Everything You Ever Wanted To Know About Underarm Botox
a love letter to my favorite neuromodulator treatment
Hello loves, Happy Valentine’s Day!
As I’ve said to anyone who has asked, underarm Botox is by far the most transformative cosmetic procedure I’ve ever had. Prior to getting Botox, my wardrobe was ruled by the possibility guarantee of sweat. I was limited in the fabrics, cuts and colors of my clothes. Yes, black is my preferred clothing color, but it’s not exactly a preference when there’s no other option. Silk? Forget about it. I didn’t own a button-down shirt until last year! I’m a devotee of Mitchum Advanced Control Antiperspirant, went through a big Numi sweat-proof undershirt phase, exclusively wear Cool Nights pajamas from Chico’s-owned (yes, Chico’s) Soma Intimates and even wrote for NYMag’s The Strategist about the only sheets that help my sweaty sleeping.
Since I started talking about this life-altering treatment, I’ve been keeping track of all the many questions I’ve received and working on a dedicated underarm Botox issue. I’m so excited to share it with you! A few weeks ago, the cosmetic dermatology clinic Ever/Body invited me in for a free treatment, but I have paid for it myself every other time (all at Ever/Body) and will happily do so again. To further help me out, I consulted Dafna Gershoony, the CEO and Co-Founder of CONTŌR, where they also offer the treatment. One million thank yous to the Ever/Body team for changing my life & letting me document the process for Hotline Skin and thank you thank you thank you for being so gracious with your time, Dafna!
Ever/Body has locations in NYC, Westchester, Dallas, D.C. and very soon Chicago & Long Island. CONTŌR is located in Soho in NYC.
HOW IT WORKS: A Q&A with Dafna Gershoony, board-certified licensed PA & CEO and Co-Founder of CONTŌR Studio
How does Botox for sweating work? Is this different/the same as how it works for wrinkles? Botox is a neuromodulator, in other words, a protein which stops the signaling between nerves and muscles or nerves and glands. For wrinkles, botox effectively stops the ability of the muscle to contract, smoothing out the wrinkles. In the case of hyperhidrosis (or overactive sweating). Botox is injected into the underarms, palms or soles of the feet interrupting the signal from the nerve to the sweat gland, preventing release of sweat from the affected glands. In a way, it's the exact same mechanism with a different outcome.
Does getting Botox in your forehead also reduce sweat there? Theoretically yes, getting a Botox injection in your forehead for wrinkles will affect some of the sweat and oil glands in the skin where it is injected, however, the depth of the injection varies. The goal is not to stop sweating in this area, so the majority of the botox is injected into the muscle, leaving a very small amount to affect the skin (where sweat and oil glands are located). This is often why people refer to a "glow" after getting botox, the skin which is partially affected appears to have smaller pores and looks shinier due to lack of sweat and oils.
I have personally had amazing results, but I’ve heard some people say it doesn’t work for them. What can impact the efficacy? Who wouldn’t be a candidate? A few things can dictate efficacy for underarm Botox. First can be dosing/injection technique, the Botox needs to be injected at the right depth and evenly distributed across the sweat glands to be effective. The right amount of units also needs to be used based on the patient's weight and severity of sweating. Underdosing can render the whole treatment ineffective because the active sweat glands which remain unaffected/untreated will continue to produce the same amount of sweat. Another thing that can affect efficacy is the patient's individual response to Botox, although it is rare, there are some people who are resistant to Botox. Most people who have hyperhidrosis are candidates for underarm botox. If people who are treated only see a partial result, it can also be helpful to supplement the treatment with prescription medications/antiperspirants.
How long does it take to work? Around 2-3 weeks!
How long does it last? Botox for hyperhidrosis typically lasts anywhere between 5-6 months, this is longer than a typical treatment of facial muscles because the units used are pretty high.
How does Botox for sweating compare to other treatment options, like MiraDry? Botox is a more temporary solution, meaning it will act on your sweat glands for a period of time, and then eventually gets broken down and your sweating will return. Certain deodorants such as aluminum chloride will be active only for 12 hours, and oral medications are only effective for the time that you are taking them. Miradry is a technology that uses Microwaves in order to destroy the sweat glands permanently. This results in a permanent solution for the sweating, it also reduces odor and hair in the area.
