in the treatment area. It can be used locally to stop sweating in the underarms, palms, or soles of the feet without affecting sweat glands anywhere else on the body. Botox is a very quick and easy procedure to perform and requires no downtime afterwards. Dr. Frank simply injects Botox in a specific pattern in the targeted area. To maintain results, Botox injections are required every 6 months*.


Can Botox for excessive sweating weaken the arm muscles if I do it in the armpit?

It relaxes muscles as well as it does sweat glands but if you inject it in the right place you shouldn’t have any problems.

If I use Botox for excessive sweat, where does the sweat go?

This is the most common question. Under the arm, feet, or the hands it only represents about 1-3% of the total body surface area so the body can handle that decrease without any compensation.

Is it dangerous not to sweat?

It is dangerous not to sweat, but again we aren’t decreasing the amount of total sweat by that much that it would create a problem. Most people with medical Hyperhidrosis are just plain sweating too much.

How long does a Botox treatment last for excessive sweating?

Neuromodulators depending on the severity can last 3-6 months if not a little bit more. It depends on the severity and depends if you’re combining it with other things as well as exercise.

Do you build up toxins if you don’t sweat?

Don’t worry, you will still get rid of your toxins.

Are there permanent solutions for excessive sweating? Can you remove the sweat glands?

There is the surgery but it’s quite risky. There are other solutions that may be more permanent like liposuction in the armpit or the microwave technologies but there’s always a pro and con.

Does Botox treatment get rid of BO?

No it doesn’t. The bacteria on the skin causes BO. Sweating does make BO worse but it doesn’t get rid of it completely.

Can I exercise after Botox injections?

Yes! The post-op after getting the injections takes literally 5 minutes. It barely hurts and you can go exercise afterwards. You have the procedure, go, and you stop sweating a few days later.

What is the best type of Botox for sweating?

I happen to like dysport the best. Its diffusion capacity covers the area best and I find that it lasts longer. They all work but I like Dysport the best.

Would you recommend Botox for a 16 year old with an excessive sweating problem? Most treatments are 18+.

I’ve had 13 year olds that have had this done. Neuromodulators are used in infants and children for medical reasons so there’s no reason if a kid has a real problem that they can’t.

What is Miradry?

Miradry is the microwave device that you use under the arm. It can hurt, there are people who have some neurological issues afterwards, I’ve had patients where it didn’t work at all. I’ve tried it many times and I don’t find it to be a huge success in terms of efficacy, safety, pain and downtime. I really prefer Neuromodulators because it’s quick, it’s easy, it’s cost effective, and for those who aren’t super severe it’s the best option.