June 24, 2026 | Injectables
I have had patients whose excessive sweating was disabling. Not embarrassing, disabling. And for them, a botulinum toxin treatment is life-changing. That is the moment that always reminds me how much this molecule does beyond the foreheads it is famous for.
Before we talk about the different uses of Botox, which is a very exciting topic, it’s important to understand how botulinum toxin works. In essence, it inhibits the release of acetylcholine, which is the chemical signal that nerves send to the tissue on the other side. In the traditional use for the prevention of wrinkles, the nerves are sending acetylcholine to the muscles to contract and create a wrinkle, and the botulinum toxin is preventing that release so the muscle doesn’t contract. In the same fashion, it can work on other targets, like sweat glands.
Excessive Sweating
Botulinum toxin can be used for excessive sweating, in medical terms hyperhidrosis. The FDA has actually approved botulinum toxin for excessive underarm sweating. The toxin is injected into the skin every half an inch to cover the area of the sweat glands that produce the sweat. A single underarm treatment usually lasts anywhere between four to six months and does have to be repeated.
Off-label, we can use it in the same fashion for sweaty palms, the soles of the feet, a sweaty scalp, and even the forehead. It doesn’t change how much you sweat in other places that aren’t treated, but it is very effective. As I said, I’ve had patients whose excessive sweating is disabling, and for them these treatments are life-changing.
Chronic Migraine and Headaches
The FDA has approved the treatment of chronic migraines and headaches with botulinum toxin for more than fifteen years now. There is a very specific protocol, and it consists of about thirty injection points in the forehead, scalp, and neck. This is a preventative treatment, which means it prevents the onset of new headaches. It would not cure an active headache at the time of injection.
I’ve had a lot of patients who routinely get botulinum toxin for cosmetic reasons, to prevent wrinkles in the forehead, crow’s feet, and glabella, and they tell me they’ve had fewer headaches since they started.
Jaw Clenching, Teeth Grinding, and a Slimmer Jawline
Botulinum toxin is also used for jaw clenching and teeth grinding. It’s injected into the masseter muscle, which decreases the strength of the bite. As a side effect, it can be used to slim a heavy jawline by decreasing the size of the masseter, creating that shadow effect a lot of women aspire to.
It can also be used for spasms or continuous nervous tics around the eyes, to soften them. We use it often in patients with facial nerve palsy to create more symmetry between the non-paralyzed and paralyzed sides. It can be used in neck muscle spasms and even in overactive bladders.
The Less Traditional Uses
There are several uses that surprise patients.
TrapTox is injected into the trapezius muscle, sometimes called the Barbie. It reduces the mass of the trapezius, which creates a more slender and longer neck. Some people use it for comfort, as they feel they carry significant stress in their shoulders.
We use it around the mouth to correct gummy smiles, injecting the muscles that elevate the upper lip excessively, which reduces the gum show when smiling. It can treat the pebbly chin, or orange peel appearance of the chin, by relaxing the mentalis muscle. It is injected into the calf muscles to decrease their mass, which is very common in the Asian population. And it is used for rosacea flushing, where microdroplets are injected into the skin to decrease facial flushing and redness, which is off-label.
The Skin-Quality Effect
There are applications where we do microdroplets of botulinum toxin over the skin. These are very superficial injections, and overall they decrease oil production and smooth out the skin over time. It’s something we’ve noticed just in treating patients aesthetically for the prevention of frown lines and wrinkles, that the area where the Botox is injected, the skin quality improves over time and looks younger. It pairs well with skin-quality work like microneedling.
The Experimental Frontier
Depression is being studied at the moment. Some studies already suggest that relaxing the glabellar frown muscles influences emotional feedback mechanisms and pathways in a way that improves depression. It’s not FDA-approved for depression, but it remains an active area of research.
There are also nonstandard intimate-health indications. Botulinum toxin can be injected to relax the capillaries and promote engorgement during sexual stimulation, which can increase sensitivity, and it can be used to prevent vaginismus, sexual pain, and pelvic floor spasms. Some physicians use it in places you would never imagine, like the vocal cords, the salivary glands to decrease saliva production, and the hands for circulation disorders.
One last note. A side effect of injecting for decreased sweat production is a decrease in body odor production, since the smell is produced by the same glands that produce the excessive sweat.
Why Choose Dr. Agullo
Double board-certified, American Board of Plastic Surgery and American Board of Surgery. American College of Surgeons Fellow. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. Whether you are coming in for wrinkles, sweating, migraines, or jaw clenching, the toxin is the same molecule. The skill is in knowing where it belongs and how much.
Ready to Talk?
If any of these uses sounds like it might fit a problem you have lived with, ask. The cosmetic uses get all the attention, but the medical and functional ones change lives just as often.
For the surgeon’s editorial tour from the established to the experimental, see the companion essay on drworldwide.com. For the MedSpa menu of toxin treatments at the practice, see the version on swplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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