Dafna was also kind enough to indulge me by taking this question seriously: I have a theory (after watching this interview) that the reason Mark Zuckerberg looks like a frozen robot is because he has to get so much Botox in his face to prevent sweating. In your professional opinion, could this theory be correct? How much Botox would you estimate he needs? Its an interesting theory and I'm not sure of the motive behind his botox use but someone like Mark Zuckerberg could require 50-60 units to be fully frozen (Men typically have stronger facial muscles and require more Botox in order to look "frozen")
MY EXPERIENCE: A Q&A with me, Jolie
How much does it cost? In New York it runs about $1050-1295 per treatment. It will probably be slightly more affordable in other cities, but still in the high hundreds. Botox for sweating is typically a flat fee per treatment instead of per unit. Ever/Body has promotions a few times a year, which I’ve taken advantage of in the past for savings.
How many units? Ok, brace yourselves. It’s 50 units on each side. Yes, that’s 100 total and sounds insane, but I promise it doesn’t feel like that. The amount may vary slightly depending on where you go, but like Dafna said, you don’t want to risk undosing! I tried counting one time, but I actually recommend just trying not to think about how many little needle pokes are going in. It’ll be over before you know it.
Does it hurt? I personally find it to be totally tolerable and quick, nothing more than a little pinching. The whole thing takes under 10 minutes. Honestly, the most uncomfortable part for me is keeping my arm raised above my head, but this time my injector gave me the world’s comfiest pillow so that wasn’t even an issue. That being said, I have a very high pain tolerance. I know everyone likes to say that, but it’s my duty to emphasize it here because I don’t want to mislead anyone about potential discomfort. According to my injector, if someone didn’t see her injecting, they’d think I was getting a foot massage. While it’s never found to be excruciating, she said people typically have more of a reaction than I did. I was numbed using ice packs, which is their standard protocol, but you can totally request numbing cream if you really want to minimize the sensation. They also offer a stress ball to squeeze or a vibrating gold bar to hold as a distraction.
At CONTŌR, they use both numbing cream and ice prior to injections. Dafna told me that most people find the quick treatment to be painless. They also give you a small vibration tool to hold, which she explained actually distracts your pain receptors. Cool!
How long does it last? In my experience, it lasts super well (meaning, I’m dry as a bone) for about 4 months and start to notice sweat creeping in around the 5 month mark. I’ve never gone more than 6 months in between treatments.
How quickly does it kick in? After my first round, I started noticing a reduction in sweat after about a week and was fully sweat-free by week 3. In subsequent sessions, I notice a difference in 3-5 days.
Do you need to have a hyperhidrosis diagnosis? Nope! But it may help you get insurance coverage. Hyperhidrosis is the medical term for excessive sweating and has some diagnostic criteria, including self-assessment questions, a review of medical history and at times, lab testing. In most people, the cause of hyperhidrosis is overactive sweat glands, which isn’t dangerous, just annoying as hell. If your doctor believes you have secondary hyperhidrosis, or hyperhidrosis caused by a secondary disorder, you’ll have more tests to do. I have never had insurance that covers Botox for hyperhidrosis, so the official diagnosis doesn’t make a difference for me. However, more and more policies are including it, so fingers crossed that changes soon.
What’s the aftercare? You can pretty much resume normal activities immediately, but no exercise for 24 hours and no deodorant or antiperspirant for 48 hours.
Does it make you sweat more from other places? Nope, that’s just a myth. Well, I was told it’s not impossible, but it’s very, very rare. More likely you’re just noticing sweat more in other places now that you don’t have to think about your armpits. I haven’t noticed any difference. Excessive sweating doesn’t mean you have more sweat glands than the average person, just that some of them are overactive, so Botox is reducing those. Everyone has the same amount of sweat glands all over the body.
Have you considered other options, like MiraDry? Not really, but I’m not ruling it out in the future. It’s much more expensive, I’m not convinced about the efficacy and everyone says it’s excruciatingly painful, even if numbed. The one time I looked into it I was quoted $4000 for the first session and there’s no way to know in advance if you’ll need more than one. While it claims to be permanent and many find it to be so, I’ve also spoken to more than one person who started noticing some sweat again after a couple of years. None were willing to go through the pain again for a touch-up.
What’s the process like? I took pictures every step of the way during my treatment at Ever/Body last month. They’re not particularly graphic, but if you don’t like needles or blood, you can scroll past the pictures to the full written breakdown. There are short descriptions under each photo explaining what you’re seeing. You can click the photos to zoom in.
PREP
After putting on my robe for full armpit access, I laid back in the chair with an ice pack under each arm. While I was numbing my pits, my injector Heesun, a nurse practitioner, prepped the needles. After I was sufficiently iced, I raised my arm above my head, the area was wiped down with alcohol and a circle was drawn around the injection area.
