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I have treated a number of patients with axillary hyperhidrosis. I have tried the various methods and doses and have found that 100 units (50 units per side) is very effective for about 8 months. This is consistent with what I found with facial hyperhidrosis in Frey’s syndrome.

I use 4 cc of saline to reconstitute the botulinum toxin (2.5 units per 0.1 cc). I create a grid pattern in each armpit in the hair-bearing area. Each grid is approximately 4 × 5 cm (or sometimes 3 × 7 cm, depending on the hair distribution pattern). This results in 20–21 different 1 × 1 cm injection sites in each armpit. Each injection is 2.5 units (0.1 cc) and is injected intradermally. Inject intradermally rather than subdermally because the target (the sweat gland) is within the dermis. It is nice to see a blanched wheal at each of the injection sites. I find it easier to inject intradermally if I hold and “pinch up” the skin with my left thumb and finger while injecting with my right hand.