When injecting botox for hyperhidrosis in the skin for muscle relaxation as is the case for wrinkle treatment a practitioner would inject at 45 degree angle to the skin and enter directly into the belly of the muscle.
However, when we inject for excessive sweating we are trying to place the needle just below the skin - in the subdermal layer.
So first of all the needle should not go as deep as when injecting in the muscle.
Second of all when we inject for muscle relaxation we administer the entire dose in one area.
However, when injecting under the skin for excessive sweating I tend to bend the need at a 90 degree angle so it inserts into the skin almost parallel.
Then when the entire 1/2 inch of the needle has been inserted I slowly withdraw and while I'm withdrawing, I'm releasing the botox.
To paralyze a particular area of sweat glands requires not too much botox and hence with this technique you ensure that each dose stays as close to the skin while covering a larger area and prevent the drug from being injected into the fat which will dramatically reduce its uptake by neurons supplying the sweat glands.
I have noticed patients having much improved results as fewer and fewer patients come back for the free top up service at two weeks we have.
Though I have not taken on a clinical trial to prove this but just from experience I note a difference in the results.
You may want to try this technique and let me know if its any help.
Thank you