I didn’t shave for a few days before because I didn’t want to irritate my skin, but that’s not a requirement.
THE INJECTIONS
Starting from the bottom of the circled area, Heesun evenly and precisely injected Botox into my sweat glands. These are called superficial injections, right under the surface of the skin. Since the needle isn’t going deep into the muscle, it just felt like a bunch of little pinpricks. Heesun repeatedly inflated my ego by telling me it was impressive how relaxed I was.
There’s always a teeny amount of blood and my skin usually reacts instantly with a tiny bump (called a wheal) at each injection site. It’s a very common response, but the way it looks creeps me out way more than needles or blood. Luckily, they’re basically gone by the time Ieave. Once all the injections were in, Heesun cleaned up the area and I could put my arm down.
My injector drew a circle around the injection site, and started evenly injecting Botox from bottom to top. There’s always a teeny amount of blood and my skin usually reacts with tiny bumps, called wheals, at each injection site. I don’t like how that looks, but they disappear very quickly.
AFTER
Like I just mentioned, the bumps went away almost as quickly as they appeared and overall my armpits felt fine! Heesun reminded me of the aftercare protocols, signed off on me showering later and let me know I may see some blood/scabs come off in the shower, which is totally normal. The area was a little sore when I showered later that night, but no scabs.
It was a wonderful experience and I look forward to returning in a few months pre-wedding! Thanks Heesun!
Three Other Things
The complexity of men’s haircuts fascinates me and makes me wonder if I’m really a beauty professional because why don’t I understand any of this vocabulary??? This Esquire article about Travis Kelce’s enviable fade answered a lot of questions I had and many I didn’t know to ask, like what constitutes a fade and how much money would I need to make to justify flying my barber out weekly?
Last week I mentioned Dieux is launching at Sephora. It officially launched yesterday, along with another beauty-industry veteran brand Soft Services, which was a welcome surprise to me! I have a $50 Sephora gift card that I’m debating spending on this kit. I really hope they start stocking the hand cream soon, which I’ve been dying to try for a while.
On the topic of hand creams I did buy, I am very impressed by Prequel’s new Hand Wrap. Described as a hand shielding lotion that forms a flexible water-resistant film so as not to rinse away everytime you wash your hands. It sounded similar to Gloves In A Bottle, but clinically proven to last 24 hours instead of just 4. I also figured it would offer some additional skin benefits given Prequel is a dermatologist-developed brand and the products I’ve tried thus far have excellent formulations. On any given day, between giving facials, cleaning up from giving facials, testing products, doing my own skin routine, walking my dog, being licked by my dog and just being a human going about my life, I wash and sanitize my hands a ton. If you looked at my raw and red hands at the end of a marathon facial day, you’d probably assume I actually didn’t know anything or care about skin. All this to say, I am a hand cream connoisseur and I know a good hand product when I see one. I simply couldn’t believe how nourished and soft my hands felt for hours after application. A few usage notes: it’s not the most cosmetically elegant hand cream, like I wouldn’t keep it in my purse or on my desk to use throughout the day. As promised, it does fully absorb with a non-greasy finish but you need to really work it in and it took some trial & error to perfect the amount to use. Also make sure your hands are completely dry before applying. I’ve been applying once in the morning and once before bed. For all other times, I use this or this. Also, if you’re trying to get free shipping, grab Prequel’s bestselling Gleanser (pro-tip: use as hand wash) or Universal Skin Solution Spray.
My dog’s groomer did a photoshoot and it’s the best thing I’ve ever seen. Dog grooming and men’s haircuts have a lot of overlap, so I’m getting really familiar with the concept of guards.
Office Hours Reminder
Join us for Office Hours on Sunday! This exclusive weekly opportunity is available to paying subscribers.
Every Sunday at 5pm EST, I’ll begin a new thread for the week in Substack Chat, where you can ask me anything. Every Monday from 5-6pm EST, I’ll be in that chat live, answering questions for the hour. That way, if you can’t make it, you can submit any time after 5pm Sunday and still get an answer. If you can make it live, join in! You can ask questions in real time and (hopefully) interact with others in class ;)
Discount Codes
Necessaire: JOLIE10 for 10% off
Ever/Body: That link is my personal referral link, which will save you $200 on your first appointment and help me pay for my next touch-up (my wedding budget thanks you!)
Have a great week!
xx,
Jolie
thank you for this deep dive! I’m admittedly a soft services stan, but theraplush is an incredible product – and it looks good on both my nightstand and coffee table, no small feat.