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Chemodenervation From Physiology of the Skin, Third Edition

By: Zoe Draelos, MD, and Peter T. Pugliese, MD
Posted: January 5, 2011, from the January 2011 issue of Skin Inc. magazine.
female spa client's face

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Botulinum toxin can also be used for other purposes. The most common off-face treatment area is the armpit where unwanted sweating, known as hyperhidrosis, can be controlled by botulinum toxin injections. In people who experience excessive axillary sweating, botulinum toxin can interrupt the communication between the nerve and the sweat duct, thereby stopping sweating. Injections for this purpose must cover the entire hair-bearing area of both armpits and requires at least one whole bottle for treatment, which can be quite expensive. Injections can also be performed on the palms to decrease sweating. The injections in both areas must be very close to the skin’s surface to reach the sweat duct. Accidental deep injections in the hands can weaken the muscles and cause problems using the thumb and hand.

Injections for hyperhidrosis may last around six months, but there is great variability in response. These injections can also be quite painful, since the botulinum toxin must be placed every quarter inch until the entire area of sweating is covered. Sweating can be decreased with toxin injections, but not completely eliminated. It is important to help the patient develop realistic expectations.

Botulinum toxin can also be used to relax wrinkles on the neck and chest. For example, longitudinal muscle bands running down the neck can be relaxed, smoothing the neck skin. Very few units are used for the injections because too much toxin can make the neck muscles weak and cause problems speaking, swallowing and holding up the head. Botulinum toxin has also been placed in the upper chest to minimize wrinkling on the décolleté and provide a mild breast lift. These uses of toxin are very patient-specific, and the results are highly variable.

One last use for botulinum toxin off the face is in the treatment of migraine headaches. People who have a trigger point for their headaches that is located over a muscle may benefit. For example, patients with a trigger in the muscle between the eyes from frowning and squinting may find that botulinum toxin injections relax the muscle and prevent the onset of headaches. It is also possible to inject trigger points at the base of the scalp and on the neck.

The safety and versatility of botulinum toxin injections are sure to expand the applications for this technology. New and more inventive uses, including the possibility of topical cream botulinum toxin, are certainly on the horizon.

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