toxin A injections

  Definition   Medications  

 algorithm for

  Prevalence   Systemic treatment    
  Impact on quality of life   Topical treatment     Axillary and inguinal HH  

    for armpits

 >     VIDEO
  Classification   The gel Advantage     Palmoplantar HH  

    for hands

 >     VIDEO
  The Control of sweating   Needle Free Injections     Craniofacial HH  

    for feet

 >     VIDEO
Jet injection of lidocaine with Med-Jet prior to Botox injection with needle in the treatment of palmar hyperhidrosis

The chief problem encountered with the treatment of hands and feet by Botox injections is the intense pain associated with the needle puncture into the densely innervated skin of these regions. The traditional technique performed to alleviate pain during Botox injection with needle is the nerve block of the wrist. The potential complications of a nerve block are nerve or vessel damage and temporary loss of hand dexterity. For this reason, many physicians who contentedly treat axillary hyperhidrosis, hesitate to treat palmar hyperhidrosis with Botox.

The technique of jet anesthesia is the injection of a tiny amount of lidocaine <0,1 ml through a pressurized jet injector. There are many benefits to this technique :

·         The volume of lidocaine used is very small

·         Analgesia is immediate

·         Jet-injection is dispersed more extensively into the dermis than a needle injection. Needle injection tends to pool along the needle track alone. It is assumed that the spatial three-dimensional reconstruction of the jet injected liquid has a bulb shaped distribution with the broad side facing the muscle fascia and the narrow side underneath the epidermis . The broader spread of jet injection also paves the way for a better diffusion of the needle injected Botox that follows, helping it to reach a greater number of eccrine glands, hence better control of hyperhidrosis.

·         Jet injection increases tissue pressure into the dermis and compresses blood vessels resulting in reduced bleeding, contrary to the nerve block technique where the reactive hyperemia increases the tendency to bleed from the injection sites and causes some waste of Botox through reflux.

·         The average pain score reported by most patients is about 2 on a scale of 0 to 10 where 0 indicates no pain and 10 indicates the worst possible pain. Some patients reported that the pain during jet injection is less than the needle injection of Botox for axillary hyperhidrosis.

·         Vagal symptoms occur less frequently with this technique than the nerve block technique and, when they do, they are much milder.

>>  The Injection Technique For Armpits...
>>  The Full version of Botox injection on one hand...
>>  The Injection Technique For Feet...

Jet injection of Botox directly with Med-Jet into the skin in the treatment of palmar hyperhidrosis

Botox could be injected with a jet injector into the superficial dermis without requiring any analgesia or anesthesia. One of the drawbacks of this technique is the partial loss of Botox through splash and splatter. The amount of Botox waste could reach 10% of the total amount intended to be injected. For that reason it is always preferable to use jet anesthesia with lidocaine prior to injection of Botox with needle. However, this technique is particularly useful for needle phobic patients who would otherwise refuse to be treated if a needle is used. Jet injection of Botox for one hand takes about one minute. Moreover, the lack of needle involvement and the rapidity of the technique help the patient to avoid any apprehension. The waste of Botox occurs primarily due to splash and splatter that takes place during jet injection but it is not the only factor. The splash back could be considerably reduced by using a shorter spacer (1mm) or totally eliminated by avoiding the use of a spacer.


Created and financed by Antranik Benohanian MD, FRCPC -  copyright © 2000
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