We all know the feeling. The trickle down your back on a particularly packed train, the moistening of your upper lip when the sun is beating down on your face, and that instinctive awareness that yes, you definitely have sweat patches. And while sweating is a totally natural process that helps to keep the body cool, we all know that it can be less than ideal (especially if your deodorant isn't quite playing ball).
But what we may not all know is that a popular wrinkle-smoothing cosmetic treatment doubles as a sweat-stopper.
Whether you've gone under the needle or not, we've all heard of Botox and its age-defying abilities. But people aren't solely getting the cosmetic treatment to turn back the clock. In fact, people are now turning to the treatment to beat sweating.
We called on Mr Hazim Sadideen, Consultant Aesthetic Plastic and Reconstructive Surgeon at the Cadogan Clinic www.cadoganclinic.com, to find out exactly how the treatment works.
How exactly Botox can beat sweating?
Excessive sweating (i.e. out of proportion to what is required to regulate body temperature), is known as hyperhidrosis. Effectively, this is a result of over-stimulation of sweat glands. From a physiological perspective, sweat production requires acetylcholine (a neurotransmitter) to activate the eccrine sweat glands. Botulinum toxin temporarily inhibits the release of acetylcholine, preventing the hyperstimulation of these sweat glands. Therefore, by blocking or interrupting this chemical pathway, botulinum toxin minimises (or potentially stops) sweating in the area where it has been injected.
Is this different to beating wrinkles and how?
Wrinkles are formed in part by repetitive contraction of underlying facial musculature, particularly where the skin is thin. Like sweat production, muscle movement also requires the release of the neurotransmitter acetylcholine. Botulinum toxin also works by inhibiting the release of acetylcholine, but it acts specifically at the neuromuscular junction. Interestingly, with superficial injections to manage wrinkles on the forehead for example, botulinum toxin may also reduce sweating whilst weakening the muscle (because it can act on the sweat glands and muscle in the same area), thereby improving the appearance of the skin.
Which areas can it be used on for sweating?
For hyperhidrosis, it is licensed to be used in the armpits, but it can be used off-label in other areas prone to sweating in certain individuals. This includes the palms (hands), soles (feet), forehead, scalp, and potentially other more delicate areas such as the inframammary fold (underneath the breast) and scrotum. Some areas are more successful or responsive than others (e.g. armpits are usually more successful than feet), and some areas may be more painful than others (e.g. feet more painful than armpits, because of their thicker skin which is more resistant to numbing agents). However, there are ways to minimise pain and make the experience more comfortable. It is very important to have treatments performed by an experienced practitioner to ensure safe, appropriate administration.
What technique do you use for maximum effect?
It is very important to inject the appropriate dose and in the correct anatomical layer (i.e. under the skin to target the sweat glands). It is essential to gauge the extent to which the excessive sweating affects the patient. For example, according to the “hyperhidrosis disease severity scale”, this can range from very mild (which is a score of 1: never noticeable and never interferes with my daily activities), to moderate (which is a score of 3: barely tolerable and frequently interferes with my daily activities), and severe (which is a score of 4: intolerable and always interferes with my daily activities). The palms and feet usually require higher doses than the armpits, depending on the severity of the hyperhidrosis. I use a very fine needle and ensure the patient is numbed up prior to the procedure (and use ice on the palms and soles)—it is important to improve the patient experience.
How many people are seeking it? Is it gaining popularity?
It is certainly gaining more popularity. Patients who have had successful treatments previously, tend to have it before the summer (when they are most prone to hyperhidrosis). Other patients with more severe hyperhidrosis may attend clinic when they are most symptomatic, irrespective of summer vs. winter. These patients can become distressed by the psychosocial sequelae of hyperhidrosis when other treatments have not helped. Other patients may only have mild hyperhidrosis, but have an important occasion coming up and want to minimise the chance of sweat stains.
Although most patients suffer from idiopathic hyperhidrosis (i.e. there is no known underlying cause), it is important that patients are screened for possible medical causes of hyperhidrosis, such as those triggered by medications, endocrine or neurological disorders for example. They should also be graded to establish the severity of hyperhidrosis, to ensure they are suitable candidates for botulinum toxin (e.g. grades 3 or 4 on the severity scale).
Patients must also be fully informed of the risks and benefits and have no contraindications to botulinum toxin treatment.
How often should people have it and when will they see results? Botulinum toxin injections will not cure hyperhidrosis, only help control it. Symptoms tend to improve gradually (usually in about one to two weeks) and return gradually overtime. Follow-up injections will be required to maintain dryness. People are different in terms of the effects of botulinum toxin on sweat gland activity. Repeat injections may be necessary at intervals varying from 6 to 12 months-- again this would depend on the site, severity of hyperhidrosis and dose injected. If you have it under your armpits, do you still need deodorant? When used to treat armpit hyperhidrosis, Botox has been shown to result in an 82-87% decrease in sweating. This means the majority of patients will have little or no sweating i.e. their armpits will be somewhat dry. Although the anti-perspirant properties of deodorant may not be required, deodorant for odour control would be useful. The armpit contains apocrine sweat glands, which contribute to body odour. Botulinum toxin cannot inhibit these specific apocrine sweat glands, so this is where a nice deodorant would do the trick!