Frequently asked questions:


How does Botox work?
Botox prevents the release of acetylcholine, a chemical messenger that is necessary to stimulate the sweat glands. Without the stimulation, the sweat gland does not secrete any sweat.


Why do I have excessive sweating?
There is no reason why some people have hyperhidrosis and some don’t. Every person is “wired” in a different way so that one person may be under a huge amount of stress and be dry while others are reading a book and feel perspiration under their arms. Some people have, coupled with this, fast heart rates, feeling warm all the time, etc. This is also seen frequently in families and seems to show a genetic influence.


If I stop sweating under my arms, or hands and feet, will I sweat more elsewhere?
No. The areas that are injected are so small compared to the rest of the body that there have been no reports of compensatory hyperhidrosis.This is in contrast to the surgical technique of Endoscopic Thoracic Sympathectomy.

Can everyone be treated?
It should not be given to pregnant woman or woman who are about to become pregnant or patients who are receiving neuromuscular blocking drugs.


How often can I be injected?
It should not be given more frequently than every 3 months due to the theoretical risk of developing antibodies to the Botox. For the past several years, the manufacturer has decreased the amount of antibody producing protein to a minute level and there have not been any reported cases of antibody formation in the new formulation.


Are the injections painful?
NO! I receive Botox injections myself for my underarm excessive sweating so I can relate to this question. For the underarm injections I use the smallest insulin syringe and needle available. A new syringe and needle are used after 4-5 injections so that the needle stays sharp. It feels like pulling a eyebrow hair and rarely leaves anything more then a pinpoint mark on the underarm skin.
For the hands, since they receive about 50 or so injections, an anesthetic is needed. As a Board Certified anesthesiologist, I adapted a century old anesthetic technique to numb the hands so that the injections are virtually painless. I call this the Modified Bier Block Technique and have used it since 2001 with great success. You can read about it HERE and see it performed HERE.

What does it cost for underarm injections?
The cost for both underarms is currently $945.00 and uses 100 units of Botox.This is divided in half to use 50 units of Botox for each underarrm


What does it cost for hand and feet injections?
The cost for one hand is currently $945.00 and the cost for both hands or both feet is $1790.00. This is because the added expense of 100 units of Botox is needed for EACH hand and EACH foot, so a TOTAL of 200 units of Botox is used for both hands or both feet. The reason more Botox is needed is that the injections need to be done closer together than in the axillary area and more Botox is needed. This price includes the Modified Bier Block to numb the hands and feet.


Does my insurance cover this?
Usually not. Botox has been FDA approved for underarm hyperhidrosis but most insurance still may not cover it. For hands and feet, which is an “off label” use of an approved drug, most insurance companies will not cover it. Some are starting to realize that hyperhidrosis can be a disabling condition and are looking at this issue. The insurance company usually applies the cost to your out-of-pocket expenses for the year. We help you fill out the proper insurance forms for you to submit and provide any supporting documentation that they ask for.


Bridges Medical Clinic
1320 El Capitan Drive, Suite 410
Danville, CA 94526
Tel: 925-975-3353
Fax: 925-820-2267