Treating Hyperhydrosis of the hands with Botox.

John L. Abraham, MD

With the palms of the hand being particularly sensitive and with administering multiple injections I apply a topical anesthetic and leave it on for about 20 minutes. This does a decent job numbing the area.

Your other option is doing a nerve block of the medial, ulnar and radial nerve. Another helpful technique to help minimize discomfort is have a patient hold a vibrating object in their hand, the thought process behind this is the gate theory of pain control much like pinching an area of injection before actually injecting. If anyone has a Vibraderm microdermabrasion machine this works well especially if you use the paddle that helps deliver medications and serums. This added modality isn't a must but does help.

I do not use the betadine starch kit with the palms as I have not found it to be as much of an indicator as I have with the axilla. You will get some reaction but I don't feel it gives an adequate representation of areas to treat. I go ahead and inject in a grid pattern with a spacing of 1-2 cm apart and I use roughly 2 units per injection.

Make sure you don't use a needle larger than 30 gauge otherwise you will have more of a problem with Botox following the needle track out. Your results should last anywhere from 4-6 months.

If you're thinking about using Dysport watch for the possibility of hand weakness. You can get this with either Botox or Dysport but it seems to be more common with Dysport. This side effect is obviously transient and does resolve.

I have picked up many of these techniques from basic and advanced courses. Our clinic may start doing some training courses in aesthetic procedures as well as LipoLite. Good luck. If you have any other questions please let me know.

John L. Abraham, MD is the Medical Director at  DermaHealth Laser Clinic

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