Facial hyperhidrosis: best practice recommendations and special considerations

Facial hyperhidrosis (HH) is more difficult to diagnose than other forms of focal HH because many secondary causes must be considered. Pharmacologic treatment with botulinum toxin type A (BTX-A) would be appropriate for patients with severe facial HH that limits their lifestyle (eg, blurred vision from sweating, distressed with their appearance). The main concern with administering BTX-A for facial HH is aesthetics, such as facial asymmetry or brow ptosis. This article describes best practice techniques for BTX-A (Botox) in patients with facial HH, including suggested dilution and syringe selection, injection technique, dose and injection grid, and anesthesia recommendations. Special considerations and navigating the insurance reimbursement process also are discussed.