The Pain related to the treatment
The pain associated with BoNT-ONA injections for palmar and plantar hyperhidrosis can deter patients from under- going the procedure. Due to the rich nerve endings in the palms and soles, pain can be significant with the numerous injections needed to achieve the desired effect. In an effort to reduce discomfort from the injection, topical lidocaine cream will be applied.
The injection technique
With injection sites approximately 8 mm apart. During injection, the needle is inserted at a 45-degree angle approximately 2 mm into the dermis, bevel side up. Once inserted, the syringe is slowly depressed to deposit approximately 0.05 mL of the botulinum toxin solution subdermally before it is withdrawn. A total of 100 U per palm of BoNT-ONA is injected with a 26- or 30- gauge needle and a TB syringe. The BoNT-ONA is diluted in 3 to 4 mL of normal saline and then subdermally injected into each 1-cm square area of the palm and three sites in each digit. Plantar hyperhidrosis presents the same difficulties as palmar. Both regions are particularly sensitive and have a thick epidermis, making topical agents less effective. Given the larger surface area of the soles as compared to the axilla and palmar regions, 150 U of BoNT-ONA is injected through a 26- or 30-gauge needle with a TB syringe following a grid of injection sites (Figure 6). The BoNT-ONA is diluted in 6 to 8 mL of normal saline. Due to the high sensitivity of the area.
After Care and Result
After the procedure, ice packs are applied while the patient waits in the exam room for 15 minutes to confirm no immediate reaction to the toxin. Curiously, a greater reduction in sweat production often occurs in the nondominant hand after injection.
Possible Side effect
Muscle weakness is the most commonly published adverse complication. Weakness is noted usually on maximal opposition and is often transient, lasting a few weeks after injection. Reference : Treatment of Hyperhidrosis With Botulinum Toxin Melissa A. Doft, MD; Krista L. Hardy, BS; and Jeffrey A. Ascherman, MD Aesthetic Surgery Journal 32(2) 238–244